The Association between Acute Cardiac Injury and Outcomes of Hospitalized Patients with COVID-19: Long-term Follow-up Results from the Sina Hospital COVID-19 Registry, Iran
-
Danesh Soltani
,
Azar Hadadi
,
Shahrokh Karbalai Saleh
,
Alireza Oraii
,
Azadeh Sadatnaseri
,
Mostafa Roozitalab
,
Zahra Shajari
,
Shima sadat Ghaemmaghami
,
Haleh Ashraf
Abstract
Background: The present study aimed to investigate the association between acute cardiac injury (ACI) and outcomes in hospitalized patients with coronavirus disease 2019 (COVID-19) in Iran.
Methods: The current cohort study enrolled all consecutive hospitalized patients with COVID-19 (≥ 18 y) who had serum high-sensitivity cardiac troponin-I (hs-cTnT) measurements on admission between March 2020 and March 2021. ACI was determined as hs-cTnT levels exceeding the 99th percentile of normal values. Data on demographics, comorbidities, clinical and laboratory characteristics, and outcomes were collected from Web-based electronic health records.
Results: The study population consisted of 1413 hospitalized patients with COVID-19, of whom 319 patients (22.58%) presented with ACI. The patients with ACI had a significantly higher mortality rate than those without ACI (48.28% vs 15.63%; P<0.001) within a mean follow-up of 218.86 days from symptom onset. ACI on admission was independently associated with mortality (HR, 1.44; P=0.018). In multivariable logistic regression, age (OR, 1.034; P<0.001), preexisting cardiac disease (OR, 1.49; P=0.035), preexisting malignancy (OR, 2.01; P=0.030), oxygen saturation reduced to less than 90% (OR, 2.15; P<0.001), leukocytosis (OR, 1.45; P=0.043), lymphopenia (OR, 1.49; P=0.020), reduced estimated glomerular filtration rates (eGFRs) (OR, 0.99; P=0.008), and treatment with intravenous immunoglobulin during hospitalization (OR, 4.03; P=0.006) were independently associated with ACI development.
Conclusion: ACI occurrence on admission was associated with long-term mortality in our hospitalized patients with COVID-19. The finding further underscores the significance of evaluating ACI occurrence on admission, particularly in individuals more prone to ACI, including older individuals and those with preexisting comorbidities, reduced oxygen saturation, and increased inflammatory responses.
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14. Zou F, Qian Z, Wang Y, Zhao Y, Bai J. Cardiac Injury and COVID-19: A Systematic Review and Meta-analysis. CJC Open 2020;2:386-394.
15. Huang Z, Huang P, Du B, Kong L, Zhang W, Zhang Y, Dong J. Prevalence and clinical outcomes of cardiac injury in patients with COVID-19: A systematic review and meta-analysis. Nutr Metab Cardiovasc Dis 2021;31:2-13.
16. Karbalai Saleh S, Oraii A, Soleimani A, Hadadi A, Shajari Z, Montazeri M, Moradi H, Talebpour M, Sadat Naseri A, Balali P, Akhbari M, Ashraf H. The association between cardiac injury and outcomes in hospitalized patients with COVID-19. Intern Emerg Med 2020;15:1415-1424.
17. Organization WH. Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected. Interim guidance, 13 March 2020. https://www.who.int/docs/default-source/coronaviruse/clinical-management-of-novel-cov.pdf (15 Sptember 2022).
18. Salehi S, Abedi A, Balakrishnan S, Gholamrezanezhad A. Coronavirus Disease 2019 (COVID-19): A Systematic Review of Imaging Findings in 919 Patients. AJR Am J Roentgenol 2020;215:87-93.
19. Bernheim A, Mei X, Huang M, Yang Y, Fayad ZA, Zhang N, Diao K, Lin B, Zhu X, Li K, Li S, Shan H, Jacobi A, Chung M. Chest CT Findings in Coronavirus Disease-19 (COVID-19): Relationship to Duration of Infection. Radiology 2020;295:200463.
20. ARDS Definition Task Force; Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, Camporota L, Slutsky AS. Acute respiratory distress syndrome: the Berlin Definition. JAMA 2012;307:2526-2533.
