Journal Article

Cardiac involvement at presentation in patients hospitalized with COVID-19 and their outcome in a tertiary referral hospital in Northern Italy

Ferlini, Marco, Baldi Enrico, Parodi Alessandro, Bracchi Federico, Bonzano Marco, D’Amore Sabato, Di Sabatino Antonio, Klersy Catherine, Albertini Riccardo, Borrelli de Andreis Federica, Tavazzi Guido, Salinaro Francesco, Seminari Elena Maria, Pioli Di Marco Maria Serena, Greco, Alessandra, Pettenazza Pietro, Visconti, Luigi Oltrona, Sturniolo Giulia, Alfano, Claudia, Briganti Federica, Crescenzi Giuseppe, Moschella Martina, Pellegrino, Ivan, Jeva Francesco, Vicentini Alessandro, Falchi, Anna iulia, Moioli Francesco, Accordino Giulia, Lenti, Marco Vincenzo, Santacroce Giovanni, Perlini Stefano, Digiacomo Simonluca, Speciale, Francesco, Gnecchi Massimiliano, Foglia Davide, Guarnone Roberta, Quaglia Federica, Burattini Cecilia, Martino, Ilaria Francesca, Zuccaro Valentina, Zunino Ilaria, Acquaro Mauro, Sabena Anna, Scelsi, Laura, Totaro Rossana, Guglielmana, Barbara, Soriano, Simone, Magrini Giulia, Lago, Elena, Ghio Stefano, Masiello Lucrezia, Oltrona Visconti Luigi, Pezza, Laura, Montalto, Claudio, Corsico Angelo, Maggi, Elena, Valentino, Dammassi, Piloni Davide, Coccia Michela, Di, Matteo Angela, Bruno

2020

Overview

The correlation between myocardial injury and clinical outcome in COVID-19 patients is gaining attention in the literature. The aim of the present study was to evaluate the role of cardiac involvement and of respiratory failure in a cohort of COVID-19 patients hospitalized in an academic hospital in Lombardy, one of the most affected Italian (and worldwide) regions by the epidemic. The study included 405 consecutive patients with confirmed COVID-19 admitted to a medical ward from February 25th to March 31st, 2020. Follow-up of surviving patients ended either at hospital discharge or by July 30th, 2020. Myocardial injury was defined on the basis of the presence of blood levels of hs-TnI above the 99th percentile upper reference limit. Respiratory function was assessed as PaO2/FiO2 (P/F) ratio. The primary end-point was death for any cause. During hospitalization, 124 patients died. Death rate increased from 7.9% in patients with normal hs-TnI plasma levels and no cardiac comorbidity to 61.5% in patients with elevated hs-TnI and cardiac involvement (p < 0.001). At multivariable analysis, older age, P/F ratio < 200 (both p < 0.001) and hs-TnI plasma levels were independent predictors of death. However, it must be emphasized that the median values of hs-TnI were within normal range in non-survivors. Cardiac involvement at presentation was associated with poor prognosis in COVID-19 patients, but, even in a population of COVID-19 patients who did not require invasive ventilation at hospital admission, mortality was mainly driven by older age and respiratory failure.

• Publisher: Springer Nature B.V
• Subject: Blood levels / Coronaviruses / COVID-19 / Death / Heart / Mechanical ventilation / Medical prognosis / Patients / Plasma levels / Respiratory failure / Respiratory function