Turkiye Klinikleri Cardiovascular Sciences

.: ORIGINAL RESEARCH
The Relationship of In-Hospital Mortality with Cardiac Injury in COVID-19 Patients: A Retrospective Cohort Study
COVID-19 Hastalarında Hastane İçi Mortalitenin Kardiyak Hasar ile İlişkisi: Retrospektif Kohort Çalışması
Sevil GÜLAŞTIa, Ferdi GÜLAŞTIb
aDepartment of Cardiology, Adnan Menderes University Faculty of Medicine, Aydın, Türkiye
bClinic of Anesthesiology and Reanimation, Aydın Gynecology and Children's Hospital, Aydın, Türkiye
Turkiye Klinikleri J Cardiovasc Sci. 2022;34(3):106-14
doi: 10.5336/cardiosci.2022-93884
Article Language: EN
Full Text
ABSTRACT
 Objective: Coronavirus disease-2019 (COVID-19) emerged in late 2019 and has caused a pandemic, resulting in significant morbidity and mortality. However, the clinical significance of cardiac injury in patients affected by COVID-19 is still unknown. Therefore, our objective was to explore the association between cardiac injury and mortality in hospitalized patients with COVID-19. Material and Methods: The study included four hundred forty-three patients with laboratory values for troponin and follow-up. The mean age was 57.3±16.0 years. The male to female ratio was 1.53. Fever (45.6%) and cough (42.7%) were the most frequent sign and symptom at admission. Hypertension was the most common comorbidity, identified in 140 patients (31.6%). Results: In 143 (32.2%) patients, we determined cardiac injury. The median length of hospital stay was ten days. The mortality rate was 14.4%. The median length of hospital stay was longer in patients with cardiac injury (14 days vs. 9 days, respectively) (p<0.001). The mortality rate was 3.7% in the patients without cardiac injury, whereas the mortality rate was significantly higher among the patients with cardiac injury (37.7%, p<0.001). The multivariable model showed that cardiac injury was the only independent risk factor for death. There was a higher risk of death in patients with cardiac injury than in those without cardiac injury [hazard ratio, 4.01 (95% confidence interval, 1.85-8.72, p<0.001)]. Conclusion: In conclusion, cardiac injury is a common condition among hospitalized patients with COVID-19 and is associated with an elevated risk of in-hospital mortality. In addition, it is significantly more common in patients with known heart disease, complicating the treatment process.

Keywords: COVID-19; mortality; troponin I
ÖZET
 Amaç: Koronavirüs hastalığı-2019 [coronavirus disease-2019 (COVID-19)], 2019 yılının sonlarında ortaya çıktı ve önemli bir morbidite ve mortalite ile sonuçlanan bir pandemiye neden oldu. Bununla birlikte COVID-19'dan etkilenen hastalarda kardiyak hasarın klinik önemi hâlâ bilinmemektedir. Bu nedenle amacımız, hastanede yatan COVID-19 hastalarında kardiyak hasar ile mortalite arasındaki ilişkiyi araştırmaktı. Gereç ve Yöntemler: Çalışmaya troponin, diğer laboratuvar değerleri olan 443 hasta dâhil edildi. Ortalama yaş 57,3±16,0 yıl idi. Erkek-kadın oranı 1,53 saptandı. Ateş (%45,6) ve öksürük (%42,7) başvuru anında en sık görülen belirti ve semptomdu. Yüz kırk (%31,6) hastada tanımlanan en sık komorbidite hipertansiyon olarak izlendi. Bulgular: Yüz kırk üç (%32,2) hastada troponin artışı tespit ettik. Ortalama hastanede kalış süresi 10 gündü. Mortalite oranı %14,4 olarak tespit edildi. Ortanca hastanede kalış süresi kardiyak hasar olan hastalarda daha uzundu (sırasıyla 14 gün ve 9 gün) (p<0,001). Kardiyak hasar olmayan hastalarda ölüm oranı %3,7 iken, kardiyak hasar olan grupta ölüm oranı anlamlı olarak daha yüksekti (%37,7, p<0,001). Çok değişkenli model, kardiyak hasarın ölüm için tek bağımsız risk faktörü olduğunu gösterdi. Kardiyak hasarı olan hastalarda, hasar olmayanlara göre daha yüksek ölüm riski vardı (tehlike oranı, 4,01 [%95 güven aralığı, 1,85-8,72, p<0,001]). Sonuç: Sonuç olarak kardiyak hasar hastanede yatan COVID-19 hastalarında sık görülen bir durumdur ve yüksek hastane içi mortalite riski ile ilişkilidir. Ayrıca bilinen kalp hastalığı olan hastalarda belirgin şekilde daha sık görülür ve tedavi sürecini zorlaştırır.

Anahtar Kelimeler: COVID-19; mortalite; troponin I
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