21. Sandoval Y, Januzzi JL Jr, Jaffe AS. Cardiac Troponin for Assessment of Myocardial Injury in COVID-19: JACC Review Topic of the Week. J Am Coll Cardiol 2020;76:1244-1258.
22. Figliozzi S, Masci PG, Ahmadi N, Tondi L, Koutli E, Aimo A, Stamatelopoulos K, Dimopoulos MA, Caforio ALP, Georgiopoulos G. Predictors of adverse prognosis in COVID-19: A systematic review and meta-analysis. Eur J Clin Invest 2020;50:e13362.
23. Karahan S, Katkat F, Ozcan S, Sahin I, Okuyan E. Impact of acute myocardial injury on prognosis in patients with COVID-19. Eur Rev Med Pharmacol Sci 2021;25:2425-2434.
24. McCarthy CP, Raber I, Chapman AR, Sandoval Y, Apple FS, Mills NL, Januzzi JL Jr. Myocardial Injury in the Era of High-Sensitivity Cardiac Troponin Assays: A Practical Approach for Clinicians. JAMA Cardiol 2019;4:1034-1042.
25. Musher DM, Abers MS, Corrales-Medina VF. Acute Infection and Myocardial Infarction. N Engl J Med 2019;380:171-176.
26. Li WX, Xu W, Huang CL, Fei L, Xie XD, Li Q, Chen L. Acute cardiac injury and acute kidney injury associated with severity and mortality in patients with COVID-19. Eur Rev Med Pharmacol Sci 2021;25:2114-2122.
27. Uribarri A, Núñez-Gil IJ, Aparisi A, Becerra-Muñoz VM, Feltes G, Trabattoni D, et al. Impact of renal function on admission in COVID-19 patients: an analysis of the international HOPE COVID-19 (Health Outcome Predictive Evaluation for COVID 19) Registry. J Nephrol 2020;33:737-745.
28. Kellum JA, van Till JWO, Mulligan G. Targeting acute kidney injury in COVID-19. Nephrol Dial Transplant 2020;35:1652-1662.
29. Egbuche O, Jegede O, Abe T, Wagle B, Huynh K, Hayes D, Campbell ML, Mezue K, Ram P, Nwokike SI, Desai R, Effoe V, Kpodonu J, Morgan J, Ofili E, Onwuanyi A, Echols MR. Pre-existing cardiovascular disease, acute kidney injury, and cardiovascular outcomes in hospitalized blacks with COVID-19 infection. Am J Cardiovasc Dis 2021;11:212-221.
30. Davé S, Hagan J. Myocardial infarction during intravenous immunoglobulin infusion in a 65-year-old man with common variable immunodeficiency and subsequent successful repeated administration. Ann Allergy Asthma Immunol 2007;99:567-70.
31. Elkayam O, Paran D, Milo R, Davidovitz Y, Almoznino-Sarafian D, Zeltser D, Yaron M, Caspi D. Acute myocardial infarction associated with high dose intravenous immunoglobulin infusion for autoimmune disorders. A study of four cases. Ann Rheum Dis 2000;59:77-80.
2. Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, Wu Y, Zhang L, Yu Z, Fang M, Yu T, Wang Y, Pan S, Zou X, Yuan S, Shang Y. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med 2020;8:475-481.
3. Wibowo A, Pranata R, Akbar MR, Purnomowati A, Martha JW. Prognostic performance of troponin in COVID-19: A diagnostic meta-analysis and meta-regression. Int J Infect Dis 2021;105:312-318.
4. Knight SR, Ho A, Pius R, Buchan I, Carson G, Drake TM, et al. Risk stratification of patients admitted to hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: development and validation of the 4C Mortality Score. BMJ 2020;370:m3339.
5. Manocha KK, Kirzner J, Ying X, Yeo I, Peltzer B, Ang B, Li HA, Lerman BB, Safford MM, Goyal P, Cheung JW. Troponin and Other Biomarker Levels and Outcomes Among Patients Hospitalized With COVID-19: Derivation and Validation of the HA2T2 COVID-19 Mortality Risk Score. J Am Heart Assoc 2021;10:e018477.
