Association of Troponin Levels With Mortality in Italian Patients Hospitalized With Coronavirus Disease 2019 Results of a Multicenter Study
Association of Troponin Levels With Mortality in Italian Patients Hospitalized With Coronavirus Disease 2019 Results of a Multicenter Study
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DOI：
10.1001/jamacardio.2020.3538
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发表时间：
2020-11-01
期刊：
影响因子：
24
通讯作者：
Senni, Michele
中科院分区：
文献类型：
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作者：
Lombardi, Carlo Mario;Carubelli, Valentina;Senni, Michele
通过血浆肌钙蛋白水平升高检测到的心肌损伤与2019冠状病毒病（COVID-19）住院患者的死亡率相关。然而，初始数据来自中国人群的单中心或双中心研究。与这些患者相比，欧洲和美国的患者年龄较大，合并症较多，死亡率较高。目的：在大量患有COVID-19的意大利白色患者中，通过血浆肌钙蛋白水平升高检测心肌损伤的患病率和预后价值。这项横断面研究招募了2020年3月1日至4月9日在13个意大利心脏病单位住院的实验室确诊的COVID-19连续患者。排除因急性冠脉综合征入院的患者。肌钙蛋白水平升高定义为高于正常值的第99百分位数。主要结局和指标临床特征和结局分层为入院时心肌肌钙蛋白水平升高或正常，定义为肌钙蛋白T或肌钙蛋白I水平高于正常值的第99百分位数。结果本研究共纳入614例COVID-19患者（平均年龄[SD]，67 [13]岁; 70.8%为男性），其中148例患者（24.1%）在住院期间死亡。278例患者（45.3%）肌钙蛋白水平升高。这些患者年龄较大，（平均[SD]年龄，64.0 [13.6]岁vs 71.3 [12.0]岁; P < .001），高血压患病率较高（168例患者[50.5%] vs 182例患者[65.9%]; P < .001），心力衰竭（24 [7.2%]; 63 [22.8%]; P <0.001）、冠状动脉疾病（50 [15.0%] vs 87 [31.5%]; P <0.001）和房颤（33 [9.9%] vs 67 [24.3%]; P <0.001）。肌钙蛋白水平升高与院内死亡率增加相关（37% vs 13%; HR，1.71 [95% CI，1.13-2.59];通过多变量考克斯回归分析P = 0.01），这与合并心脏病无关。肌钙蛋白水平升高也与院内并发症的风险增加相关：心力衰竭（44例患者[19.2%] vs 7例患者[2.9%]; P < .001），脓毒症（31例[11.7%] vs 21例[6.4%]; P = .03），急性肾衰竭（41例[20.8%] vs 13例[6.2%]; P < .001），多器官衰竭（21例[10.9%] vs 6例[2.9%]; P = .003），肺栓塞（27例[9.9%] vs 17例[5.2%]; P = .04），谵妄（13例[6.8%] vs 3例[1.5%]; P =.02）和大出血（16例[7.0%] vs 4例[1.6%];结论和相关性在这项针对意大利COVID-19患者的多中心横断面研究中，肌钙蛋白升高是与住院期间死亡率以及因COVID-19住院期间心血管和非心血管并发症风险增加相关的独立变量。
IMPORTANCE Myocardial injury, detected by elevated plasma troponin levels, has been associated with mortality in patients hospitalized with coronavirus disease 2019 (COVID-19). However, the initial data were reported from single-center or 2-center studies in Chinese populations. Compared with these patients, European and US patients are older, with more comorbidities and higher mortality rates.OBJECTIVE To evaluate the prevalence and prognostic value of myocardial injury, detected by elevated plasma troponin levels, in a large population of White Italian patients with COVID-19.DESIGN, SETTING, AND PARTICIPANTS This is a multicenter, cross-sectional study enrolling consecutive patients with laboratory-confirmed COVID-19 who were hospitalized in 13 Italian cardiology units from March 1 to April 9, 2020. Patients admitted for acute coronary syndrome were excluded. Elevated troponin levels were defined as values greater than the 99th percentile of normal values.MAIN OUTCOMES AND MEASURES Clinical characteristics and outcomes stratified as elevated or normal cardiac troponin levels at admission, defined as troponin T or troponin I at a level greater than the 99th percentile of normal values.RESULTS A total of 614 patients with COVID-19 were included in this study (mean age [SD], 67 [13] years; 70.8% male), of whom 148 patients (24.1%) died during the hospitalization. Elevated troponin levels were found in 278 patients (45.3%). These patients were older (mean [SD] age, 64.0 [13.6] years vs 71.3 [12.0] years; P < .001) and had higher prevalence of hypertension (168 patients [50.5%] vs 182 patients [65.9%]; P < .001), heart failure (24 [7.2%]; 63 [22.8%]; P < .001), coronary artery disease (50 [15.0%] vs 87 [31.5%]; P < .001), and atrial fibrillation (33 [9.9%] vs 67 [24.3%]; P < .001). Elevated troponin levels were associated with an increased in-hospital mortality (37% vs 13%; HR, 1.71 [95% CI, 1.13-2.59]; P = .01 via multivariable Cox regression analysis), and this was independent from concomitant cardiac disease. Elevated troponin levels were also associated with a higher risk of in-hospital complications: heart failure (44 patients [19.2%] vs 7 patients [2.9%]; P < .001), sepsis (31 [11.7%] vs 21 [6.4%]; P = .03), acute kidney failure (41 [20.8%] vs 13 [6.2%]; P < .001), multiorgan failure (21 [10.9%] vs 6 [2.9%]; P = .003), pulmonary embolism (27 [9.9%] vs 17 [5.2%]; P = .04), delirium (13 [6.8%] vs 3 [1.5%]; P =.02), and major bleeding (16 [7.0%] vs 4 [1.6%]; P = .008).CONCLUSIONS AND RELEVANCE In this multicenter, cross-sectional study of Italian patients with COVID-19, elevated troponin was an independent variable associated with in-hospital mortality and a greater risk of cardiovascular and noncardiovascular complications during a hospitalization for COVID-19.