Incidence and determinants of high-sensitivity troponin and natriuretic peptides elevation at admission in hospitalized COVID-19 pneumonia patients.
COVID-19
D-dimer
Hs-troponin
Natriuretic peptide
PaO2/FIO2
Journal
Internal and emergency medicine
ISSN: 1970-9366
Titre abrégé: Intern Emerg Med
Pays: Italy
ID NLM: 101263418
Informations de publication
Date de publication:
Nov 2020
Nov 2020
Historique:
received:
25
06
2020
accepted:
05
09
2020
pubmed:
29
9
2020
medline:
25
11
2020
entrez:
28
9
2020
Statut:
ppublish
Résumé
Myocardial involvement in the course of coronavirus disease 2019 (COVID-19) pneumonia has been reported, though not fully characterized yet. The aim of the present study is to undertake a joint evaluation of hs-Troponin and natriuretic peptides (NP) in patients hospitalized for COVID-19 pneumonia. In this multicenter observational study, we analyzed data from n = 111 patients. Cardiac biomarkers subgroups were identified according to values beyond reference range. Increased hs-Troponin and NP were found in 38 and 56% of the cases, respectively. As compared to those with normal cardiac biomarkers, these patients were older, had higher prevalence of cardiovascular diseases (CVD) and had more severe COVID-19 pneumonia by higher CRP and D-dimer and lower PaO2/FIO2. Two-dimensional echocardiography performed in a subset of patients (n = 24) showed significantly reduced left ventricular ejection fraction in patients with elevated NP (p = 0.02), whereas right ventricular systolic function (tricuspid annular plane systolic excursion) was significantly reduced both in patients with high hs-Troponin and NP (p = 0.022 and p = 0.03, respectively). Both hs-Troponin and NP were higher in patients with in-hospital mortality (p = 0.001 and p = 0.002, respectively). On multivariable analysis, independent associations were found of hs-Troponin with age, PaO2/FIO2 and D-dimer (B = 0.419, p = 0.001; B = - 0.212, p = 0.013; and B = 0.179, p = 0.037, respectively) and of NP with age and previous CVD (B = 0.480, p < 0.001; and B = 0.253, p = 0.001, respectively). Myocardial involvement at admission is common in COVID-19 pneumonia. Independent associations of hs-Troponin with markers of disease severity and of NP with underlying CVD might point toward existing different mechanisms leading to their elevation in this setting.
Sections du résumé
BACKGROUND
BACKGROUND
Myocardial involvement in the course of coronavirus disease 2019 (COVID-19) pneumonia has been reported, though not fully characterized yet. The aim of the present study is to undertake a joint evaluation of hs-Troponin and natriuretic peptides (NP) in patients hospitalized for COVID-19 pneumonia.
METHODS
METHODS
In this multicenter observational study, we analyzed data from n = 111 patients. Cardiac biomarkers subgroups were identified according to values beyond reference range.
RESULTS
RESULTS
Increased hs-Troponin and NP were found in 38 and 56% of the cases, respectively. As compared to those with normal cardiac biomarkers, these patients were older, had higher prevalence of cardiovascular diseases (CVD) and had more severe COVID-19 pneumonia by higher CRP and D-dimer and lower PaO2/FIO2. Two-dimensional echocardiography performed in a subset of patients (n = 24) showed significantly reduced left ventricular ejection fraction in patients with elevated NP (p = 0.02), whereas right ventricular systolic function (tricuspid annular plane systolic excursion) was significantly reduced both in patients with high hs-Troponin and NP (p = 0.022 and p = 0.03, respectively). Both hs-Troponin and NP were higher in patients with in-hospital mortality (p = 0.001 and p = 0.002, respectively). On multivariable analysis, independent associations were found of hs-Troponin with age, PaO2/FIO2 and D-dimer (B = 0.419, p = 0.001; B = - 0.212, p = 0.013; and B = 0.179, p = 0.037, respectively) and of NP with age and previous CVD (B = 0.480, p < 0.001; and B = 0.253, p = 0.001, respectively).
CONCLUSIONS
CONCLUSIONS
Myocardial involvement at admission is common in COVID-19 pneumonia. Independent associations of hs-Troponin with markers of disease severity and of NP with underlying CVD might point toward existing different mechanisms leading to their elevation in this setting.
