Cardiac troponin and COVID‐19 severity: Results from BIOCOVID study

Guadiana-Romualdo, Luis García de; Morell-García, Daniel; Rodríguez-Fraga, Olaia; Morales‐Indiano, Cristian; Jiménez, Ana María Lourdes Padilla; Revilla, José Ignacio Gutiérrez; Urrechaga, Eloísa; Álamo, J.M.; Holgado, Ana María Hernando; Lorenzo-Lozano, María-Carmen; Fdez-Pacheco, Silvia Sánchez; Cagigal, Patricia de la Hera; Tobarra, María Ángeles Juncos; Vı́lchez, Juan Antonio; Chamorro, Isabel Vírseda; García, Irene; Murcia, Yolanda Pastor; Frías, L.; Queral, Laura Altimira; Nuez-Zaragoza, Elisa; León, Juan Adell Ruiz de; Ripa, Alicia Ruiz; Gómez-Pablos, Paloma Salas; López, Iría Cebreiros; Uriarte, Amaia Fernández; Larruzea, Álex; Yepes, María Luisa López; Sancho‐Rodríguez, Natalia; Andrés, María C Zamorano; Díaz, José Pedregosa; Alcaraz, Cristina; Manzanera, A.L. Blázquez; Sanmartín, Sonia Pérez; Calzada, María del Carmen Baamonde; Vera, Marina; Nuñez, Elena Valera; Campás, Magdalena Canalda; Muñoz, Sara García; Bauça, Josep Miquel; Gutiérrez, Luis Vicente; Añón, Laura Jiménez; Martínez, Alfonso Pérez; Castillo, Aurelio Pons; Tamayo, Ruth González; Vivancos, J.; Martín, María José Alcaide; Fernández, Vicente Ferrer Díaz de Brito; Aguadero, Vicente; Arévalo, María Gloria García; Carrillo, María Arnaldos; Morales, Mercedes González; Gárate, María Núñez; Iruela, Cristina Ruiz; Torrella, Patricia Esteban; Pérez, Martí Vila; Egea-Caparrós, José M.; Sáenz, Luis Casis; Ortega, Amparo Galán; Consuegra-Sánchez, Luciano

doi:10.1111/eci.13532

Cited by 49 publications

(40 citation statements)

References 36 publications

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“…Myocardial injury is defined as the presence of at least one cardiac troponin value above the 99th percentile upper reference limit (URL) according to the Fourth Universal Definition of Myocardial Infarction ( Thygesen et al., 2018 ). Consistent with many other reports ( Lombardi et al., 2020 ; Garcia De Guadiana-Romualdo et al., 2021 ; Majure et al., 2021 ), elevated hsTnI was detected in the COVID-19 patients in our study. The mechanisms for myocardial injury in COVID-19 has not been elucidated.…”

Section: Discussionsupporting

confidence: 94%

Elevated Plasma Fibrinogen Is Associated With Excessive Inflammation and Disease Severity in COVID-19 Patients

Sui

Noubouossié

Gandotra

et al. 2021

Front. Cell. Infect. Microbiol.

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BackgroundThe coronavirus disease-19 (COVID-19) is characterized with intense inflammatory response, cardiac involvement, and coagulopathy. Fibrinogen, as a biomarker for inflammation, cardiovascular disease, and coagulation, has not been fully investigated yet. The aim of this study was to assess the clinical application of fibrinogen in COVID-19 patients.MethodsWe retrospectively analyzed the demographic and laboratory characteristics of 119 COVID-19 patients in the University of Alabama of Birmingham Medical Center. Correlations of fibrinogen on admission with intensive care unit (ICU) admission, disease severity, and laboratory parameters were analyzed.ResultsAmong the 119 COVID-19 patients, 77.3% (92/119) had severe disease, and 59.5% (71/119) patients were admitted to the ICU. Elevated fibrinogen was detected in 67.2% (80/119) of the patients. Fibrinogen levels were significantly associated with inflammatory markers and disease severity, but not with cardiac injury biomarker high sensitivity troponin I. Patients with severe disease had increased fibrinogen levels upon admission compared to patients with non-severe disease (P = 0.001). Fibrinogen level at 528.0 mg/dl was the optimal cutoff to predict disease severity, with a sensitivity and specificity of 66.7% and 70.3% (area undty -60er the curve [AUC] 0.72, P = 0.0006).ConclusionsFibrinogen is commonly elevated in COVID-19 patients, especially in those with severe disease. Elevated fibrinogen correlates with excessive inflammation, disease severity, and ICU admission in COVID-19 patients.

