Predictive Value of Myocardial injury in Patients with COVID-19 Admitted to a Quaternary Hospital in the City of Rio de Janeiro

Abstract

Background:In Brazil the factors involved in the risk of death in patients with COVID-19 have not been well established. Objective:To analyze whether elevations of high-sensitivity troponin I (hTnI) levels influence the mortality of patients with COVID-19.Methods: Clinical and laboratory characteristics of hospitalized patients with COVID-19 were collected upon hospital admission. Univariate and binary logistic regression analyzes were performed to assess the factors that influence mortality. P-value<0.05 was considered significant.Results: This study analyzed192 patients who received hospital admission between March 16 and June 2, 2020 and who were discharged or died by July 2, 2020. The mean age was 70±15 years, 80 (41.7%) of whom were women. In comparison to those who were discharged, the 54 (28.1%) who died were older (79±12 vs 66±15years; P=0.004), and with a higher Charlson´s index (5±2 vs 3±2; P=0.027). More patients, aged≥60years (P <0.0001), Charlson´s index>1 (P=0.004), lung injury>50% in chest computed tomography (P=0.011), with previous coronary artery disease (P=0.037), hypertension (P=0.033), stroke (P=0.008), heart failure (P=0.002), lymphocytopenia (P=0.024), high D-dimer (P=0.024), high INR (P=0.003), hTnI (P<0.0001), high creatinine (P<0.0001), invasive mechanical ventilation (P<0.0001), renal replacement therapy (P<0.0001), vasoactive amine (P<0.0001), and transfer to the ICU (P=0.001), died when compared to those who were discharged. In logistic regression analysis, elevated hTnI levels (OR=9.504; 95% CI=1.281-70.528; P=0.028) upon admission, and the need for mechanical ventilation during hospitalization (OR=46.691; 95% CI=2.360-923.706; P=0.012) increased the chance of in-hospital mortality. Conclusion:This study suggests that in COVID-19 disease, myocardial injury upon hospital admission is a harbinger of poor prognosis.

Rivaroxabana em Pacientes Ambulatoriais com COVID-19 Leve ou Moderada: Fundamentação e Desenho do Estudo CARE (CARE – Coalition COVID-19 Brazil VIII)

“…[21][22][23][24][25] Além disso, vários estudos realizados no contexto epidemiológico e sanitário brasileiro relataram uma série de fatores de risco cardiovascular associados tanto à sobrecarga como ao prognóstico da COVID-19. [26][27][28][29] Foram realizados ensaios controlados randomizados de terapias antitrombóticas em pacientes com COVID-19 hospitalizados, especialmente em pacientes críticos em unidades de terapia intensiva. [30][31][32][33][34][35] De fato, as diretrizes atuais recomendam a profilaxia antitrombótica com heparina de baixo peso molecular (LMWH) ou heparina não fracionada (UFH) para pacientes hospitalizados.…”