Identifiants
pubmed: 32986136
doi: 10.1007/s11739-020-02498-7
pii: 10.1007/s11739-020-02498-7
pmc: PMC7520380
doi:
Substances chimiques
Biomarkers
0
Natriuretic Peptides
0
Troponin
0
Types de publication
Journal Article
Multicenter Study
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1467-1476Références
Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, Zhao X, Huang B, Shi W, Lu R, Niu P, Zhan F, Ma X, Wang D, Xu W, Wu G, Gao GF, Tan W (2020) A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med 382:727–733. https://doi.org/10.1056/NEJMoa2001017
doi: 10.1056/NEJMoa2001017
Pennica A, Conforti G, Falangone F, Martocchia A, Tafaro L, Sentimentale A, Marini V, Pezzuto A, Spuntarelli V, Martelletti P (2020) Clinical management of adult coronavirus infection disease 2019 (COVID-19) positive in the setting of low and medium intensity of care: a short practical review. SN Compr Clin Med. https://doi.org/10.1007/s42399-020-00333-w
doi: 10.1007/s42399-020-00333-w
Baraboutis IG, Gargalianos P, Aggelonidou E, Adraktas A (2020) Initial real-life experience from a designated COVID-19 centre in Athens, Greece: a proposed therapeutic algorithm. SN Compr Clin Med. https://doi.org/10.1007/s42399-020-00324-x
doi: 10.1007/s42399-020-00324-x
Cogliati C, Ceriani E, Brambilla AM (2020) When internal and emergency medicine speak to each other: organization in the time of COVID. Intern Emerg Med 15:891–892
doi: 10.1007/s11739-020-02380-6
Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, Ren R, Leung KSM, Lau EHY, Wong JY, Xing X, Xiang N, Wu Y, Li C, Chen Q, Li D, Liu T, Zhao J, Liu M, Tu W, Chen C, Jin L, Yang R, Wang Q, Zhou S, Wang R, Liu H, Luo Y, Liu Y, Shao G, Li H, Tao Z, Yang Y, Deng Z, Liu B, Ma Z, Zhang Y, Shi G, Lam TTY, Wu JT, Gao GF, Cowling BJ, Yang B, Leung GM, Feng Z (2020) Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med 382:1199–1207. https://doi.org/10.1056/NEJMoa2001316
doi: 10.1056/NEJMoa2001316
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, Zhang L, Fan G, Xu J, Gu X, Cheng Z, Yu T, Xia J, Wei Y, Wu W, Xie X, Yin W, Li H, Liu M, Xiao Y, Gao H, Guo L, Xie J, Wang G, Jiang R, Gao Z, Jin Q, Wang J, Cao B (2020) Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 395:497–506. https://doi.org/10.1016/S0140-6736(20)30183-5
doi: 10.1016/S0140-6736(20)30183-5
Fogarty H, Townsend L, Ni Cheallaigh C, Bergin C, Martin-Loeches I, Browne P, Bacon CL, Gaule R, Gillett A, Byrne M, Ryan K, O’Connell N, O’Sullivan JM, Conlon N, O’Donnell JS (2020) COVID19 coagulopathy in Caucasian patients. Br J Haematol. https://doi.org/10.1111/bjh.16749
doi: 10.1111/bjh.16749
Landi A, De Servi S (2020) The burden of thrombotic complications in critically ill patients with COVID-19: charting the uncharted. Intern Emerg Med 15:893–895
doi: 10.1007/s11739-020-02393-1
Zhang L, Yan X, Fan Q, Liu H, Liu X, Liu Z, Zhang Z (2020) D-dimer levels on admission to predict in-hospital mortality in patients with Covid-19. J Thromb Haemost. https://doi.org/10.1111/jth.14859
doi: 10.1111/jth.14859
Guo T, Fan Y, Chen M, Wu X, Zhang L, He T, Wang H, Wan J, Wang X, Lu Z (2020) Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19). JAMA Cardiol. https://doi.org/10.1001/jamacardio.2020.1017
doi: 10.1001/jamacardio.2020.1017
