The relationship between cardiac injury, inflammation and coagulation in predicting COVID-19 outcome

Abstract

High sensitivity troponin T (hsTnT) is a strong predictor of adverse outcome during SARS-CoV-2 infection. However, its determinants remain partially unknown. We aimed to assess the relationship between severity of inflammatory response/coagulation abnormalities and hsTnT in Coronavirus Disease 2019 (COVID-19). We then explored the relevance of these pathways in defining mortality and complications risk and the potential effects of the treatments to attenuate such risk. In this single-center, prospective, observational study we enrolled 266 consecutive patients hospitalized for SARS-CoV-2 pneumonia. Primary endpoint was in-hospital COVID-19 mortality. hsTnT, even after adjustment for confounders, was associated with mortality. D-dimer and CRP presented stronger associations with hsTnT than PaO2. Changes of hsTnT, D-dimer and CRP were related; but only D-dimer was associated with mortality. Moreover, low molecular weight heparin showed attenuation of the mortality in the whole population, particularly in subjects with higher hsTnT. D-dimer possessed a strong relationship with hsTnT and mortality. Anticoagulation treatment showed greater benefits with regard to mortality. These findings suggest a major role of SARS-CoV-2 coagulopathy in hsTnT elevation and its related mortality in COVID-19. A better understanding of the mechanisms related to COVID-19 might pave the way to therapy tailoring in these high-risk individuals.

Dexamethasone Improves Cardiovascular Outcomes in Critically Ill COVID-19, a Real World Scenario Multicenter Analysis

“…As troponin levels are strongly associated with D-Dimer concentrations in COVID-19 ( 12 ), we further investigated this observation. So far, only one study investigated D-Dimer levels in COVID-19 patients treated by steroids ( 33 ).…”

“…Therefore, our results implicate further speculations regarding the potential protective cardiovascular effects of dexamethasone therapy in severe COVID-19. While both cardiac injury and thrombogenicity are associated with COVID-19 related inflammation ( 8 , 12 , 38 , 39 ), anti-inflammatory effects seem possible. Furthermore, one could speculate, that a reduction in COVID-19 related vasculitis might further promote protective cardiovascular and antithrombotic effects ( 40 ).…”

“…Accordingly, in this study we aimed to investigate the effects of dexamethasone treatment on cardiac injury and thromboembolic events in severe COVID-19 disease requiring mechanical ventilation. Since both processes are promoted by a COVID-19 dependent high inflammatory burden ( 12 ), we hypothesized that dexamethasone treatment might result in a reduction of myocardial injury as well as thrombotic events.…”

Subclinical myocardial injury, coagulopathy, and inflammation in COVID-19: A meta-analysis of 41,013 hospitalized patients

“… [6] , [7] , [8] These cardiac biomarkers include troponin (cTnI), n-terminal pro-b-type natriuretic peptide (NT-proBNP), galectin-3, d-dimer, interleukin-6 (IL-6), and c-reactive protein (CRP). [9] , [10] , [11] In one study of 2,736 patients hospitalized for COVID-19 in New York City, small elevations in cTnI laboratory values were associated with increased mortality. NT-proBNP, a hormone that is predominantly produced by ventricular myocytes in response to increased ventricular wall stress, is an established biomarker for diagnosis and prognosis of heart failure.…”

Microvascular Inflammation and Cardiovascular Prevention: The Role of Microcirculation as Earlier Determinant of Cardiovascular Risk

“…The inflammatory response is a multi-facet condition, influencing CV health both in acute [5] and in chronic conditions [6], which is aroused by a plethora of stimuli such as infections [5], metabolic disease [6], central nervous system alterations [7] and also environmental pollution [8][9][10]. Nevertheless, large randomized controlled trials (RCTs) targeting inflammation failed to provide positive results [2,4,11].…”