The role of cardiac troponin-I as a prognostic tool for mortality in patients hospitalized with COVID-19

Background

Coronavirus disease 2019 (COVID-19) has been associated with significant morbidity and mortality, with cardiovascular involvement being usual. Elevations in cardiac Troponin-I level has proposed as an independent biomarker for mortality among patients with COVID-19.

Aim

To evaluate the role of high sensivity Troponin-I (hs-TnI) level at hospital admission in predicting 30 day in-hospital mortality and 6-month mortality in patients hospitalized with a COVID-19 diagnosis.

Methods

We performed a retrospective single-center cohort study including consecutive patients aged 18 years and older who were admitted for COVID-19, during a 1-year period (n=818). We excluded patients with acute coronary syndrome (n=23), patients with acute heart failure (n=42), and patients in which hs-TnI level was not dosed at admission (n=163). Patients were divided into two groups according to hs-TnI levels: hs-TnI <19.8 vs hs-TnI ≥19.8 pg/mL. Primary outcomes were 30-day in-hospital mortality and 6-months mortality. According to the data distribution, appropriate statistical tests were conducted to compare independent samples. Multivariable logistic regression was used to analyze mortality risk. Receiver operator characteristics (ROC) curve and area under the curve (AUC) were obtained to determine the discriminative power of hs-TnI as a predictor of mortality. (Figure 1).

Results

This cohort included 590 patients. Mean age was 71 ≥±15 years and 52.4% were men. Overall, 209 patients (35.4%) had elevated hs-TnI levels and 381 patients had normal hs-TnI levels. Individuals in the hs-TnI ≥19.8 pg/mL group were older (80±11 vs 66±14 years, p<0.001) and presented higher prevalence of chronic heart failure (24.9% vs 7.1%, p<0.001), hypertension (77.0% vs 57.5%, p<0.001), atrial fibrillation/flutter (19.1% vs 5.5%, p<0.001), prior stroke (12.4% vs 5.2%, p=0.001) and ischemic heart disease (12.4% vs 3.7%, p<0.001). There was no difference in length of hospital stay between the groups (8.0 [IQR 9.6] in hs-TnI 19.8 pg/mL group vs 9.0 [IQR 8.0] normal hs-TnI group, p=0.669). Troponin-I was the only independent predictor of in-hospital mortality (OR 3.80, CI 95%: 2.44–5.93, p<0.001), see Table 1. The troponin levels had the highest area under the receiver operating characteristic curv (AUC) with an AUC of 0.705 (95% CI: 0.667–0.742, p<0.001) for association with the in-hospital mortality (figure 1). There was no difference in 6-months mortality between the two groups.

Conclusion

Acute myocardial injury is common in patients hospitalized with COVID-19. In the present study a TnI level ≥19.8 pg/mL was predictor of 30 days in-hospital mortality, suggesting that raised levels of this biomarker is associated with adverse prognosis. This tool might be useful for COVID-19 patient risk stratification. Further studies are needed to provide robust data and reliable recommendations on this theme.

Funding Acknowledgement

Type of funding sources: None.

Prognostic markers of low-grade squamous intraepithelial lesions: the role of topoisomerase IIalpha and active caspase-3

PURPOSE

To study the relationship between topoisomerase IIalpha, active caspase-3 expressions and HPV DNA in uterine cervices with low-grade squamous intraepithelial lesions (LSIL).

METHODS

Forty women with LSIL and 32 without cervical neoplasia diagnosed through cytologic and histopathologic examination were evaluated regarding topoisomerase IIalpha and active caspase-3 expressions and HPV DNA detection using PCR (GP5/GP6) in cervicovaginal smears.

RESULTS

The mean percentage of cells immunomarked by topoisomerase in the group with LSIL was 11.62% while in the control it was 4.13% (p < 0.0001). In the presence of HPV DNA, topoisomerase expression was higher in the group with productive viral infection than in nonneoplastic tissue (p = 0.004). Caspase-3 expression was observed in 17 patients with LSIL (42.5%) and in five without cervical neoplasia (15.63%).

CONCLUSION

The use of topoisomerase IIalpha and active caspase-3 in cervical biopsies may help to define the prognosis of HPV cervical infection.

[Lupus band test: diagnostic value in disseminated lupus erythematosus]

By direct immunoflurescence, deposits of immunoglubins and complement were investigated at the dermal epidermal junction in skin specimens from 210 patients divided into three groups: A--134 patients without lupus; B--54 patients with Systemic Lupus Erythematosus (SLE); C--22 patients with Discoid Lupus Erythematosus. Twenty two patients from group B were submitted to renal biopsy: 20 of these demonstrated a positive lupus band test and data suggested a positive correlation between the intensity of immunoglobulin and complement deposition at the dermal epidermal junction with more severe renal involvement. The other 32 patients were not submitted to renal biopsy; in sediment and band test, may be of value in the prevision of patients with higher probability of developing more serious renal lesions. Our results revealed a high specificity (85.5%) and sensitivity (87%). Test positivity was uninfluenced by steroid and immunosuppressive therapy. The test appears to be of great interest for use on all patients who fail to meet the criteria for the diagnosis of SLE but whose condition suggest such a diagnosis.