The Association between Acute Cardiac Injury and Outcomes of Hospitalized Patients with COVID-19: Long-term Follow-up Results from the Sina Hospital COVID-19 Registry, Iran

Danesh Soltani; Azar Hadadi; Shahrokh Karbalai Saleh; Alireza Oraii; Azadeh Sadatnaseri; Mostafa Roozitalab; Zahra Shajari; Shima Sadat Ghaemmaghami; Haleh Ashraf

doi:10.18502/jthc.v18i3.14114

Danesh Soltani Cardiac Primary Prevention Research Center (CPPRC), Cardiovascular Diseases Research Institute, Tehran
Azar Hadadi Department of Infectious Diseases, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Shahrokh Karbalai Saleh Department of Cardiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Alireza Oraii Department of Cardiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Azadeh Sadatnaseri Department of Cardiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Mostafa Roozitalab Department of Cardiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Zahra Shajari Department of Cardiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Shima Sadat Ghaemmaghami Research Development Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Haleh Ashraf Cardiac Primary Prevention Research Center (CPPRC), Cardiovascular Diseases Research Institute, Tehran

DOI: https://doi.org/10.18502/jthc.v18i3.14114

Keywords: COVID-19; SARS-CoV-2; Troponin; Mortality

Abstract

Background: The present study aimed to investigate the association between acute cardiac injury (ACI) and outcomes in hospitalized patients with coronavirus disease 2019 (COVID-19) in Iran.

Methods: The current cohort study enrolled all consecutive hospitalized patients with COVID-19 (≥ 18 y) who had serum high-sensitivity cardiac troponin-I (hs-cTnT) measurements on admission between March 2020 and March 2021. ACI was determined as hs-cTnT levels exceeding the 99th percentile of normal values. Data on demographics, comorbidities, clinical and laboratory characteristics, and outcomes were collected from Web-based electronic health records.

Results: The study population consisted of 1413 hospitalized patients with COVID-19, of whom 319 patients (22.58%) presented with ACI. The patients with ACI had a significantly higher mortality rate than those without ACI (48.28% vs 15.63%; P<0.001) within a mean follow-up of 218.86 days from symptom onset. ACI on admission was independently associated with mortality (HR, 1.44; P=0.018). In multivariable logistic regression, age (OR, 1.034; P<0.001), preexisting cardiac disease (OR, 1.49; P=0.035), preexisting malignancy (OR, 2.01; P=0.030), oxygen saturation reduced to less than 90% (OR, 2.15; P<0.001), leukocytosis (OR, 1.45; P=0.043), lymphopenia (OR, 1.49; P=0.020), reduced estimated glomerular filtration rates (eGFRs) (OR, 0.99; P=0.008), and treatment with intravenous immunoglobulin during hospitalization (OR, 4.03; P=0.006) were independently associated with ACI development.

Conclusion: ACI occurrence on admission was associated with long-term mortality in our hospitalized patients with COVID-19. The finding further underscores the significance of evaluating ACI occurrence on admission, particularly in individuals more prone to ACI, including older individuals and those with preexisting comorbidities, reduced oxygen saturation, and increased inflammatory responses.