Biomarkers Predict In-Hospital Major Adverse Cardiac Events in COVID-19 Patients: A Multicenter International Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Study Outcomes
2.3. Statistical Analysis
3. Results
3.1. Follow-Up
3.2. Clinical and Biohumoral Characteristics
3.3. Biomarkers Associated with In-Hospital Cardiovascular Events
4. Discussion
4.1. Renal Disease in COVID-19
4.2. The Use of Cardiac Troponin in COVID-19
4.3. Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A
Luton Hospital, United Kingdom | 213 patients |
San Donato Hospital, Milan, Italy | 200 patients |
Guglielmo da Saliceto Hospital, Piacenza, Italy | 78 patients |
San Giovanni di Dio e Ruggi d’Aragona University Hospital, Salerno, Italy | 73 patients |
Santa Maria alle Scotte University Hospital, Siena, Italy | 71 patients |
S.Elia Hospital, Caltanissetta, Italy | 27 patients |
Westmead Hospital, Sydney, Australia | 25 patients |
Karolinska Institute, Stockholm, Sweden | 21 patients |
Federico II University Hospital, Naples Italy | 20 patients |
Hospital Universitari Vall d’Hebron, Barcelona, Spain | 20 patients |
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Whole Population (n = 748) | No CV Events (n = 607) | CV Events (n = 141) | p-Value | |
---|---|---|---|---|
Baseline Features | ||||
Age (years) | 67 ± 16 | 65 ± 17 | 72 ± 15 | 0.008 |
Sex (female) | 274 (37) | 226 (37) | 48 (34) | 0.604 |
Hypertension n, (%) | 402 (54) | 312 (50) | 90 (64) | 0.008 |
Diabetes | 198 (26) | 155 (24) | 43 (30) | 0.187 |
Dyslipidemia | 155 (20) | 124 (19) | 31 (21) | 0.704 |
Renal failure | 243 (30) | 184 (28) | 59 (39) | 0.024 |
Chronic obstructive pulmonary disease | 105 (13) | 77 (11) | 28 (19) | 0.013 |
History of AF | 81 (11) | 57 (9) | 24 (17) | 0.013 |
Systolic blood pressure (mmHg) | 127 ± 22 | 127 ± 21 | 128 ± 22 | 0.385 |
Heart rate (bpm) | 87 ± 18 | 87 ± 17 | 128 ± 22 | 0.849 |
Temperature (°C) | 37.4 ± 1.0 | 37.4 ± 1.0 | 37.6 ± 1.1 | 0.042 |
Saturation (%) | 84 ± 29 | 84 ± 29 | 84 ± 28 | 0.942 |
Length of follow up (days) | 18 ± 17 | 18 ± 16 | 21 ± 20 | 0.041 |
Laboratory findings | ||||
Hemoglobin (g/dL) | 13.0 ± 2.1 | 13.0 ± 2.1 | 13.0 ± 2.3 | 0.133 |
White blood cells (cells/mmc) | 1234 ± 3286 | 1085 ± 2837 | 1990 ± 4934 | <0.001 |
Platelets (cells/mmc) | 228408 ± 102893 | 226385 ± 98926 | 239968 ± 123121 | 0.007 |
C reactive protein (mg/dL) | 15.10 (5.60–53.50) | 16.00 (6.02–56.00) | 11.84 (4.75–38.83) | 0.713 |
Serum creatinine (mg/dL) | 1.16 ± 0.91 | 1.14 ± 0.93 | 2 ± 0.83 | <0.001 |
Sodium (mEq/L) | 138 ± 6 | 138 ± 5 | 138 ± 7 | 0.24 |
Potassium (mEq/L) | 4.1 ± 0.5 | 4.1 ± 0.5 | 4.0 ± 0.1 | 0.146 |
Troponin (ng/L) | 16 (7–40) | 12 (6–29) | 31 (17–94) | <0.001 |
ALT (IU/L) | 35 ± 34 | 37 ± 35 | 30 ± 23 | 0.225 |
Electrocardiographic findings | ||||
Supraventricular arrhythmias | 91 (12) | 69 (11) | 22 (16) | 0.214 |
Therapy | ||||
ACE inhibitors/ARB | 252 (34) | 192 (32) | 60 (42) | 0.046 |
Beta blockers | 153 (21) | 122 (20) | 31 (22) | 0.701 |
MRA | 24 (3) | 21 (4) | 3 (2) | 0.587 |
CCB | 110 (15) | 84 (14) | 26 (18) | 0.208 |
Diuretics | 115 (15) | 80 (13) | 25 (18) | 0.001 |
Antiarrhythmics | 48 (6) | 39 (7) | 9 (6) | 0.418 |