6. Li X, Pan X, Li Y, An N, Xing Y, Yang F, Tian L, Sun J, Gao Y, Shang H, Xing Y. Cardiac injury associated with severe disease or ICU admission and death in hospitalized patients with COVID-19: a meta-analysis and systematic review. Crit Care 2020;24:468.
7. Bavishi C, Bonow RO, Trivedi V, Abbott JD, Messerli FH, Bhatt DL. Special Article - Acute myocardial injury in patients hospitalized with COVID-19 infection: A review. Prog Cardiovasc Dis 2020;63:682-689.
8. Guo T, Fan Y, Chen M, Wu X, Zhang L, He T, Wang H, Wan J, Wang X, Lu Z. Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19). JAMA Cardiol 2020;5:811-818.
9. Shi S, Qin M, Shen B, Cai Y, Liu T, Yang F, Gong W, Liu X, Liang J, Zhao Q, Huang H, Yang B, Huang C. Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China. JAMA Cardiol 2020;5:802-810.
10. Lala A, Johnson KW, Januzzi JL, Russak AJ, Paranjpe I, Richter F, Zhao S, Somani S, Van Vleck T, Vaid A, Chaudhry F, De Freitas JK, Fayad ZA, Pinney SP, Levin M, Charney A, Bagiella E, Narula J, Glicksberg BS, Nadkarni G, Mancini DM, Fuster V; Mount Sinai COVID Informatics Center. Prevalence and Impact of Myocardial Injury in Patients Hospitalized With COVID-19 Infection. J Am Coll Cardiol 2020;76:533-546.
11. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, Zhang L, Fan G, Xu J, Gu X, Cheng Z, Yu T, Xia J, Wei Y, Wu W, Xie X, Yin W, Li H, Liu M, Xiao Y, Gao H, Guo L, Xie J, Wang G, Jiang R, Gao Z, Jin Q, Wang J, Cao B. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497-506.
12. Manolis AS, Manolis AA, Manolis TA, Melita H. COVID-19 and Acute Myocardial Injury and Infarction: Related Mechanisms and Emerging Challenges. J Cardiovasc Pharmacol Ther 2021;26:399-414.
13. Sinclair JE, Zhu Y, Xu G, Ma W, Shi H, Ma KL, Cao CF, Kong LX, Wan KQ, Liao J, Wang HQ, Arentz M, Redd MA, Gallo LA, Short KR. A meta-analysis on the role of pre-existing chronic disease in the cardiac complications of SARS-CoV-2 infection. iScience 2021;24:102264.
14. Zou F, Qian Z, Wang Y, Zhao Y, Bai J. Cardiac Injury and COVID-19: A Systematic Review and Meta-analysis. CJC Open 2020;2:386-394.
15. Huang Z, Huang P, Du B, Kong L, Zhang W, Zhang Y, Dong J. Prevalence and clinical outcomes of cardiac injury in patients with COVID-19: A systematic review and meta-analysis. Nutr Metab Cardiovasc Dis 2021;31:2-13.
16. Karbalai Saleh S, Oraii A, Soleimani A, Hadadi A, Shajari Z, Montazeri M, Moradi H, Talebpour M, Sadat Naseri A, Balali P, Akhbari M, Ashraf H. The association between cardiac injury and outcomes in hospitalized patients with COVID-19. Intern Emerg Med 2020;15:1415-1424.
17. Organization WH. Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected. Interim guidance, 13 March 2020. https://www.who.int/docs/default-source/coronaviruse/clinical-management-of-novel-cov.pdf (15 Sptember 2022).
18. Salehi S, Abedi A, Balakrishnan S, Gholamrezanezhad A. Coronavirus Disease 2019 (COVID-19): A Systematic Review of Imaging Findings in 919 Patients. AJR Am J Roentgenol 2020;215:87-93.
19. Bernheim A, Mei X, Huang M, Yang Y, Fayad ZA, Zhang N, Diao K, Lin B, Zhu X, Li K, Li S, Shan H, Jacobi A, Chung M. Chest CT Findings in Coronavirus Disease-19 (COVID-19): Relationship to Duration of Infection. Radiology 2020;295:200463.
