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The authors compared the prevalence and outcomes of myocardial injury in 243 patients with severe COVID-19 and patients with acute respiratory distress syndrome (ARDS) unrelated to COVID-19. Over half the intubated patients with COVID-19 had troponin levels exceeding the upper limit of normal (ULN). Factors associated with myocardial injury in COVID patients were chronic kidney disease and lactate, ferritin, and fibrinogen levels. Although mortality was associated with troponin levels higher than 10 time the ULN, this association was not significant after adjusting for age, sex, and multisystem organ dysfunction. COVID-19 patients were older with higher creatinine and less favorable vital signs than non-COVID ARDS patients. COVID-19 was associated with a lower risk of myocardial injury compared with non-COVID ARDS.
The adverse prognosis associated with myocardial injury in COVID-19 is driven largely by multisystem organ involvement.
This abstract is available on the publisher's site.
Knowledge gaps remain in the epidemiology and clinical implications of myocardial injury in COVID-19. Our goal was to determine the prevalence and outcomes of myocardial injury in severe COVID-19 compared to acute respiratory distress syndrome (ARDS) unrelated to COVID-19.
We included intubated COVID-19 patients from 5 hospitals between March 15 and June 11, 2020 with troponin levels assessed. We compared them to patients from a cohort study of myocardial injury in ARDS. We performed survival analysis with primary outcome of in-hospital death associated with myocardial injury. We performed linear regression to identify clinical factors associated with myocardial injury in COVID-19.
Of 243 patients intubated with COVID-19, 51% had troponin levels > upper limit of normal (ULN). Chronic kidney disease, lactate, ferritin and fibrinogen were associated with myocardial injury. Mortality was 22.7% among COVID-19 patients with troponin < ULN and 61.5% for those with troponin levels > 10xULN (P< 0.001). The association of myocardial injury with mortality was not statistically significant after adjusting for age, sex and multi-system organ dysfunction. Compared to non-COVID ARDS patients, patients with COVID-19 were older with higher creatinine and less favorable vital signs. After adjustment, COVID-19 was associated with lower odds of myocardial injury compared to non-COVID ARDS (OR 0.55 95% CI 0.36-0.84, P=0.005).
Myocardial injury in severe COVID-19 is a function of baseline comorbidities, advanced age and multisystem organ dysfunction similar to traditional ARDS. The adverse prognosis of myocardial injury in COVID-19 relates largely to multisystem organ involvement and critical illness.