1. The Impact of COVID-19 Patients With Troponin Elevation on Renal Impairment and Clinical Outcome.
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Case, Brian C., Yerasi, Charan, Forrestal, Brian J., Chezar-Azerrad, Chava, Shea, Corey, Rappaport, Hank, Medranda, Giorgio A., Zhang, Cheng, Satler, Lowell F., Ben-Dor, Itsik, Hashim, Hayder, Rogers, Toby, Weintraub, William S., and Waksman, Ron
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COVID-19 , *TREATMENT effectiveness , *TROPONIN , *ACUTE kidney failure , *MYOCARDIAL injury - Abstract
Background: Cardiac involvement in coronavirus disease 2019 (COVID-19) is known, manifested by troponin elevation, and these patients have a worse prognosis than patients without myocardial injury.Methods: We analyzed COVID-19-positive patients who presented to the MedStar Health system (11 hospitals in Washington, DC, and Maryland) during the pandemic (March 1-September 30, 2020). We compared renal function and subsequent in-hospital clinical outcomes based on the presence or absence of troponin elevation. The primary outcome was the incidence of acute kidney injury in COVID-19 patients with troponin elevation. We also evaluated in-hospital mortality, overall and based on the presence and absence of both troponin elevation and renal dysfunction.Results: The cohort included 3386 COVID-19-positive admitted patients for whom troponin was drawn. Of these patients, 195 had troponin elevation (defined as ≥1.0 ng/mL), mean age was 61 ± 16 years, and 51% were men. In-hospital mortality was significantly higher (53.8%) in COVID-19-positive patients with concomitant troponin elevation than in those without troponin elevation (14.5%; p < 0.001). COVID-19-positive patients with troponin elevation had a higher prevalence of renal dysfunction (58.5%) than those without troponin elevation (23.4%; p < 0.001). Further analysis demonstrated that having both troponin elevation and renal dysfunction carried the worst in-hospital prognosis (in-hospital mortality 57.9%; intensive-care-unit admission 76.8%; ventilation requirement 63.2%), as compared to the absence or presence of either.Conclusion: COVID-19 patients with troponin elevation are at higher risk for worsening renal function, and these patients subsequently have worse in-hospital clinical outcomes. Efforts should focus on early recognition, evaluation, and intensifying care of these patients. [ABSTRACT FROM AUTHOR]- Published
- 2021
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