Prognostic Value of Troponin Elevation in COVID-19 Hospitalized Patients

Benedek

et al. 2021

JCM

COVID-19 is currently considered an inflammatory disease affecting the entire organism. In severe forms, an augmented inflammatory response leads to the fulminant “cytokine storm”, which may result in severe multisystemic end-organ damage. Apart from the acute inflammatory response, it seems that chronic inflammation also plays a major role in the clinical evolution of COVID-19 patients. Pre-existing inflammatory conditions, such as those associated with chronic coronary diseases, type 2 diabetes mellitus or obesity, may be associated with worse clinical outcomes in the context of COVID-19 disease. These comorbidities are reported as powerful predictors of poor outcomes and death following COVID-19 disease. Moreover, in the context of chronic coronary syndrome, the cytokine storm triggered by SARS-CoV-2 infection may favor vulnerabilization and rupture of a silent atheromatous plaque, with consequent acute coronary syndrome, leading to a sudden deterioration of the clinical condition of the patient. This review aims to present the current status of knowledge regarding the link between COVID-19 mortality, systemic inflammation and several major diseases associated with poor outcomes, such as cardiovascular diseases, diabetes and obesity.

Section: Biomarkers Associated With Worse Prognosis In Covid-19 Patients Suffering Acute Coronary Syndromesmentioning

confidence: 99%

Systemic Inflammation and COVID-19 Mortality in Patients with Major Noncommunicable Diseases: Chronic Coronary Syndromes, Diabetes and Obesity

Benedek

et al. 2021

JCM

“…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

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.

Journal of Critical Care

“…Despite the detection of myocardial injury based on troponin elevation has been an established risk factor in critical COVID-19 patient [ 24 ], this diagnosis based on LV dysfunction by cardiac ultrasound is not a consensus. In a prospective multicenter survey, including 1216 patients, 38% of COVID-19 patients presented LV impairment in the hospital setting [ 25 ] and a systematic review showed that most COVID-19 myocarditis has reduced LVEF [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Rapid prognostic stratification using Point of Care ultrasound in critically ill COVID patients: The role of epicardial fat thickness, myocardial injury and age

Millman

Santos

Pianca

et al. 2022

Purpose The burden of critical COVID-19 patients in intensive care units (ICU) demands new tools to stratify patient risk. We aimed to investigate the role of cardiac and lung ultrasound, together with clinical variables, to propose a simple score to help predict short-term mortality in these patients. Material and methods We collected clinical and laboratorial data, and a point-of-care cardiac and lung ultrasound was performed in the first 36 h of admission in the ICU. Results Out of 78 patients (61 ± 12y-o, 55% male), 33 (42%) died during the hospitalization. Deceased patients were generally older, had worse values for SOFA score, baseline troponin levels, left ventricular ejection fraction (LVEF), LV diastolic function, and increased epicardial fat thickness (EFT), despite a similar prevalence of severe lung ultrasound scores. Based on the multivariable model, we created the POCOVID score, including age (>60 years), myocardial injury (LVEF<50% and/or usTnI>99til), and increased EFT (>0.8 cm). The presence of two out of these three criteria identified patients with almost twice the risk of death. Conclusions A higher POCOVID score at ICU admission can be helpful to stratify critical COVID-19 patients with increased in-hospital mortality and to optimize medical resources allocation in more strict-resource settings.