J Korean Med Sci.  2020 Oct;35(39):e349. 10.3346/jkms.2020.35.e349.

The Implication of Cardiac Injury Score on In-hospital Mortality of Coronavirus Disease 2019

• Kim IC
• Song JE
• Lee HJ
• Park JH
• Hyun M
• Lee JY
• Kim HA
• Kwon YS
• Park JS
• Youn JC
• Hwang J
• Lee CH
• Cho YK
• Park HS
• Yoon HJ
• Nam CW
• Han S
• Hur SH
• Eisen HJ
• Kim H

• KMID: 2507610
• DOI: http://doi.org/10.3346/jkms.2020.35.e349

Abstract

Background
s: The severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) has spread worldwide. Cardiac injury after SARS-CoV-2 infection is a major concern. The present study investigated impact of the biomarkers indicating cardiac injury in coronavirus disease 2019 (COVID-19) on patients' outcomes.
Methods
This study enrolled patients who were confirmed to have COVID-19 and admitted at a tertiary university referral hospital between February 19, 2020 and March 15, 2020. Cardiac injury was defined as an abnormality in one of the following result markers: 1) myocardial damage marker (creatine kinase-MB or troponin-I), 2) heart failure marker (N-terminal-pro B-type natriuretic peptide), and 3) electrical abnormality marker (electrocardiography). The relationship between each cardiac injury marker and mortality was evaluated. Survival analysis of mortality according to the scoring by numbers of cardiac injury markers was also performed.
Results
A total of 38 patients with COVID-19 were enrolled. Twenty-two patients (57.9%) had at least one of cardiac injury markers. The patients with cardiac injuries were older (69.6 ± 14.9 vs. 58.6 ± 13.9 years old, P = 0.026), and were more male (59.1% vs. 18.8%, P = 0.013). They showed lower initial oxygen saturation (92.8 vs. 97.1%, P = 0.002) and a trend toward higher mortality (27.3 vs. 6.3%, P = 0.099). The increased number of cardiac injury markers was significantly related to a higher incidence of in-hospital mortality which was also evidenced by Kaplan-Meier survival analysis (P = 0.008).
Conclusion
The increased number of cardiac injury markers is related to in-hospital mortality in patients with COVID-19.

Keyword

Coronavirus; COVID-19; Cardiac Injury Markers; In-hospital Mortality

Figure

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  Fig. 1 Proportion of the components of cardiac injury markers according to the cardiac injury score. Sum of the proportion in each cardiac injury marker is 100% for score 1, 200% for score 2, and 300% for score 3.

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  Fig. 2 Kaplan-Meier survival curve for in-hospital mortality according to the cardiac injury score. Kaplan-Meier survival analysis showed significantly lower survival as the cardiac injury score increases.

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  Fig. 3 Algorithm for the evaluation of the cardiac injury and risk stratification in COVID-19. After the cardiac evaluation according to the physician's discretion based on the patient's condition, the cardiac injury score was calculated for the stratification of the risk.COVID-19 = coronavirus disease 2019, CT = computed tomography, URL = upper reference limit, ECG = electrocardiography.

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