Document Type : Original Article(s)
- Fahimeh Safarnezhad-Tameshkel 1
- Nima Motamed 2
- Mohammad Hadi Karbalaie-Niya 3
- Dhayaneethie Perumal 4
- Nader Rezaie 5
- Shirin Izadi 6
- Mitra Ranjbar 7
- Mahdi Yadollahzadeh 8
- Behnam Behdad 9
- Gholamreza Hemmasi 10
- Vahid Kaveh 11
- Ali Arash Anoushirvani 12
- Mojtaba Malek 13
- Behzad Farahani 14
- Ramin Eskandari 14
- Mahshid Panahi 15
- Mandana Rahimi 15
- Sepideh Emami 14
- Farhad Zamani 16
- Mohsen Farrokhpour 8
1 Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran
2 Associate Professor, Department of Social Medicine, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
3 Assistant Professor, Gastrointestinal and Liver Diseases Research Center AND Department of Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
4 Assistant Professor, School of Science, Engineering and Computing, Kingston University, Kingston, United Kingdom
5 Associate Professor, Department of Pulmonology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
6 Assistant Professor, Department of Pulmonology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
7 Professor, Department of Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran
8 Assistant Professor, Department of Internal Medicine, School of Medicine, Firoozgar General Hospital, Iran University of Medical Sciences, Tehran, Iran
9 Resident, Department of Internal Medicine, School of Medicine, Firoozgar General Hospital, Iran University of Medical Sciences, Tehran, Iran
10 Associate Professor, Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran
11 Assistant Professor, Department of Hematology and Medical Oncology, School of Medicine, Iran University Medical Sciences, Tehran, Iran
12 Associate Professor, Department of Interventional Radiology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
13 Associate Professor, Research Center for Prevention of Cardiovascular Disease, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
14 Assistant Professor, Department of Cardiology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
15 Assistant Professor, Department of Pathology, Iran University of Medical Sciences, Tehran, Iran
16 Professor, Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran
BACKGROUND: COVID-19 was introduced by the World Health Organization (WHO) as a global pandemic. The spectrum of symptoms of the disease ranges from a mild cold to death. It has a higher mortality rate in people with a history of comorbidities, including cardiovascular disease (CVD) and can also contribute to cardiac injury. This study was conducted to evaluate the relationship between troponin levels as a cardiac marker and adverse outcomes in this disease.METHODS: The study sample included 438 patients hospitalized with COVID-19; however, the troponin data of 6 patients were not available. The need to be admitted to the intensive care unit (ICU), and death were considered the adverse outcome in patients with COVID-19. Troponin levels were checked in all patients on day 1 and day 3 of hospitalization. Multiple logistic regression analysis was performed to determine whether there was an independent association between the adverse outcomes and troponin enzyme in hospitalized patients with COVID-19.RESULTS: The mean age of patients was 61.29 ± 15.84 years. Among the 432 patients tested on day 1 of hospitalization, 24 patients (5.6%) tested positive (Troponin 1), and among the 303 patients tested on day 3, 13 patients (4.3%) tested positive (Troponin 2). Based on our results, Troponin 1 showed an independent association with both death (3.008 [95%CI = 1.091-8.290]; P = 0.033) and need for ICU admission (8.499 [95%CI = 3.316-21.788]; P < 0.001) in multiple logistic regression analysis. Moreover, the status of Troponin 2 had an independent significant association with both death (4.159 [95%CI = 1.156-14.961]; P = 0.029) and ICU admission (7.796 [95%CI = 1.954-31.097]; P = 0.004).CONCLUSION: Troponin showed a significant association with adverse outcomes in people who were hospitalized with COVID-19. The serial assessment of this enzyme from the time of hospitalization may improve the clinical decision making of clinicians.
- Malik YS, Sircar S, Bhat S, Sharun K, Dhama K, Dadar M, et al. Emerging novel coronavirus (2019-nCoV)-current scenario, evolutionary perspective based on genome analysis and recent developments. Vet Q 2020; 40(1): 68-76.
- Fehr AR, Perlman S. Coronaviruses: an overview of their replication and pathogenesis. Methods Mol Biol 2015; 1282: 1-23.
- Corman VM, Muth D, Niemeyer D, Drosten C. Hosts and sources of endemic human coronaviruses. Adv Virus Res 2018; 100: 163-88.
- Channappanavar R, Perlman S. Pathogenic human coronavirus infections: Causes and consequences of cytokine storm and immunopathology. Semin Immunopathol 2017; 39(5): 529-39.