20. ARDS Definition Task Force; Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, Camporota L, Slutsky AS. Acute respiratory distress syndrome: the Berlin Definition. JAMA 2012;307:2526-2533.
21. Sandoval Y, Januzzi JL Jr, Jaffe AS. Cardiac Troponin for Assessment of Myocardial Injury in COVID-19: JACC Review Topic of the Week. J Am Coll Cardiol 2020;76:1244-1258.
22. Figliozzi S, Masci PG, Ahmadi N, Tondi L, Koutli E, Aimo A, Stamatelopoulos K, Dimopoulos MA, Caforio ALP, Georgiopoulos G. Predictors of adverse prognosis in COVID-19: A systematic review and meta-analysis. Eur J Clin Invest 2020;50:e13362.
23. Karahan S, Katkat F, Ozcan S, Sahin I, Okuyan E. Impact of acute myocardial injury on prognosis in patients with COVID-19. Eur Rev Med Pharmacol Sci 2021;25:2425-2434.
24. McCarthy CP, Raber I, Chapman AR, Sandoval Y, Apple FS, Mills NL, Januzzi JL Jr. Myocardial Injury in the Era of High-Sensitivity Cardiac Troponin Assays: A Practical Approach for Clinicians. JAMA Cardiol 2019;4:1034-1042.
25. Musher DM, Abers MS, Corrales-Medina VF. Acute Infection and Myocardial Infarction. N Engl J Med 2019;380:171-176.
26. Li WX, Xu W, Huang CL, Fei L, Xie XD, Li Q, Chen L. Acute cardiac injury and acute kidney injury associated with severity and mortality in patients with COVID-19. Eur Rev Med Pharmacol Sci 2021;25:2114-2122.
27. Uribarri A, Núñez-Gil IJ, Aparisi A, Becerra-Muñoz VM, Feltes G, Trabattoni D, et al. Impact of renal function on admission in COVID-19 patients: an analysis of the international HOPE COVID-19 (Health Outcome Predictive Evaluation for COVID 19) Registry. J Nephrol 2020;33:737-745.
28. Kellum JA, van Till JWO, Mulligan G. Targeting acute kidney injury in COVID-19. Nephrol Dial Transplant 2020;35:1652-1662.
29. Egbuche O, Jegede O, Abe T, Wagle B, Huynh K, Hayes D, Campbell ML, Mezue K, Ram P, Nwokike SI, Desai R, Effoe V, Kpodonu J, Morgan J, Ofili E, Onwuanyi A, Echols MR. Pre-existing cardiovascular disease, acute kidney injury, and cardiovascular outcomes in hospitalized blacks with COVID-19 infection. Am J Cardiovasc Dis 2021;11:212-221.
30. Davé S, Hagan J. Myocardial infarction during intravenous immunoglobulin infusion in a 65-year-old man with common variable immunodeficiency and subsequent successful repeated administration. Ann Allergy Asthma Immunol 2007;99:567-70.
31. Elkayam O, Paran D, Milo R, Davidovitz Y, Almoznino-Sarafian D, Zeltser D, Yaron M, Caspi D. Acute myocardial infarction associated with high dose intravenous immunoglobulin infusion for autoimmune disorders. A study of four cases. Ann Rheum Dis 2000;59:77-80.
| Files | ||
| Issue | Vol 18 No 3 (2023): J Teh Univ Heart Ctr | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/jthc.v18i3.14114 | |
| Keywords | ||
| COVID-19 ; SARS-CoV-2 Troponin Mortality | ||
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How to Cite
1.
Soltani D, Hadadi A, Karbalai Saleh S, Oraii A, Sadatnaseri A, Roozitalab M, Shajari Z, Ghaemmaghami S sadat, Ashraf H. The Association between Acute Cardiac Injury and Outcomes of Hospitalized Patients with COVID-19: Long-term Follow-up Results from the Sina Hospital COVID-19 Registry, Iran. J Tehran Heart Cent. 2023;18(3):196-206.
