Arq. Bras. Cardiol. 2023; 120(2): e20220151
Myocardial Injury and Prognosis in Hospitalized COVID-19 Patients in Brazil: Results From The Brazilian COVID-19 Registry
Hannah Cardoso Barbosa
, Maria Auxiliadora Parreiras Martins
, Jordana Cristina de Jesus
, Karina Cardoso Meira
, Luiz Guilherme Passaglia
, Manuela Furtado Sacioto
, Adriana Falangola Benjamin Bezerra
, Alexandre Vargas Schwarzbold
, Amanda de Oliveira Maurílio
, Barbara Lopes Farace
, Carla Thais Cândida Alves da Silva
, Christiane Corrêa Rodrigues Cimini
, Daniel Vitorio Silveira
, Daniela do Reis Carazai
, Daniela Ponce
, Emanuel Victor Alves Costa, Euler Roberto Fernandes Manenti
, Evelin Paola de Almeida Cenci
, Frederico Bartolazzi
, Glícia Cristina de Castro Madeira
, Guilherme Fagundes Nascimento
, Isabela Vasconcellos Pires Velloso
, Joanna d’Arc Lyra Batista
, Júlia Drumond Parreiras de Morais
, Juliana da Silva Nogueira Carvalho
, Karen Brasil Ruschel
, Karina Paula Medeiros Prado Martins
, Liege Barella Zandoná
, Luanna Silva Monteiro Menezes
, Luciane Kopittke
, Luís César de Castro
, Luiz Antônio Nasi
, Maiara Anschau Floriani
, Maíra Dias Souza
, Marcelo Carneiro
, Maria Aparecida Camargos Bicalho
, Maria Clara Pontello Barbosa Lima
, Mariana Frizzo de Godoy
, Milton Henriques Guimarães-Júnior
, Paulo Mascarenhas Mendes
, Polianna Delfino-Pereira
, Raquel Jaqueline Eder Ribeiro, Renan Goulart Finger
, Rochele Mosmann Menezes
, Saionara Cristina Francisco
, Silvia Ferreira Araújo
, Talita Fischer Oliveira
, Thainara Conceição de Oliveira
, Carisi Anne Polanczyk
, Milena Soriano Marcolino
This Original Article is referred by the Short Editorial "A Biochemical Kaleidoscope Called Troponin".
Abstract
Background
Cardiovascular complications of COVID-19 are important aspects of the disease’s pathogenesis and prognosis. Evidence on the prognostic role of troponin and myocardial injury in Latin American hospitalized COVID-19 patients is still scarce.
Objectives
To evaluate myocardial injury as independent predictor of in-hospital mortality and invasive mechanical ventilation support in hospitalized patients, from the Brazilian COVID-19 Registry.
Methods
This cohort study is a substudy of the Brazilian COVID-19 Registry, conducted in 31 Brazilian hospitals of 17 cities, March-September 2020. Primary outcomes included in-hospital mortality and invasive mechanical ventilation support. Models for the primary outcomes were estimated by Poisson regression with robust variance, with statistical significance of p<0.05.
Results
Of 2,925 patients (median age of 60 years [48-71], 57.1% men), 27.3% presented myocardial injury. The proportion of patients with comorbidities was higher among patients with cardiac injury (median 2 [1-2] vs. 1 [0-2]). Patients with myocardial injury had higher median levels of brain natriuretic peptide, lactate dehydrogenase, creatine phosphokinase, N-terminal pro-brain natriuretic peptide, and C-reactive protein than patients without myocardial injury. As independent predictors, C-reactive protein and platelet counts were related to the risk of death, and neutrophils and platelet counts were related to the risk of invasive mechanical ventilation support. Patients with high troponin levels presented a higher risk of death (RR 2.03, 95% CI 1.60-2.58) and invasive mechanical ventilation support (RR 1.87, 95% CI 1.57-2.23), when compared to those with normal troponin levels.
Conclusion
Cardiac injury was an independent predictor of in-hospital mortality and the need for invasive mechanical ventilation support in hospitalized COVID-19 patients.
Keywords: Artificial Respiration; Coronavirus Infections; COVID-19; Mortality; Troponin
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