Backgrounds Patients at greatest risk of severe clinical conditions from coronavirus disease 2019 (COVID-19) and death are elderly and comorbid patients. Increased levels of cardiac troponins identify patients with poor outcome. The present study aimed to describe the clinical characteristics and outcomes of a cohort of Italian inpatients, admitted to a medical COVID-19 Unit, and to investigate the relative role of cardiac injury on in-hospital mortality. Methods and results We analyzed all consecutive patients with laboratory-confirmed COVID-19 referred to our dedicated medical Unit between February 26th and March 31st 2020. Patients’ clinical data including comorbidities, laboratory values, and outcomes were collected. Predictors of in-hospital mortality were investigated. A mediation analysis was performed to identify the potential mediators in the relationship between cardiac injury and mortality. A total of 109 COVID-19 inpatients (female 36%, median age 71 years) were included. During in-hospital stay, 20 patients (18%) died and, compared with survivors, these patients were older, had more comorbidities defined by Charlson comorbidity index ≥ 3(65% vs 24%, p = 0.001), and higher levels of high-sensitivity cardiac troponin I (Hs-cTnI), both at first evaluation and peak levels. A dose–response curve between Hs-cTnI and in-hospital mortality risk up to 200 ng/L was detected. Hs-cTnI, chronic kidney disease, and chronic coronary artery disease mediated most of the risk of in-hospital death, with Hs-cTnI mediating 25% of such effect. Smaller effects were observed for age, lactic dehydrogenase, and d -dimer. Conclusions In this cohort of elderly and comorbid COVID-19 patients, elevated Hs-cTnI levels were the most important and independent mediators of in-hospital mortality. Electronic supplementary material The online version of this article (10.1007/s11739-020-02495-w) contains supplementary material, which is available to authorized users.
【저자키워드】 COVID-19, cardiac troponin, cardiac injury, Coronavirus 2019, 【초록키워드】 coronavirus disease, Coronavirus disease 2019, Mortality, Clinical characteristics, Comorbidities, Comorbidity, risk, Chronic kidney disease, outcome, Laboratory, Coronary artery disease, cardiac injury, Cohort, Survivors, female, Patient, death, Kidney disease, age, Mediation analysis, troponin I, in-hospital mortality, COVID-19 patients, Injury, mediators, referred to, Coronary artery, peak levels, lactic dehydrogenase, In-hospital death, Inpatients, In-hospital, Inpatient, Older, supplementary material, Laboratory-confirmed COVID-19, Clinical data, median age, Charlson Comorbidity Index, d -dimer, unit, clinical condition, laboratory-confirmed, lactic, response curve, Effect, Italian, independent, defined, analyzed, identify, collected, died, investigated, elevated, was performed, Increased, comorbid patients, consecutive patient, had more, Smaller, 【제목키워드】 Coronavirus disease 2019, Mortality, Patient,