TY - JOUR
T1 - Cardiac involvement at presentation in patients hospitalized with COVID-19 and their outcome in a tertiary referral hospital in Northern Italy
AU - San Matteo COVID Cardiac Injury Task Force
AU - Ghio, Stefano
AU - Baldi, Enrico
AU - Vicentini, Alessandro
AU - Lenti, Marco Vincenzo
AU - Di Sabatino, Antonio
AU - Di Matteo, Angela
AU - Zuccaro, Valentina
AU - Piloni, Davide
AU - Corsico, Angelo
AU - Gnecchi, Massimiliano
AU - Speciale, Francesco
AU - Sabena, Anna
AU - Visconti, Luigi Oltrona
AU - Perlini, Stefano
AU - Visconti, Luigi Oltrona
AU - Ferlini, Marco
AU - Greco, Alessandra
AU - Magrini, Giulia
AU - Scelsi, Laura
AU - Totaro, Rossana
AU - Acquaro, Mauro
AU - Coccia, Michela
AU - D’Amore, Sabato
AU - Foglia, Simonluca Digiacomo Davide
AU - Jeva, Francesco
AU - Masiello, Lucrezia
AU - Montalto, Claudio
AU - Moschella, Martina
AU - Pezza, Laura
AU - Alfano, Claudia
AU - Bonzano, Marco
AU - Briganti, Federica
AU - Crescenzi, Giuseppe
AU - Falchi, Anna iulia
AU - Maggi, Elena
AU - Guarnone, Roberta
AU - Guglielmana, Barbara
AU - Martino, Ilaria Francesca
AU - Di Marco, Maria Serena Pioli
AU - Pettenazza, Pietro
AU - Quaglia, Federica
AU - Salinaro, Francesco
AU - Zunino, Ilaria
AU - Sturniolo, Giulia
AU - Parodi, Alessandro
AU - Bruno, Raffaele
AU - Seminari, Elena Maria
AU - Tavazzi, Guido
AU - Albertini, Riccardo
AU - Klersy, Catherine
PY - 2020
Y1 - 2020
N2 - 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.
AB - 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.
KW - Cardiac injury
KW - COVID-19
KW - Italy
KW - Prognosis
UR - http://www.scopus.com/inward/record.url?scp=85091389248&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85091389248&partnerID=8YFLogxK
U2 - 10.1007/s11739-020-02493-y
DO - 10.1007/s11739-020-02493-y
M3 - Article
AN - SCOPUS:85091389248
JO - Internal and Emergency Medicine
JF - Internal and Emergency Medicine
SN - 1828-0447
ER -