Cardiac injury and mortality in patients with Coronavirus disease 2019 (COVID-19): insights from a mediation analysis
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Cardiac injury and mortality in patients with Coronavirus disease 2019 (COVID‑19): insights from a mediation analysis Alberto Cipriani1,3 · Federico Capone2,3 · Filippo Donato1,3 · Leonardo Molinari2,3 · Davide Ceccato2,3 · Alois Saller2,3 · Lorenzo Previato2,3 · Raffaele Pesavento2,3 · Cristiano Sarais1,3 · Paola Fioretto2,3 · Sabino Iliceto1,3 · Dario Gregori1,3 · Angelo Avogaro2,3 · Roberto Vettor2,3 Received: 6 July 2020 / Accepted: 4 September 2020 © The Author(s) 2020
Abstract 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. Keywords Coronavirus 2019 · COVID-19 · Cardiac injury · Cardiac troponin
Introduction Alberto Cipriani and Federico Capone are joint co-first authors. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11739-020-02495-w) contains supplementary material, which is available to authorized users. * Alberto Cipriani [email protected] 1
Department of Cardio‑Thoraco‑Vascular Sciences and Public Health, University of Padova, Via Giustiniani, 2, 35128 Padua, Italy
2
Department of Medicine, University of Padova, Via Giustiniani, 2, Padua 35128, Italy
3
Azienda Ospedaliera, University of Padua, Via Giustiniani, 2, Padua 35128, Italy
The severe acute respiratory syndrome coronavirus 2 (
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