Distinct etiologies of high-sensitivity troponin T elevation predict different mortality risks for patients
Pegah Khaloo1, Ayman Shaqdan1, Pablo A Ledesma1
1Cardiac Arrhythmia Service, MGH Heart Center, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States of America.
Insights
Elevated high sensitivity troponin (hs-TnT) in COVID-19 patients indicates increased mortality risk. Cardiac causes of hs-TnT elevation nearly double the mortality risk compared to non-cardiac causes.
Area of Science:
- Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- COVID-19 infection is linked to adverse cardiovascular events and poor patient outcomes.
- Limited large-scale studies exist on the association between cardiovascular events and mortality in COVID-19 patients.
- This study investigates cardiovascular events and mortality in hospitalized COVID-19 patients.
Purpose of the Study:
- To examine the association between cardiovascular events and mortality in patients hospitalized with COVID-19.
- To identify predictors of mortality in this patient cohort.
- To differentiate the impact of cardiac versus non-cardiac etiologies on mortality.
Main Methods:
- Retrospective chart review of 2450 patients hospitalized with confirmed COVID-19.
- Data collected between March 15 and June 15, 2020.
- Logistic regression analysis to determine mortality predictors.
Main Results:
- 57% of patients had elevated high sensitivity troponin (hs-TnT) levels.
- Acute heart failure (23%) and arrhythmias (8%) were observed.
- Elevated hs-TnT associated with increased mortality; cardiac etiology (OR 4.6) showed higher risk than non-cardiac (OR 2.7).
Conclusions:
- Elevated hs-TnT in COVID-19 patients significantly increases mortality risk.
- Cardiac etiology for hs-TnT elevation confers a nearly 2-fold higher mortality risk than non-cardiac etiology.
- Early identification and management of cardiac complications in COVID-19 are crucial.
Background:
Cardiovascular events in the context of COVID-19 infection increase the risk of negative patient outcomes, but large cohort studies describing this association are limited. The purpose of the current study was to investigate the potential associations between cardiovascular events and mortality in patients hospitalized due to COVID-19.
Methods:
A retrospective chart review was performed in 2450 patients hospitalized for confirmed COVID-19 infection within a single hospital network between March 15 and June 15, 2020. Logistic regression analysis was used to identify predictors of mortality.
Results:
In the study population, 57% of patients had elevated high sensitivity troponin (hs-TnT) levels. Acute heart failure occurred in 23% of patients and arrhythmias were observed in 8% of patients. Of the 1401 patients with elevated hs-TnT levels, a primary cardiac etiology (e.g., myocardial infarction) was identified in 653 (47%) patients. In the remaining 748 (53%) patients, there was evidence of a primary non-cardiac etiology for hs-TnT elevation such as renal failure (n = 304) and critical illness (n = 286). Elevated hs-TnT was associated with increased risk of mortality. A significantly higher mortality rate was observed for hs-TnT elevation associated with a primary cardiac etiology (OR 4.6, 95% CI: 2.7-7.6; P < 0.001) than a primary non-cardiac etiology (OR 2.7, 95% CI: 1.6-4.5; P < 0.001).
Conclusions:
Elevated hs-TnT in the context of COVID-19 infection is associated with a significantly increased mortality risk. Hs-TnT elevation in the context of a primary cardiac etiology confers a nearly 2-fold higher mortality risk than hs-TnT elevation due to a primary non-cardiac etiology.
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