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

2020; Springer Science+Business Media; Volume: 15; Issue: 8 Linguagem: Inglês

10.1007/s11739-020-02493-y

1970-9366

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

Cardiac Arrest and Resuscitation

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.