Antiplatelet drugs | 110 (15) | 84 (14) | 26 (18) | 0.208 |
Anticoagulants | 71 (10) | 47 (8) | 24 (17) | 0.001 |
Corticosteroids | 67 (9) | 51 (8) | 16 (11) | 0.427 |
Unadjusted HR (CI (95%)) | Unadjusted p-Value | Adjusted HR (CI (95%)) | Adjusted p-Value | |
---|---|---|---|---|
Age | 1.025 [1.012–1.038] | <0.001 | 0.991 [0.968–1.016] | 0.481 |
Renal failure | 1.605 [1.407–1.890] | 0.013 | 1.314 [1.139–1.706] | 0.005 |
Chronic obstructive disease | 0.628 [0.401–0.982] | 0.041 | 0.746 [0.275–2.021] | 0.621 |
Oxygen saturation | 0.992 [0.985–0.999] | 0.027 | 0.998 [0.976–1.021] | 0.805 |
History of AF | 0.579 [0.371–0.902] | 0.016 | 4.737 [0.314–7.134] | 0.311 |
Troponin | 1.607 [1.346–1.918] | <0.001 | 1.396 [1.122–1.737] | 0.003 |
Diuretics | 0.55 [0.372–0.813] | 0.003 | 0.523 [0.194–1.413] | 0.201 |
Anticoagulants | 0.490 [0.314–0.764] | 0.002 | 0.489 [0.031–7.741] | 0.611 |
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Henein, M.Y.; Mandoli, G.E.; Pastore, M.C.; Ghionzoli, N.; Hasson, F.; Nisar, M.K.; Islam, M.; Bandera, F.; Marrocco-Trischitta, M.M.; Baroni, I.; Malagoli, A.; Rossi, L.; Biagi, A.; Citro, R.; Ciccarelli, M.; Silverio, A.; Biagioni, G.; Moutiris, J.A.; Vancheri, F.; Mazzola, G.; Geraci, G.; Thomas, L.; Altman, M.; Pernow, J.; Ahmed, M.; Santoro, C.; Esposito, R.; Casas, G.; Fernández-Galera, R.; Gonzalez, M.; Rodriguez Palomares, J.; Bytyçi, I.; Dini, F.L.; Cameli, P.; Franchi, F.; Bajraktari, G.; Badano, L.P.; Cameli, M. Biomarkers Predict In-Hospital Major Adverse Cardiac Events in COVID-19 Patients: A Multicenter International Study. J. Clin. Med. 2021, 10, 5863. https://doi.org/10.3390/jcm10245863
Henein MY, Mandoli GE, Pastore MC, Ghionzoli N, Hasson F, Nisar MK, Islam M, Bandera F, Marrocco-Trischitta MM, Baroni I, Malagoli A, Rossi L, Biagi A, Citro R, Ciccarelli M, Silverio A, Biagioni G, Moutiris JA, Vancheri F, Mazzola G, Geraci G, Thomas L, Altman M, Pernow J, Ahmed M, Santoro C, Esposito R, Casas G, Fernández-Galera R, Gonzalez M, Rodriguez Palomares J, Bytyçi I, Dini FL, Cameli P, Franchi F, Bajraktari G, Badano LP, Cameli M. Biomarkers Predict In-Hospital Major Adverse Cardiac Events in COVID-19 Patients: A Multicenter International Study. Journal of Clinical Medicine. 2021; 10(24):5863. https://doi.org/10.3390/jcm10245863
Chicago/Turabian StyleHenein, Michael Y., Giulia Elena Mandoli, Maria Concetta Pastore, Nicolò Ghionzoli, Fouhad Hasson, Muhammad K. Nisar, Mohammed Islam, Francesco Bandera, Massimiliano M. Marrocco-Trischitta, Irene Baroni, Alessandro Malagoli, Luca Rossi, Andrea Biagi, Rodolfo Citro, Michele Ciccarelli, Angelo Silverio, Giulia Biagioni, Joseph A. Moutiris, Federico Vancheri, Giovanni Mazzola, Giulio Geraci, Liza Thomas, Mikhail Altman, John Pernow, Mona Ahmed, Ciro Santoro, Roberta Esposito, Guillem Casas, Rubén Fernández-Galera, Maribel Gonzalez, Jose Rodriguez Palomares, Ibadete Bytyçi, Frank Lloyd Dini, Paolo Cameli, Federico Franchi, Gani Bajraktari, Luigi Paolo Badano, and Matteo Cameli. 2021. "Biomarkers Predict In-Hospital Major Adverse Cardiac Events in COVID-19 Patients: A Multicenter International Study" Journal of Clinical Medicine 10, no. 24: 5863. https://doi.org/10.3390/jcm10245863