- Li G, Fan Y, Lai Y, Han T, Li Z, Zhou P, et al. Coronavirus infections and immune responses. J Med Virol 2020; 92(4): 424-32.
- Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395(10223): 497-506.
- Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020; 323(11): 1061-9.
- Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study. Lancet 2020; 395(10223): 507-13.
- Saltiel AR, Olefsky JM. Inflammatory mechanisms linking obesity and metabolic disease. J Clin Invest 2017; 127(1): 1-4.
- Hartmann-Boyce J, Davies N, Frost R, Bussey J, Park S. Maximising mobility in older people when isolated with COVID-19. Centre for Evidence-Based Medicine [Online]. [cited 2020 Mar 20]; Available from: URL: https://www.cebm.net/covid-19/maximising-mobility-in-the-older-people-when-isolated-with-covid-19/
- Driggin E, Madhavan MV, Bikdeli B, Chuich T, Laracy J, Biondi-Zoccai G, et al. Cardiovascular considerations for patients, health care workers, and health systems during the COVID-19 pandemic. J Am Coll Cardiol 2020; 75(18): 2352-71.
- Zheng YY, Ma YT, Zhang JY, Xie X. COVID-19 and the cardiovascular system. Nat Rev Cardiol 2020; 17(5): 259-60.
- Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, et al. Fourth universal definition of myocardial infarction (2018). J Am Coll Cardiol 2018; 72(18): 2231-64.
- Lim W, Qushmaq I, Devereaux PJ, Heels-Ansdell D, Lauzier F, Ismaila AS, et al. Elevated cardiac troponin measurements in critically ill patients. Arch Intern Med 2006; 166(22): 2446-54.
- Needham DM, Shufelt KA, Tomlinson G, Scholey JW, Newton GE. Troponin I and T levels in renal failure patients without acute coronary syndrome: A systematic review of the literature. Can J Cardiol 2004; 20(12): 1212-8.
- Khan NA, Hemmelgarn BR, Tonelli M, Thompson CR, Levin A. Prognostic value of troponin T and I among asymptomatic patients with end-stage renal disease: A meta-analysis. Circulation 2005; 112(20): 3088-96.
- Li B, Yang J, Zhao F, Zhi L, Wang X, Liu L, et al. Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China. Clin Res Cardiol 2020; 109(5): 531-8.
- Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study. Lancet 2020; 395(10229): 1054-62.
- Chen C, Chen C, Yan JT, Zhou N, Zhao JP, Wang DW. Analysis of myocardial injury in patients with COVID-19 and association between concomitant cardiovascular diseases and severity of COVID-19. Zhonghua Xin Xue Guan Bing Za Zhi 2020; 48(7): 567-71. [In Chinese].
- Lippi G, Plebani M. Laboratory abnormalities in patients with COVID-2019 infection. Clin Chem Lab Med 2020; 58(7): 1131-4.
- Yang J, Zheng Y, Gou X, Pu K, Chen Z, Guo Q, et al. Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: A systematic review and meta-analysis. Int J Infect Dis 2020; 94: 91-5.
- Ruan Q, Yang K, Wang W, Jiang L, Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med 2020; 46(5): 846-8.
- Libby P, Ridker PM, Hansson GK. Inflammation in atherosclerosis: from pathophysiology to practice. J Am Coll Cardiol 2009; 54(23): 2129-38.
- Tall AR, Yvan-Charvet L. Cholesterol, inflammation and innate immunity. Nat Rev Immunol 2015; 15(2): 104-16.
- Zhou P, Yang XL, Wang XG, Hu B, Zhang L, Zhang W, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature 2020; 579(7798): 270-3.
- Ge XY, Li JL, Yang XL, Chmura AA, Zhu G, Epstein JH, et al. Isolation and characterization of a bat SARS-like coronavirus that uses the ACE2 receptor. Nature 2013; 503(7477): 535-8.
- Zhang H, Penninger JM, Li Y, Zhong N, Slutsky AS. Angiotensin-converting enzyme 2 (ACE2) as a SARS-CoV-2 receptor: molecular mechanisms and potential therapeutic target. Intensive Care Med 2020; 46(4): 586-90.
- Wadhera RK, Joynt KE. Insurance and cardiovascular health: Time for evidence to trump politics. Circulation 2017; 135(21): 1988-90.
- Lippi G, Plebani M. Procalcitonin in patients with severe coronavirus disease 2019 (COVID-19): A meta-analysis. Clin Chim Acta 2020; 505: 190-1.