Shi S, Qin M, Shen B, Cai Y, Liu T, Yang F, Gong W, Liu X, Liang J, Zhao Q, Huang H, Yang B, Huang C (2020) Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China. JAMA Cardiol. https://doi.org/10.1001/jamacardio.2020.0950
doi: 10.1001/jamacardio.2020.0950
Inciardi RM, Adamo M, Lupi L, Cani DS, Di Pasquale M, Tomasoni D, Italia L, Zaccone G, Tedino C, Fabbricatore D, Curnis A, Faggiano P, Gorga E, Lombardi CM, Milesi G, Vizzardi E, Volpini M, Nodari S, Specchia C, Maroldi R, Bezzi M, Metra M (2020) Characteristics and outcomes of patients hospitalized for COVID-19 and cardiac disease in Northern Italy. Eur Heart J. 41(19):1821–1829. https://doi.org/10.1093/eurheartj/ehaa388
doi: 10.1093/eurheartj/ehaa388
Gao L, Jiang D, Wen XS, Cheng XC, Sun M, He B, You LN, Lei P, Tan XW, Qin S, Cai GQ, Zhang DY (2020) Prognostic value of NT-proBNP in patients with severe COVID-19. Respir Res. https://doi.org/10.1186/s12931-020-01352-w
doi: 10.1186/s12931-020-01352-w
Rath D, Petersen-Uribe Á, Avdiu A, Witzel K, Jaeger P, Zdanyte M, Heinzmann D, Tavlaki E, Müller K, Gawaz MP (2020) Impaired cardiac function is associated with mortality in patients with acute COVID-19 infection. Clin Res Cardiol. https://doi.org/10.1007/s00392-020-01683-0
doi: 10.1007/s00392-020-01683-0
Karbalai Saleh S, Oraii A, Soleimani A, Hadadi A, Shajari Z, Montazeri M, Moradi H, Talebpour M, Sadat Naseri A, Balali P, Akhbari M, Ashraf H (2020) The association between cardiac injury and outcomes in hospitalized patients with COVID-19. Intern Emerg Med. https://doi.org/10.1007/s11739-020-02466-1
doi: 10.1007/s11739-020-02466-1
Libby P (2020) The heart in COVID19: primary target or secondary bystander? JACC Basic to Transl Sci. https://doi.org/10.1016/j.jacbts.2020.04.001
doi: 10.1016/j.jacbts.2020.04.001
Tersalvi G, Vicenzi M, Calabretta D, Biasco L, Pedrazzini G, Winterton D (2020) Elevated troponin in patients with Coronavirus Disease 2019 (COVID-19): possible mechanisms. J Card Fail. https://doi.org/10.1016/j.cardfail.2020.04.009
doi: 10.1016/j.cardfail.2020.04.009
Tomasoni D, Italia L, Adamo M, Inciardi RM, Lombardi CM, Solomon SD, Metra M (2020) <scp>COVID</scp> 19 and heart failure: from infection to inflammation and angiotensin <scp>II</scp> stimulation. Searching for evidence from a new disease. Eur J Heart Fail. https://doi.org/10.1002/ejhf.1871
doi: 10.1002/ejhf.1871
Puntmann VO, Carerj ML, Wieters I, Fahim M, Arendt C, Hoffmann J, Shchendrygina A, Escher F, Vasa-Nicotera M, Zeiher AM, Vehreschild M, Nagel E (2020) Outcomes of cardiovascular magnetic resonance imaging in patients recently recovered from coronavirus disease 2019 (COVID-19). JAMA Cardiol. https://doi.org/10.1001/jamacardio.2020.3557
doi: 10.1001/jamacardio.2020.3557
Skulstad H, Cosyns B, Popescu BA, Galderisi M, Di Salvo G, Donal E, Petersen S, Gimelli A, Haugaa KH, Muraru D, Almeida AG, Schulz-Menger J, Dweck MR, Pontone G, Sade LE, Gerber B, Maurovich-Horvat P, Bharucha T, Cameli M, Magne J, Westwood M, Maurer G, Edvardsen T (2020) COVID-19 pandemic and cardiac imaging: EACVI recommendations on precautions, indications, prioritization, and protection for patients and healthcare personnel. Eur Heart J Cardiovasc Imaging. 21(6):592–598. https://doi.org/10.1093/ehjci/jeaa072
doi: 10.1093/ehjci/jeaa072
Favaloro E, Thachil J (2020) Reporting of D-dimer data in COVID-19: some confusion and potential for misinformation. Clin Chem Lab Med. https://doi.org/10.1515/CCLM-2020-0573
doi: 10.1515/CCLM-2020-0573
Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola V-P, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P, ESC Scientific Document Group (2016) 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 37:2129–2200. https://doi.org/10.1093/eurheartj/ehw128
doi: 10.1093/eurheartj/ehw128
Blackshear JL, Safford RE, Thomas CS, Bos JM, Ackerman MJ, Geske JB, Ommen SR, Shapiro BP, Johns GS (2018) Platelet function analyzer 100 and brain natriuretic peptide as biomarkers in obstructive hypertrophic cardiomyopathy. Am J Cardiol 121:768–774. https://doi.org/10.1016/j.amjcard.2017.12.009
doi: 10.1016/j.amjcard.2017.12.009
Liu F, Li L, Da XuM, Wu J, Luo D, Zhu YS, Li BX, Song XY, Zhou X (2020) Prognostic value of interleukin-6, C-reactive protein, and procalcitonin in patients with COVID-19. J Clin Virol 127:104370. https://doi.org/10.1016/j.jcv.2020.104370
doi: 10.1016/j.jcv.2020.104370
Deng Q, Hu B, Zhang Y, Wang H, Zhou X, Hu W, Cheng Y, Yan J, Ping H, Zhou Q (2020) Suspected myocardial injury in patients with COVID-19: evidence from front-line clinical observation in Wuhan, China. Int J Cardiol. https://doi.org/10.1016/j.ijcard.2020.03.087
doi: 10.1016/j.ijcard.2020.03.087
https://www.epicentro.iss.it/coronavirus/bollettino/Bollettino-sorveglianza-integrata-COVID-19_7-maggio-2020.pdf (last accessed on June 1
Wang Y, Zhang D, Du G, Du R, Zhao J, Jin Y, Fu S, Gao L, Cheng Z, Lu Q, Hu Y, Luo G, Wang K, Lu Y, Li H, Wang S, Ruan S, Yang C, Mei C, Wang Y, Ding D, Wu F, Tang X, Ye X, Ye Y, Liu B, Yang J, Yin W, Wang A, Fan G, Zhou F, Liu Z, Gu X, Xu J, Shang L, Zhang Y, Cao L, Guo T, Wan Y, Qin H, Jiang Y, Jaki T, Hayden FG, Horby PW, Cao B, Wang C (2020) Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial. Lancet 395:1569–1578. https://doi.org/10.1016/S0140-6736(20)31022-9
doi: 10.1016/S0140-6736(20)31022-9
Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, Camporota L, Slutsky AS (2012) Acute respiratory distress syndrome: the Berlin definition. JAMA 307:2526–2533. https://doi.org/10.1001/jama.2012.5669
doi: 10.1001/jama.2012.5669
Christie DB, Nemec HM, Scott AM, Buchanan JT, Franklin CM, Ahmed A, Khan MS, Callender CW, James EA, Christie AB, Ashley DW (2020) Early outcomes with utilization of tissue plasminogen activator in COVID-19 associated respiratory distress: a series of five cases. J Trauma Acute Care Surg. https://doi.org/10.1097/TA.0000000000002787
doi: 10.1097/TA.0000000000002787
Gattinoni L, Vassalli F, Romitti F (2018) Benefits and risks of the P/F approach. Intensive Care Med 44:2245–2247
doi: 10.1007/s00134-018-5413-4
Leonard-Lorant I, Delabranche X, Severac F, Helms J, Pauzet C, Collange O, Schneider F, Labani A, Bilbault P, Moliere S, Leyendecker P, Roy C, Ohana M (2020) Acute pulmonary embolism in COVID-19 patients on CT angiography and relationship to D-Dimer levels. Radiology. https://doi.org/10.1148/radiol.2020201561
doi: 10.1148/radiol.2020201561
Kang Y, Chen T, Mui D, Ferrari V, Jagasia D, Scherrer-Crosbie M, Chen Y, Han Y (2020) Cardiovascular manifestations and treatment considerations in covid-19. Heart. https://doi.org/10.1136/heartjnl-2020-317056
doi: 10.1136/heartjnl-2020-317056
Coccheri S (2020) COVID-19: the crucial role of blood coagulation and fibrinolysis. Intern Emerg Med. https://doi.org/10.1007/s11739-020-02443-8
doi: 10.1007/s11739-020-02443-8
