Association of Troponin Levels With Mortality in Italian Patients Hospitalized With Coronavirus Disease 2019: Results of a Multicenter Study

Carlo Mario Lombardi; Valentina Carubelli; Annamaria Iorio; Riccardo M Inciardi; Antonio Bellasi; Claudia Canale; Rita Camporotondo; Francesco Catagnano; Laura A Dalla Vecchia; Stefano Giovinazzo; Gloria Maccagni; Massimo Mapelli; Davide Margonato; Luca Monzo; Vincenzo Nuzzi; Chiara Oriecuia; Giulia Peveri; Andrea Pozzi; Giovanni Provenzale; Filippo Sarullo; Daniela Tomasoni; Pietro Ameri; Massimiliano Gnecchi; Sergio Leonardi; Marco Merlo; Piergiuseppe Agostoni; Stefano Carugo; Gian Battista Danzi; Marco Guazzi; Maria Teresa La Rovere; Andrea Mortara; Massimo Piepoli; Italo Porto; Gianfranco Sinagra; Maurizio Volterrani; Claudia Specchia; Marco Metra; Michele Senni

doi:10.1001/jamacardio.2020.3538

Association of Troponin Levels With Mortality in Italian Patients Hospitalized With Coronavirus Disease 2019: Results of a Multicenter Study

Carlo Mario Lombardi, Valentina Carubelli, Annamaria Iorio, Riccardo M Inciardi, Antonio Bellasi, Claudia Canale, Rita Camporotondo, Francesco Catagnano, Laura A Dalla Vecchia, Stefano Giovinazzo, Gloria Maccagni, Massimo Mapelli, Davide Margonato, Luca Monzo, Vincenzo Nuzzi, Chiara Oriecuia, Giulia Peveri, Andrea Pozzi, Giovanni Provenzale, Filippo SarulloDaniela Tomasoni, Pietro Ameri, Massimiliano Gnecchi, Sergio Leonardi, Marco Merlo, Piergiuseppe Agostoni, Stefano Carugo, Gian Battista Danzi, Marco Guazzi, Maria Teresa La Rovere, Andrea Mortara, Massimo Piepoli, Italo Porto, Gianfranco Sinagra, Maurizio Volterrani, Claudia Specchia, Marco Metra, Michele Senni

Research output: Contribution to journal › Article › peer-review

Abstract

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.

Original language	English
Pages (from-to)	1274-1280
Number of pages	7
Journal	JAMA Cardiology
Volume	5
Issue number	11
DOIs	https://doi.org/10.1001/jamacardio.2020.3538
Publication status	Published - Nov 1 2020

Keywords

Aged
Aged, 80 and over
COVID-19/blood
Cardiovascular Diseases/blood
Comorbidity
Cross-Sectional Studies
Female
Hospital Mortality/trends
Hospitalization/statistics & numerical data
Humans
Italy/epidemiology
Male
Middle Aged
Prevalence
Risk Factors
SARS-CoV-2/genetics
Troponin I/blood
Troponin T/blood

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10.1001/jamacardio.2020.3538

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Lombardi, C. M., Carubelli, V., Iorio, A., Inciardi, R. M., Bellasi, A., Canale, C., Camporotondo, R., Catagnano, F., Dalla Vecchia, L. A., Giovinazzo, S., Maccagni, G., Mapelli, M., Margonato, D., Monzo, L., Nuzzi, V., Oriecuia, C., Peveri, G., Pozzi, A., Provenzale, G., ... Senni, M. (2020). Association of Troponin Levels With Mortality in Italian Patients Hospitalized With Coronavirus Disease 2019: Results of a Multicenter Study. JAMA Cardiology, 5(11), 1274-1280. https://doi.org/10.1001/jamacardio.2020.3538

