Myocardial Injury in Adults Hospitalized With COVID-19

Abstract

][3] Myocardial injury, defined by elevated cardiac troponin (cTn) concentrations, is common in critical illness and has been reported during hospitalization in up to 36% of COVID-19 hospitalizations. 1,4We explored the frequency of myocardial injury at admission and during hospitalization and evaluated associations between myocardial injury and clinical outcomes in a large cohort of patients with CO-VID-19 from a high-volume health care system in New York.The study was approved by the New York University School of Medicine Institutional Review Board with a waiver of informed consent.Identifiable data will not be made available to the public.We identified consecutive adults age ≥18 years with confirmed SARS CoV-2 infection admitted to the New York University Langone Health system between March 1, 2020 and April 16, 2020.Patients were eligible for inclusion if ≥1 cTn was measured during hospitalization.Routine cTn surveillance was performed in 95% of COVID-19 admissions because cTn assays were included in COVID-19-specific order sets in the electronic heath record.Non-high-sensitivity cTn assays were used (Siemens Dimension Vista Troponin I, Washington DC; Abbot Architect Troponin I, Chicago, IL).The initial and maximum cTnI measured during hospital admission were recorded.Myocardial injury was defined as cTn >99% upper reference limit for the cTn assay.Individuals were stratified into tertiles by initial and maximum cTn concentrations normalized to the assay-specific limit of detection.All-cause, in-hospital mortality was recorded for all patients.Critical illness was defined by treatment in an intensive care unit, need for mechanical ventilation, discharge to hospice, or death.Patient characteristics, laboratory data, and clinical outcomes were ascertained via automated extraction from the electronic health record.Categorical variables were compared by χ 2 tests, and continuous variables were compared using Mann-Whitney tests.Logistic regression models were generated to estimate the odds of the study end points, adjusted for demographics, comorbidities, vital signs, laboratory findings, and baseline medications.Statistical tests are 2-sided, and P values <0.05 were considered statistically significant.A total of 2163 consecutive adults with COVID-19 and ≥1 cTn measurement were identified.Myocardial injury was present at the initial cTn measurement in 665 (30.7%) cases.Patients with myocardial injury were older (71 versus 61 years; P<0.001) and more likely to be male (67.1% versus 61.5%; P=0.016).In-hospital mortality was higher in patients with myocardial injury at initial cTn measurement compared with those without myocardial injury (37.0%versus 15.4%; P<0.001; adjusted odds ratio [aOR], 2.04 [95% CI, 1.52-2.82]).Critical illness (54.1% versus 28.9%; P<0.001; aOR, 1.67 [95% CI, 1.23-2.07])was