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Myocardial Injury and Prognosis in Hospitalized COVID-19 Patients in Brazil: Results From The Brazilian COVID-19
Hannah Cardoso Barbosa1, Maria Auxiliadora Parreiras Martins1, Jordana Cristina de Jesus2
1Hospital das Clínicas - Universidade Federal de Minas Gerais,Belo Horizonte, MG - Brasil.
Insights
Myocardial injury in COVID-19 patients independently predicted higher in-hospital mortality and the need for mechanical ventilation. This finding highlights the importance of cardiac biomarkers in assessing COVID-19 severity.
Area of Science:
- Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Cardiovascular complications are key to COVID-19 pathogenesis and prognosis.
- Limited data exists on the prognostic value of troponin and myocardial injury in Latin American COVID-19 patients.
Purpose of the Study:
- To determine if myocardial injury independently predicts in-hospital mortality.
- To assess if myocardial injury predicts the need for invasive mechanical ventilation support in hospitalized COVID-19 patients.
Main Methods:
- A cohort study involving 2,925 hospitalized COVID-19 patients from the Brazilian COVID-19 Registry (March-September 2020).
- Primary outcomes were in-hospital mortality and invasive mechanical ventilation.
- Poisson regression with robust variance was used to estimate outcome models.
Main Results:
- 27.3% of patients had myocardial injury, with higher comorbidity rates.
- Patients with myocardial injury showed elevated levels of cardiac biomarkers and inflammatory markers.
- High troponin levels were associated with a significantly increased risk of death (RR 2.03) and mechanical ventilation (RR 1.87).
Conclusions:
- Cardiac injury is an independent predictor of in-hospital mortality in COVID-19 patients.
- Myocardial injury also independently predicts the need for invasive mechanical ventilation support.
Background:
Cardiovascular complications of COVID-19 are important aspects of the disease's pathogenesis and prognosis. Evidence on the prognostic role of troponin and myocardial injury in Latin American hospitalized COVID-19 patients is still scarce.
Objectives:
To evaluate myocardial injury as independent predictor of in-hospital mortality and invasive mechanical ventilation support in hospitalized patients, from the Brazilian COVID-19 Registry.
Methods:
This cohort study is a substudy of the Brazilian COVID-19 Registry, conducted in 31 Brazilian hospitals of 17 cities, March-September 2020. Primary outcomes included in-hospital mortality and invasive mechanical ventilation support. Models for the primary outcomes were estimated by Poisson regression with robust variance, with statistical significance of p<0.05.
Results:
Of 2,925 patients (median age of 60 years [48-71], 57.1% men), 27.3% presented myocardial injury. The proportion of patients with comorbidities was higher among patients with cardiac injury (median 2 [1-2] vs. 1 [0-2]). Patients with myocardial injury had higher median levels of brain natriuretic peptide, lactate dehydrogenase, creatine phosphokinase, N-terminal pro-brain natriuretic peptide, and C-reactive protein than patients without myocardial injury. As independent predictors, C-reactive protein and platelet counts were related to the risk of death, and neutrophils and platelet counts were related to the risk of invasive mechanical ventilation support. Patients with high troponin levels presented a higher risk of death (RR 2.03, 95% CI 1.60-2.58) and invasive mechanical ventilation support (RR 1.87, 95% CI 1.57-2.23), when compared to those with normal troponin levels.
Conclusion:
Cardiac injury was an independent predictor of in-hospital mortality and the need for invasive mechanical ventilation support in hospitalized COVID-19 patients.
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