Serial measurements of myocardial injury in mechanically ventilated patients with COVID-19
Serial Assessment of Myocardial Injury Markers in Mechanically Ventilated Patients With SARS-CoV-2 (from the Prospective MaastrICCht Cohort)
Introduction and methods
There is a strong association between myocardial injury in COVID-19 and in-hospital mortality [1-3]. However, the development of myocardial injury over time and whether myocardial injury in patients with COVID-19 at the intensive care unit (ICU) is associated with outcome, has not yet been elucidated.
Aim of the study
The objective of this study was to investigate myocardial injury by serial measurements of cardiac biomarkers and serial ECGs over the full course of ICU admission in mechanically ventilated patients with COVID-19, comparing ICU survivors with non-survivors.
This study – which took place between March 25, 2020 to June 23, 2020 – was part of a larger prospective observational study, the Maastricht Intensive Care COVID (MaastrICCht) cohort. A total of 90 patients with respiratory insufficiency who required mechanical ventilation and who had a positive SARS-CoV-2 test and/or chest CT scan strongly suggestive for SARS-CoV-2 infection was included in the final analysis. Of those, 37% were ICU non-survivors and 63% were ICU survivors. Patients were followed up until death in the ICU or discharge from the ICU. High-sensitivity cardiac troponin T (hs-cTnT), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels were assessed daily and serial ECGs were collected at least every other day.
- Survivors had lower log-hs-cTnT than non-survivors at day 1 (β -0.93, 95%CI:1.37 to -0.49, P<0.001). This association stayed significant after correction for gender, age, APACHE II score, creatinine concentrations and CV risk factors. Change in log-hs-cTnT over time was not significant different between the 2 groups.
- There was no difference in log-NT-proBNP at day 1 between both groups, but log-NT-proBNP decreased more over time in the survivors (β -0.08, 95%CI: -0.11 to -0.04, P<0.001) compared with non-survivors. This association stayed significant after correction for gender, age, APACHE II score, creatinine concentrations and COVID-19 related CV risk factors.
- Both survivors and non-survivors had many ECG abnormalities; there were no significant differences between both groups.
Higher hs-cTnT at time of admission and an increase in NT-proBNP over time are strongly associated with mortality in mechanically ventilated patients with COVID-19, irrespective of gender, age, APACHE II score, daily creatinine concentrations and COVID-19 related CV risk factors.