Association of Troponin Levels With Mortality in Italian Patients Hospitalized With Coronavirus Disease 2019: Results of a Multicenter Study. / Lombardi, Carlo Mario; Carubelli, Valentina; Iorio, Annamaria; Inciardi, Riccardo M; Bellasi, Antonio; Canale, Claudia; Camporotondo, Rita; Catagnano, Francesco; Dalla Vecchia, Laura A; Giovinazzo, Stefano; Maccagni, Gloria; Mapelli, Massimo; Margonato, Davide; Monzo, Luca; Nuzzi, Vincenzo; Oriecuia, Chiara; Peveri, Giulia; Pozzi, Andrea; Provenzale, Giovanni; Sarullo, Filippo; Tomasoni, Daniela ; Ameri, Pietro ; Gnecchi, Massimiliano ; Leonardi, Sergio; Merlo, Marco; Agostoni, Piergiuseppe; Carugo, Stefano; Danzi, Gian Battista; Guazzi, Marco ; La Rovere, Maria Teresa; Mortara, Andrea; Piepoli, Massimo; Porto, Italo; Sinagra, Gianfranco; Volterrani, Maurizio; Specchia, Claudia; Metra, Marco; Senni, Michele.

In: JAMA Cardiology, Vol. 5, No. 11, 01.11.2020, p. 1274-1280.

Research output: Contribution to journal › Article › peer-review

Lombardi, CM, Carubelli, V, Iorio, A, Inciardi, RM, Bellasi, A, Canale, C, Camporotondo, R, Catagnano, F, Dalla Vecchia, LA, Giovinazzo, S, Maccagni, G, Mapelli, M, Margonato, D, Monzo, L, Nuzzi, V, Oriecuia, C, Peveri, G, Pozzi, A, Provenzale, G, Sarullo, F, Tomasoni, D , Ameri, P , Gnecchi, M , Leonardi, S, Merlo, M, Agostoni, P, Carugo, S, Danzi, GB, Guazzi, M , La Rovere, MT, Mortara, A, Piepoli, M, Porto, I, Sinagra, G, Volterrani, M, Specchia, C, Metra, M & Senni, M 2020, 'Association of Troponin Levels With Mortality in Italian Patients Hospitalized With Coronavirus Disease 2019: Results of a Multicenter Study', JAMA Cardiology, vol. 5, no. 11, pp. 1274-1280. https://doi.org/10.1001/jamacardio.2020.3538

Lombardi, Carlo Mario ; Carubelli, Valentina ; Iorio, Annamaria ; Inciardi, Riccardo M ; Bellasi, Antonio ; Canale, Claudia ; Camporotondo, Rita ; Catagnano, Francesco ; Dalla Vecchia, Laura A ; Giovinazzo, Stefano ; Maccagni, Gloria ; Mapelli, Massimo ; Margonato, Davide ; Monzo, Luca ; Nuzzi, Vincenzo ; Oriecuia, Chiara ; Peveri, Giulia ; Pozzi, Andrea ; Provenzale, Giovanni ; Sarullo, Filippo ; Tomasoni, Daniela ; Ameri, Pietro ; Gnecchi, Massimiliano ; Leonardi, Sergio ; Merlo, Marco ; Agostoni, Piergiuseppe ; Carugo, Stefano ; Danzi, Gian Battista ; Guazzi, Marco ; La Rovere, Maria Teresa ; Mortara, Andrea ; Piepoli, Massimo ; Porto, Italo ; Sinagra, Gianfranco ; Volterrani, Maurizio ; Specchia, Claudia ; Metra, Marco ; Senni, Michele. / Association of Troponin Levels With Mortality in Italian Patients Hospitalized With Coronavirus Disease 2019: Results of a Multicenter Study. In: JAMA Cardiology. 2020 ; Vol. 5, No. 11. pp. 1274-1280.