Varga Z, Flammer AJ, Steiger P, Haberecker M, Andermatt R, Zinkernagel AS, Mehra MR, Schuepbach RA, Ruschitzka F, Moch H (2020) Endothelial cell infection and endotheliitis in COVID-19. Lancet 395:1417–1418
doi: 10.1016/S0140-6736(20)30937-5
Boral BM, Williams DJ, Boral LI (2016) Disseminated intravascular coagulation. Am J Clin Pathol 146:670–680. https://doi.org/10.1093/ajcp/aqw195
doi: 10.1093/ajcp/aqw195
Hendren NS, Drazner MH, Bozkurt B, Cooper LT Jr (2020) Description and Proposed Management of the Acute COVID-19 Cardiovascular Syndrome. Circulation. 141(23):1903–1914. https://doi.org/10.1161/CIRCULATIONAHA.120.047349
doi: 10.1161/CIRCULATIONAHA.120.047349
Hanley B, Naresh KN, Roufosse C, Nicholson AG, Weir J, Cooke GS, Thursz M, Manousou P, Corbett R, Goldin R, Al-Sarraj S, Abdolrasouli A, Swann OC, Baillon L, Penn R, Barclay WS, Viola P, Osborn M (2020) Histopathological findings and viral tropism in UK patients with severe fatal COVID-19: a post-mortem study. Lancet Microbe. https://doi.org/10.1016/S2666-5247(20)30115-4
doi: 10.1016/S2666-5247(20)30115-4
Grein J, Ohmagari N, Shin D, Diaz G, Asperges E, Castagna A, Feldt T, Green G, Green ML, Lescure F-X, Nicastri E, Oda R, Yo K, Quiros-Roldan E, Studemeister A, Redinski J, Ahmed S, Bernett J, Chelliah D, Chen D, Chihara S, Cohen SH, Cunningham J, D’Arminio Monforte A, Ismail S, Kato H, Lapadula G, L’Her E, Maeno T, Majumder S, Massari M, Mora-Rillo M, Mutoh Y, Nguyen D, Verweij E, Zoufaly A, Osinusi AO, DeZure A, Zhao Y, Zhong L, Chokkalingam A, Elboudwarej E, Telep L, Timbs L, Henne I, Sellers S, Cao H, Tan SK, Winterbourne L, Desai P, Mera R, Gaggar A, Myers RP, Brainard DM, Childs R, Flanigan T (2020) Compassionate use of Remdesivir for patients with severe Covid-19. N Engl J Med. https://doi.org/10.1056/nejmoa2007016
doi: 10.1056/nejmoa2007016
Panati K, Narala VR (2020) COVID-19 outbreak: an update on therapeutic options. SN Compr Clin Med 2:379–380. https://doi.org/10.1007/s42399-020-00264-6
doi: 10.1007/s42399-020-00264-6
Gattinoni L, Chiumello D, Caironi P, Busana M, Romitti F, Brazzi L, Camporota L (2020) COVID-19 pneumonia: different respiratory treatment for different phenotypes ? Intensive Care Med. https://doi.org/10.1007/s00134-020-06033-2
doi: 10.1007/s00134-020-06033-2
Tang N, Bai H, Chen X, Gong J, Li D, Sun Z (2020) Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost 18:1094–1099. https://doi.org/10.1111/jth.14817
doi: 10.1111/jth.14817
Kim L, Garg S, O’Halloran A, Whitaker M, Pham H, Anderson EJ, Armistead I, Bennett NM, Billing L, Como-Sabetti K, Hill M, Kim S, Monroe ML, Muse A, Reingold AL, Schaffner W, Sutton M, Talbot HK, Torres SM, Yousey-Hindes K, Holstein R, Cummings C, Brammer L, Hall AJ, Fry AM, Langley GE (2020) Risk factors for intensive care unit admission and in-hospital mortality among hospitalized adults identified through the U.S. coronavirus disease 2019 (COVID-19)-associated hospitalization surveillance network (COVID-NET). Clin Infect Dis. https://doi.org/10.1093/cid/ciaa1012
doi: 10.1093/cid/ciaa1012
Szekely Y, Lichter Y, Taieb P, Banai A, Hochstadt A, Merdler I, Gal Oz A, Rothschild E, Baruch G, Peri Y, Arbel Y, Topilsky Y (2020) The spectrum of cardiac manifestations in coronavirus disease 2019 (COVID-19)—a systematic echocardiographic study. Circulation. https://doi.org/10.1161/CIRCULATIONAHA.120.047971
doi: 10.1161/CIRCULATIONAHA.120.047971