Myocardial injury characterized by elevated cardiac troponin and in‐hospital mortality of COVID‐19: An insight from a meta‐analysis

Aikawa, Tadao; Takagi, Hisato; Ishikawa, Kiyotake; Kuno, Toshiki

doi:10.1002/jmv.26108

Cited by 39 publications

(38 citation statements)

References 12 publications

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“…We revealed that the majority of MIS‐C patients recovered successfully with a relatively high rate of improvement in myocardial dysfunction, however, the underlying mechanism of myocardial dysfunction in MIS‐C has not been fully elucidated. The pathogenesis of myocardial injury characterized by the elevation of cardiac troponin in acute COVID‐19 can be direct damage of myocardial cells by the virus or a severe cytokine storm induced by inflammatory responses, leading to myocarditis 62–66 . Recent studies have identified that IL‐6 is elevated in COVID‐19 patients with myocarditis 67 and IL‐6 plays a crucial role in a cytokine storm associated with COVID‐19 by forming hyperinflammation and promoting the production of the coagulation cascade activator plasminogen activator inhibitor‐1 68 .…”

Section: Discussionmentioning

confidence: 99%

COVID‐19 and multisystem inflammatory syndrome in children: A systematic review and meta‐analysis

Yasuhara

Watanabe

Takagi

et al. 2021

Pediatric Pulmonology

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Background Multisystem inflammatory syndrome in children (MIS‐C) associated with coronavirus disease 2019 has been increasingly recognized. However, the clinical features of MIS‐C and the differences from Kawasaki disease remain unknown. The study aims to investigate the epidemiology and clinical course of MIS‐C. Methods PubMed and EMBASE were searched through August 30, 2020. Observational studies describing MIS‐C were included. Data regarding demographic features, clinical symptoms, laboratory, echocardiography and radiology findings, treatments, and outcomes were extracted. Study‐specific estimates were combined using one‐group meta‐analysis in a random‐effects model. Results A total of 27 studies were identified including 917 MIS‐C patients. The mean age was 9.3 (95% confidence interval [CI], 8.4–10.1). The pooled proportions of Hispanic and Black cases were 34.6% (95% CI, 28.3–40.9) and 31.5% (95% CI, 24.8–38.1), respectively. The common manifestations were gastrointestinal symptoms (87.3%; 95% CI, 82.9–91.6) and cardiovascular involvement such as myocardial dysfunction (55.3%; 95% CI, 42.4–68.2), coronary artery aneurysms (21.7%; 95% CI, 12.8–30.1) and shock (65.8%; 95% CI, 51.1–80.4), with marked elevated inflammatory and cardiac markers. The majority of patients received intravenous immunoglobulin (81.0%; 95% CI, 75.0–86.9), aspirin (67.3%; 95% CI, 48.8–85.7), and corticosteroids (63.6%; 95% CI, 53.4–73.8) with a variety of anti‐inflammatory agents. Although myocardial dysfunction improved in 55.1% (95% CI, 33.4–76.8) at discharge, the rate of extracorporeal membrane oxygenation use was 6.3% (95% CI, 2.8–9.8) and the mortality was 1.9% (95% CI, 1.0–2.8). Conclusion Our findings suggest that MIS‐C leads to multiple organ failure, including gastrointestinal manifestations, myocardial dysfunction and coronary abnormalities, and has distinct features from Kawasaki disease.

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Section: Discussionmentioning

confidence: 99%

COVID‐19 and multisystem inflammatory syndrome in children: A systematic review and meta‐analysis

Yasuhara

Watanabe

Takagi

et al. 2021

Pediatric Pulmonology

Self Cite

134

131

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“…2 Even in the absence of an acute coronary syndrome, troponin elevation indicative of myocardial injury has been identified in 20-30% of hospitalized patients with COVID-19 and has been associated with increased risk of mortality in retrospective studies. [3][4][5] However, given the non-specific nature of troponin elevations, some have argued against its routine use unless there is clinical concern for an acute coronary plaque rupture. 6,7 The objective of this study is to determine the predictive value of high sensitivity troponin-T (hs-TnT) as compared to traditional inflammatory markers for adverse outcomes that include the need for critical care, respiratory failure requiring intubation, cardiac arrest, and in-hospital mortality.…”

Section: Introductionmentioning

confidence: 99%

“…Even in the absence of an acute coronary syndrome, troponin elevation indicative of myocardial injury has been identified in 20–30% of hospitalized patients with COVID-19 and has been associated with increased risk of mortality in retrospective studies (Aikawa et al. 2020 , Hendren et al. 2020 , Shi et al.…”