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Section: Discussionsupporting

confidence: 94%

Elevated Plasma Fibrinogen Is Associated With Excessive Inflammation and Disease Severity in COVID-19 Patients

Sui

Noubouossié

Gandotra

et al. 2021

Front. Cell. Infect. Microbiol.

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“…37 Consistent with the recent two studies of cardiac microthrombi in fatal COVID-19, 13,14 we found that the minority of COVID-19 autopsies had any focal cardiac necrosis. The infrequency of cardiac necrosis in fatal COVID-19 13,14,49 contrasts with the high prevalence, magnitude, and mortality risk of cTn elevation among critically ill COVID-19 patients, 9,48,49 even after controlling for renal dysfunction. 50,51 Our cell composition and single nuclei transcriptomic data demonstrate that SARS-CoV-2 indeed impacts cardiomyocytes, resulting in their cell death and dysfunction.…”

Section: Discussionmentioning

confidence: 94%

Molecular Pathophysiology of Cardiac Injury and Cardiac Microthrombi in Fatal COVID-19: Insights from Clinico-histopathologic and Single Nuclei RNA Sequencing Analyses

Fukuma

Hulke

Brener

et al. 2021

Preprint

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Cardiac injury is strongly associated with critical COVID-19, yet its etiology remains debated. To elucidate the pathogenic mechanisms of COVID-19-associated cardiac injury, we conducted a single-center prospective cohort study of 69 COVID-19 decedents. Of six cardiac histopathologic features, microthrombi was the most commonly detected (n=48, 70%). We tested associations of cardiac microthrombi with biomarkers of inflammation, cardiac injury, and fibrinolysis and with in-hospital antiplatelet therapy, therapeutic anticoagulation, and corticosteroid treatment, while adjusting for multiple clinical factors, including COVID-19 therapies. Higher peak ESR and CRP during hospitalization were independently associated with higher odds of microthrombi. Using single nuclei RNA-sequence analysis, we discovered an enrichment of pro-thrombotic/anti-fibrinolytic, extracellular matrix remodeling, and immune-potentiating signaling amongst cardiac fibroblasts in microthrombi-positive COVID-19 hearts relative to microthrombi-negative COVID-19 and non-COVID-19 reference hearts. Our cumulative findings identify the specific transcriptomic changes in cardiac fibroblasts as salient features of COVID-19-associated cardiac microthrombi.

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“…One study showed that 41 (22%) of admitted patients had myocardial injury and the mortality was similar among those with myocardial injury regardless of whether they had or did not have COVID-19 infection [47]. The included studies also examined the relationship between troponin level and mortality or the prevalence of elevated cardiac enzymes among hospitalized COVID-19 patients [35,39,41,44,51,52,54,58,61,66].…”

Section: N Resultsmentioning

confidence: 99%

Myocardial injuries among patients with COVID-19: a systematic review

Alali¹,

Smaisem²,

Alsheikh³

et al. 2021

Infez Med

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This is a systematic review of the literature specifically aimed to explore myocardial injury in coronavirus disease-19 (COVID-19) patients who were hospitalized with severe complicated infections. The medical literature was examined through the large medical databases, including Medline, Ovid, PubMed, and Embase, over the last year between January 2020 and May 2021. The search terms used were a combination of ''myocardial injury'' AND ''COVID-19'' AND "Hospitalization". Then we applied a step to filter the results to select original research articles only evaluating the myocardial injuries in severe COVID-19 hospitalized patients. Selected trials mentioned the type of myocardial injury detected with the infection. A total of 245 articles were extracted. Considering the exclusion of ineligible articles, 42 articles appeared. A total of 42 articles were eligible and were included SUMMARY in the review. These studies included a total of 4326 COVID-19 patients. The 30-day mortality was found to be associated with increased cardiac troponin and myocardial infarction could be a systemic reaction rather than the direct action of COVID-19. Patients with myocardial injury were significantly older and with co-morbid conditions. Studies also found a correlation of higher concentrations of cardiac enzymes with disease severity and increased in-hospital mortality. Myocardial injury was a significant predictor for severe COVID-19 infection and in-hospital mortality. Cardiac enzymes should be monitored in hospitalized patients with severe COVID-19 infections.

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Cardiac troponin and COVID‐19 severity: Results from BIOCOVID study

Cited by 49 publications

References 36 publications

Elevated Plasma Fibrinogen Is Associated With Excessive Inflammation and Disease Severity in COVID-19 Patients

Elevated Plasma Fibrinogen Is Associated With Excessive Inflammation and Disease Severity in COVID-19 Patients

Molecular Pathophysiology of Cardiac Injury and Cardiac Microthrombi in Fatal COVID-19: Insights from Clinico-histopathologic and Single Nuclei RNA Sequencing Analyses

Myocardial injuries among patients with COVID-19: a systematic review

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