ABSTRACT
BACKGROUND: Myocardial injury is a common finding in COVID-19 strongly associated with severity. We analysed the prevalence and prognostic utility of myocardial injury, characterized by elevated cardiac troponin, in a large population of COVID-19 patients, and further evaluated separately the role of troponin T and I. METHODS: This is a multicentre, retrospective observational study enrolling patients with laboratory-confirmed COVID-19 who were hospitalized in 32 Spanish hospitals. Elevated troponin levels were defined as values above the sex-specific 99th percentile upper reference limit, as recommended by international guidelines. Thirty-day mortality was defined as endpoint. RESULTS: A total of 1280 COVID-19 patients were included in this study, of whom 187 (14.6%) died during the hospitalization. Using a nonspecific sex cut-off, elevated troponin levels were found in 344 patients (26.9%), increasing to 384 (30.0%) when a sex-specific cut-off was used. This prevalence was significantly higher (42.9% vs 21.9%; P < .001) in patients in whom troponin T was measured in comparison with troponin I. Sex-specific elevated troponin levels were significantly associated with 30-day mortality, with adjusted odds ratios (ORs) of 3.00 for total population, 3.20 for cardiac troponin T and 3.69 for cardiac troponin I. CONCLUSION: In this multicentre study, myocardial injury was a common finding in COVID-19 patients. Its prevalence increased when a sex-specific cut-off and cardiac troponin T were used. Elevated troponin was an independent predictor of 30-day mortality, irrespective of cardiac troponin assay and cut-offs to detect myocardial injury. Hence, the early measurement of cardiac troponin may be useful for risk stratification in COVID-19.
Subject(s)
COVID-19/blood , Cardiomyopathies/blood , Mortality , Troponin I/blood , Troponin T/blood , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Odds Ratio , Prognosis , Retrospective Studies , SARS-CoV-2 , Severity of Illness IndexABSTRACT
El análisis de gases en sangre es una prueba frecuentemente solicitada en diferentes ámbitos hospitalarios. La medida de los parámetros incluidos en este análisis puede verse afectada por un elevado número de condiciones preanalíticas y es responsabilidad del laboratorio garantizar que los resultados reflejan de forma segura el equilibrio ácido-base y el estado de oxigenación del paciente. Aunque muchas de estas condiciones son comunes al resto de las magnitudes del laboratorio, como la identificación correcta del espécimen, algunas son propias del análisis de gases debido a la estabilidad de las magnitudes incluidas en él. Este documento establece recomendaciones para el control de las condiciones preanalíticas y otras fuentes de error relacionadas con el análisis de gases en sangre, tales como las características de los materiales empleados para la toma de muestra (jeringas, agujas y anticoagulantes), tipo de muestra (sangre arterial, venosa y capilar «arterializada») y las condiciones para el manejo y transporte de la muestra, incluyendo la influencia del tiempo transcurrido entre la extracción y el análisis, la temperatura de la muestra durante el transporte y el transporte en sí
Blood gas analysis is a commonly ordered test in different hospital settings. The measurement of the parameters included in this analysis is vulnerable to a huge number of pre-analytical conditions. Laboratory staff are responsible for ensuring that these results accurately reflect the acid-base and oxygenation status of the patient. Despite many pre-analytical steps in blood gas testing being common to other laboratory tests, such as proper sample identification, others are particular for this determination, such as the stability of the analytes measured. The aim of this document is to provide recommendations for the control of the pre-analytical variables and other error sources related to blood gas analysis. These include the characteristics of the materials used to collect the blood samples (syringes, needles and anticoagulants), the sample types (arterial, venous and «arterialised» capillary blood), as well as the conditions for sample handling and transport, including the effect of the time between sampling and analysis, the temperature during transport, and the type of transport
Subject(s)
Humans , Pre-Analytical Phase/methods , Acid-Base Imbalance/diagnosis , Blood Gas Analysis/methods , Acid-Base Equilibrium/physiology , Guidelines as Topic , Carbonic Acid/analysis , Bicarbonates/analysis , Carbon Dioxide/analysis , Oximetry/methods , Specimen Handling/methods , Anticoagulants/therapeutic useABSTRACT
La homocistinuria es un error innato del metabolismo de la metionina con una alta tasa de morbimortalidad. Mutaciones en la cistationina beta-sintetasa son la causa más frecuente de homocistinuria, conocida esta como homocistinuria clásica. Hay descritas más de 150 mutaciones diferentes, de las cuales la más prevalente en España es la T191M. La detección mediante cribado neonatal puede prevenir las complicaciones más graves de la enfermedad y posibilitar un desarrollo cognitivo normal. Presentamos un caso de homocistinuria clásica debida a la mutación T353M, con fenotipo no respondedor a piridoxina (AU)
Homocystinuria is an inherited disorder of methionine metabolism, and has a high morbidity-mortality rate. Mutations in the cystathionine beta-synthase gene are the most common cause of homocystinuria, known as classic homocystinuria. More than 150 mutations have been described, with T191M being the most prevalent in Spain. Neonatal identification by newborn screening may prevent severe complications, and allow normal intellectual development. A case is presented of pyridoxine non-responsive homocystinuria due to T353 mutation (AU)