Section: Introductionmentioning

confidence: 99%

High sensitivity Troponin-T for prediction of adverse events in patients with COVID-19

et al. 2020

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Background: High sensitivity troponin-T (hs-TnT) has been associated with mortality in patients hospitalized with COVID-19. We aimed to determine if hs-TnT levels and their timing are independent predictors of adverse events in these patients. Design: Retrospective chart review was performed for all patients hospitalized at our institution between March 23 rd and April 13 th , 2020 who were found to be COVID-19-positive. Clinical, demographic, and laboratory variables including initial and peak hs-TnT were recorded. Univariable and multivariable analyses were completed for a primary composite endpoint of inhospital death, intubation, need for critical care, or cardiac arrest. Results: In the 276 patients analyzed, initial hs-TnT above the median (17ng/L) was associated with increased length of stay, need for vasoactive medications, and death, along with the composite endpoint (OR 3.92, p < 0.001). Multivariable analysis demonstrated that elevated initial hs-TnT was independently associated with the primary endpoint (OR 2.92, p = 0.01). Latepeaking hs-TnT (OR 2.19 for each additional day until peak, p < 0.001) was also independently associated with the composite endpoint. Conclusions: In patients hospitalized with COVID-19, hs-TnT identifies patients at high risk for adverse in-hospital events, and trends of hs-TnT over time, particularly during the first day, provide additional prognostic information.

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“…Candidate predictors (main candidate predictor and adjustment variables) for the primary outcome should be clinically and biologically plausible, and their relationships with all-cause death should be demonstrated in previous studies 15 , 16 , 17 , 18 , 19 , 20 . We considered all candidate predictors that we included in the model under these principles and finally draw a directed acyclic graph to inform regression models (Supplementary Figure- 1).…”

Section: Methodsmentioning

confidence: 99%

“…However, a recent meta-analysis of studies comparing cTn levels in patients who were critically ill to those who were not demonstrated no significant differences between cTn levels 14 . Finally, the impact of elevated cTn on the outcomes in COVID-19 patients is not well studied and characterized 15 , 16 , 17 , 18 , 19 , 20 . In the current nationwide study, we sought to determine whether cTn at admission may help identify 30-day all-cause mortality in hospitalized patients.…”

Section: Introductionmentioning

confidence: 99%

The prognostic role of cardiac troponin in hospitalized COVID-19 patients

et al. 2021

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Background and aim Myocardial injury defined by elevation of cardiac troponins (cTn) in the course of coronavirus disease 2019 (COVID-19) pandemic has been reported, though not fully characterized yet. Using the Turkish nationwide centralized COVID-19 database, we sought to determine whether cTn measured within 24 hours of admission may help identify 30-day all-cause mortality in hospitalized patients. Methods This retrospective cohort study was conducted at all hospitals in Turkey between March 11, 2020, and June 22, 2020. All hospitalized COVID-19 patients (≥18 years) who had cTn measurements within 24 hours of admission were included. The primary outcome was 30-day all-cause mortality. Results A total of 14,855 COVID-19 patients (median age 49 years and 54% male) from 81 provinces of Turkey were included. Of these, 2020 patients (13.6%) were transferred to intensive care unit, 1165 patients (7.8%) needed mechanical ventilation, and 882 patients (5.9%) died during hospitalization. The prevalence of cTn positivity was 6.9% (n = 1027) in the hospitalized patients. cTn positivity was 5% in those patients alive at 30-day, and 44% in those who died. In multivariable Cox proportional hazard regression model, age, lactate dehydrogenase, and cTn were the strongest predictors of 30-day mortality, irrespective of cTn definition as a continuous, ordinal variable, or dichotomic variables. Conclusions A single measurement of cTn at admission in patients with COVID-19 is associated with 30-day all-cause mortality and may have an important prognostic role for optimizing risk stratification.

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Myocardial injury characterized by elevated cardiac troponin and in‐hospital mortality of COVID‐19: An insight from a meta‐analysis

Cited by 39 publications

References 12 publications

COVID‐19 and multisystem inflammatory syndrome in children: A systematic review and meta‐analysis

COVID‐19 and multisystem inflammatory syndrome in children: A systematic review and meta‐analysis

High sensitivity Troponin-T for prediction of adverse events in patients with COVID-19

The prognostic role of cardiac troponin in hospitalized COVID-19 patients

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