@article{c1f7ca9c244c4654838160fe324e945e,

title = "Association of Troponin Levels With Mortality in Italian Patients Hospitalized With Coronavirus Disease 2019: Results of a Multicenter Study",

abstract = "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.",

keywords = "Aged, Aged, 80 and over, COVID-19/blood, Cardiovascular Diseases/blood, Comorbidity, Cross-Sectional Studies, Female, Hospital Mortality/trends, Hospitalization/statistics & numerical data, Humans, Italy/epidemiology, Male, Middle Aged, Prevalence, Risk Factors, SARS-CoV-2/genetics, Troponin I/blood, Troponin T/blood",

author = "Lombardi, {Carlo Mario} and Valentina Carubelli and Annamaria Iorio and Inciardi, {Riccardo M} and Antonio Bellasi and Claudia Canale and Rita Camporotondo and Francesco Catagnano and {Dalla Vecchia}, {Laura A} and Stefano Giovinazzo and Gloria Maccagni and Massimo Mapelli and Davide Margonato and Luca Monzo and Vincenzo Nuzzi and Chiara Oriecuia and Giulia Peveri and Andrea Pozzi and Giovanni Provenzale and Filippo Sarullo and Daniela Tomasoni and Pietro Ameri and Massimiliano Gnecchi and Sergio Leonardi and Marco Merlo and Piergiuseppe Agostoni and Stefano Carugo and Danzi, {Gian Battista} and Marco Guazzi and {La Rovere}, {Maria Teresa} and Andrea Mortara and Massimo Piepoli and Italo Porto and Gianfranco Sinagra and Maurizio Volterrani and Claudia Specchia and Marco Metra and Michele Senni",

year = "2020",

month = nov,

day = "1",

doi = "10.1001/jamacardio.2020.3538",

language = "English",

volume = "5",

pages = "1274--1280",

journal = "JAMA Cardiology",

issn = "2380-6583",

publisher = "American Medical Association",

number = "11",

}

TY - JOUR

T1 - Association of Troponin Levels With Mortality in Italian Patients Hospitalized With Coronavirus Disease 2019: Results of a Multicenter Study

AU - Lombardi, Carlo Mario

AU - Carubelli, Valentina

AU - Iorio, Annamaria

AU - Inciardi, Riccardo M

AU - Bellasi, Antonio

AU - Canale, Claudia

AU - Camporotondo, Rita

AU - Catagnano, Francesco

AU - Dalla Vecchia, Laura A

AU - Giovinazzo, Stefano

AU - Maccagni, Gloria

AU - Mapelli, Massimo

AU - Margonato, Davide

AU - Monzo, Luca

AU - Nuzzi, Vincenzo

AU - Oriecuia, Chiara

AU - Peveri, Giulia

AU - Pozzi, Andrea

AU - Provenzale, Giovanni

AU - Sarullo, Filippo

AU - Tomasoni, Daniela

AU - Ameri, Pietro

AU - Gnecchi, Massimiliano

AU - Leonardi, Sergio

AU - Merlo, Marco

AU - Agostoni, Piergiuseppe

AU - Carugo, Stefano

AU - Danzi, Gian Battista

AU - Guazzi, Marco

AU - La Rovere, Maria Teresa

AU - Mortara, Andrea

AU - Piepoli, Massimo

AU - Porto, Italo

AU - Sinagra, Gianfranco

AU - Volterrani, Maurizio

AU - Specchia, Claudia

AU - Metra, Marco

AU - Senni, Michele

PY - 2020/11/1

Y1 - 2020/11/1

N2 - 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.

AB - 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.

KW - Aged

KW - Aged, 80 and over

KW - COVID-19/blood

KW - Cardiovascular Diseases/blood

KW - Comorbidity

KW - Cross-Sectional Studies

KW - Female

KW - Hospital Mortality/trends

KW - Hospitalization/statistics & numerical data

KW - Humans

KW - Italy/epidemiology

KW - Male

KW - Middle Aged

KW - Prevalence

KW - Risk Factors

KW - SARS-CoV-2/genetics

KW - Troponin I/blood

KW - Troponin T/blood

U2 - 10.1001/jamacardio.2020.3538

DO - 10.1001/jamacardio.2020.3538

M3 - Article

C2 - 32845276

VL - 5

SP - 1274

EP - 1280

JO - JAMA Cardiology

JF - JAMA Cardiology

SN - 2380-6583

IS - 11

ER -

Association of Troponin Levels With Mortality in Italian Patients Hospitalized With Coronavirus Disease 2019: Results of a Multicenter Study

Abstract

Keywords

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