.: ORİJİNAL ARAŞTIRMA
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
Turkiye Klinikleri J Cardiovasc Sci. 2022;34(3):106-14
doi: 10.5336/cardiosci.2022-93884
Makale Dili: EN
Tam Metin
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
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
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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