ABSTRACT
INTRODUCTION: Previous cardiovascular disease (CVD) and myocardial involvement are common in coronavirus disease-19 (COVID-19). We investigated relationships between CVD, cardiac biomarkers and outcome in COVID-19. METHODS: We analyzed nâ=â252 patients from a multicenter study and provided comparison according to the presence or absence of underlying CVD. Cardiac biomarkers high-sensitivity Troponin [upper reference of normality (URN) 35âpg/ml for Troponin I and 14âpg/ml for Troponin T] and natriuretic peptides (Nt-pro-B-type natriuretic peptide, URN 300âpg/ml and B-type natriuretic peptide, URN 100âpg/ml) were both available in nâ=â136. RESULTS: Mean age was 69â±â16âyears (56% men, 31% with previous CVD). Raised hs-Troponin and natriuretic peptides were detected in 36 and 50% of the cases respectively. Age, chronic obstructive pulmonary disease, hemoglobin, hs-Troponin and natriuretic peptides were independently associated with underlying CVD (Pâ<â0.05 for all). Compared with the normal biomarkers subgroups, patients with isolated hs-Troponin elevation had higher in-hospital mortality (31 vs. 4%, Pâ<â0.05), similar CVD prevalence (15 vs. 11%) and trend towards higher D-dimer (930 vs. 397âng/ml, Pâ=â0.140). Patients with both biomarkers elevated had higher age, D-dimer, CVD and in-hospital mortality prevalence compared with other subgroups (all Pâ<â0.05 for trend). Outcome analysis revealed previous CVD [model 1: OR 2.72 (95% CI 1.14-6.49), Pâ=â0.024. model 2: OR 2.65 (95% CI 1.05-6.71), Pâ=â0.039], hs-Troponin (log10) [OR 2.61 (95% CI 1.21-5.66), Pâ=â0.015] and natriuretic peptides (log10) [OR 5.84 (95%CI 2.43-14), Pâ<â0.001] to be independently associated with in-hospital mortality. CONCLUSION: In our population, previous CVD was part of a vulnerable phenotype including older age, comorbidities, increased cardiac biomarkers and worse prognosis. Patients with isolated increase in hs-Troponin suffered higher mortality rates despite low prevalence of CVD, possibly explained by higher COVID-19-related systemic involvement.
Subject(s)
COVID-19 , Cardiovascular Diseases , Natriuretic Peptides/blood , Troponin/blood , Aged , Biomarkers/blood , COVID-19/blood , COVID-19/diagnosis , COVID-19/mortality , Cardiovascular Diseases/classification , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/epidemiology , Comorbidity , Female , Fibrin Fibrinogen Degradation Products/analysis , Hospital Mortality , Humans , Italy/epidemiology , Male , Outcome Assessment, Health Care , Prognosis , Risk Assessment , Risk Factors , SARS-CoV-2/isolation & purificationABSTRACT
Lung ultrasound (LUS) and chest computed tomography (chest CT) are largely employed to evaluate coronavirus disease 2019 (COVID-19) pneumonia. We investigated semi-quantitative LUS and CT scoring in hospitalized COVID-19 patients. LUS and chest CT were performed within 24 h upon admission. Both were analyzed according to semi-quantitative scoring systems. Subgroups were identified according to median LUS score. Patients within higher LUS score group were older (79 vs 60 years, p<0.001), had higher C-reactive protein (CRP) (7.2 mg/dl vs 1.3 mg/dl, p<0.001) and chest CT score (10 vs 4, p=0.027) as well as lower PaO2/FiO2 (286 vs 356, p=0.029) as compared to patients within lower scores. We found a significant correlation between scores (r=0.390, p=0.023). Both LUS and CT scores correlated directly with patients age (r=0.586, p<0.001 and r=0.399, p=0.021 respectively) and CRP (r=0.472, p=0.002 and r=0.518, p=0.002 respectively), inversely with PaO2/FiO2 (r=-0.485, p=0.003 and r=-0.440, p=0.017 respectively). LUS score only showed significant correlation with hs-troponin T, NT-pro-BNP, and creatinine (r=0.433, p=0.019; r=0.411, p=0.027, and r=0.497, p=0.001, respectively). Semi-quantitative bedside LUS is related to the severity of COVID-19 pneumonia similarly to chest CT. Correlation of LUS score with markers of cardiac and renal injury suggests that LUS might contribute to a more comprehensive evaluation of this heterogeneous population.