Association among myocardial injury and mortality in Influenza: A prospective cohort study. (15th December 2022)

• Record Type: Journal Article
• Authors: Biasco, Luigi; Valotta, Amabile; Klersy, Catherine; Valgimigli, Marco; Gabutti, Luca; Bruna, Roberto Della; Pagnamenta, Alberto; Ruinelli, Lorenzo; Senatore, Gaetano; Pedrazzini, Giovanni B.
• Is Part Of: International journal of cardiology. Volume 369(2022)
• Page Start: 48
• Page End: 53
• Publication Date: 2022-12-15
• Subjects: Myocarditis -- Myocardial injury -- Troponin -- Biomarker -- Influenza -- Mortality; ARDS Acute Respiratory Distress Syndrome -- COPD Chronic Obstructive Pulmonary Disease -- COVID-19 Coronavirus Disease-19 -- CRP C-reactive protein -- hs-cTnT High Sensitivity Cardiac Troponin T -- ICU Intensive Care Unit -- IQR Interquartile Range -- LVEF Left Ventricular Ejection Fraction -- MINJ Myocardial Injury -- pts patients; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2022.08.016
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Myocardial injury (MINJ) is a well-recognized prognostic marker in different acute cardio-respiratory illnesses, nonetheless, its relevance in Influenza remains poorly defined. Our aim was to assess incidence, correlates, short and mid-term prognostic role of MINJ in Influenza. Methods: Hospitalized patients (pts) with laboratory confirmed Influenza A or B underwent highly sensitive cardiac T Troponin (hs-cTnT) measurement at admission in four regional Swiss hospitals during the 2018–2019 epidemic. MINJ was defined as hs-cTnT >14 ng/L. Clinical, laboratory and outcome data were prospectively collected. The primary endpoint was mortality at 28 days while the composite of mortality, admission to intensive care unit (ICU) or need for mechanical ventilation at 28-days and mortality at 30-months were set as secondary endpoints. Results: The presence of MINJ was assessed within 48 h from admission in 145 consecutive hospitalized pts, being evident in 94 (65.5%) pts and associated with older age, higher C-reactive protein levels, renal impairment or chronic obstructive pulmonary disease. At a 28-days follow-up, 7 deaths (4.8%) occurred, all in patients with MINJ at admission (log-rank p = 0.048). MINJ was strongly associated with occurrence of death, ICU admission or mechanical ventilation (OR 5.74, 95% CI 1.28–53.29; p = 0.015). After a median follow-up of 32.7 months (IQR 32.2–33.4), 15 (10.3%) deaths occurred, all among pts with MINJ at index hospitalization leading to a higher mortality at follow-up among patients with MINJ (log-rank p = 0.003). Conclusions: MINJ is common in patients hospitalized for Influenza and is able to stratify the risk of short-term adverse events and mid-term mortality. Highlights: Myocardial injury is a prognostic factor in critically ill patients with Influenza. Myocardial injury is common in Influenza, evident in 65.5% of hospitalized patients. Influenza associated myocardial injury stratifies short term risk of adverse events. Mid term mortality is higher in patients with Influenza associated myocardial injury.