Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 May 13;10(10):2096.
doi: 10.3390/jcm10102096.

Myocardial Injury in COVID-19 Patients: Association with Inflammation, Coagulopathy and In-Hospital Prognosis

Victor Arévalos  1   2 , Luis Ortega-Paz  1   2 , Juan José Rodríguez-Arias  1   2 , Margarita Calvo  1 , Leticia Castrillo  1 , Anthony Salazar  1 , Merce Roque  1   2 , Ana Paula Dantas  2 , Manel Sabaté  1   2 , Salvatore Brugaletta  1   2
Affiliations

Myocardial Injury in COVID-19 Patients: Association with Inflammation, Coagulopathy and In-Hospital Prognosis

Victor Arévalos et al. J Clin Med. .

Abstract

The exact mechanisms leading to myocardial injury in the coronavirus disease 2019 (COVID-19) are still unknown. In this retrospective observational study, we include all consecutive COVID-19 patients admitted to our center. They were divided into two groups according to the presence of myocardial injury. Clinical variables, Charlson Comorbidity Index (CCI), C-reactive protein (CRP), CAC (COVID-19-associated coagulopathy), defined according to the ISTH score, treatment and in-hospital events were collected. Between March and April 2020, 331 COVID-19 patients were enrolled, 72 of them (21.8%) with myocardial injury. Patients with myocardial injury showed a higher CCI score (median (interquartile range), 5 (4-7) vs. 2 (1-4), p = 0.001), higher CRP values (18.3 (9.6-25.9) mg/dL vs. 12.0 (5.4-19.4) mg/dL, p ˂ 0.001) and CAC score (1 (0-2) vs. 0 (0-1), p = 0.001), and had lower use of any anticoagulant (57 patients (82.6%) vs. 229 patients (90.9%), p = 0.078), than those without. In the adjusted logistic regression, CRP, myocardial injury, CCI and CAC score were positive independent predictors of mortality, whereas anticoagulants resulted as a protective factor. Myocardial injury in COVID-19 patients is associated with inflammation and coagulopathy, resulting in a worse in-hospital prognosis. Treatment with anticoagulant agents may help to improve in-hospital outcomes.

Keywords: coagulopathy; coronavirus disease 2019; mortality; myocardial injury.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of participant selection.
Figure 2
Figure 2
Incidence of mortality, ICU (intensive care unit) admission and mechanical ventilation in patients grouped according to their CAC (COVID-19-associated coagulopathy) score. Higher CAC scores were associated to higher ICU admission rates, higher invasive mechanical ventilation and higher mortality.
See this image and copyright information in PMC

References

    1. Yang C.L., Qiu X., Zeng Y.K., Jiang M., Fan H.R., Zhang Z.M. Coronavirus Disease 2019: A Clinical Review. Eur. Rev. Med. Pharmacol. Sci. 2020;24:4585–4596. doi: 10.26355/eurrev_202004_21045. - DOI - PubMed
    1. Bourgonje A.R., Abdulle A.E., Timens W., Hillebrands J., Bourgonje A.R., Abdulle A.E., Timens W., Hillebrands J. Angiotensin-converting enzyme 2 (ACE2), SARS-CoV-2 and the pathophysiology of coronavirus disease 2019 (COVID-19) J. Pathol. 2019;251:228–248. doi: 10.1002/path.5471. - DOI - PMC - PubMed
    1. Driggin E., Madhavan M.V., Bikdeli B., Chuich T., Laracy J., Biondi-Zoccai G., Brown T.S., Der Nigoghossian C., Zidar D.A., Haythe J., et al. Cardiovascular Considerations for Patients, Health Care Workers, and Health Systems during the COVID-19 Pandemic. J. Am. Coll. Cardiol. 2020;75:2352–2371. doi: 10.1016/j.jacc.2020.03.031. - DOI - PMC - PubMed
    1. Nie S., Yu M., Xie T., Yang F., Wang H., Wang Z., Li M., Gao X., Lv B., Wang S., et al. Cardiac Troponin I Is an Independent Predictor for Mortality in Hospitalized Patients with Coronavirus Disease 2019. Circulation. 2020;142:608–610. doi: 10.1161/CIRCULATIONAHA.120.048789. - DOI - PMC - PubMed
    1. Shi S., Qin M., Shen B., Cai Y., Liu T., Yang F., Gong W., Liu X., Liang J., Zhao Q., et al. Association of Cardiac Injury with Mortality in Hospitalized Patients with COVID-19 in Wuhan, China. JAMA Cardiol. 2020;5:802–810. doi: 10.1001/jamacardio.2020.0950. - DOI - PMC - PubMed