23 research outputs found
Myocardial Work in Patients Hospitalized With COVIDâ19:Relation to Biomarkers, COVIDâ19 Severity, and AllâCause Mortality
BACKGROUND: COVIDâ19 infection has been hypothesized to affect left ventricular function; however, the underlying mechanisms and the association to clinical outcome are not understood. The global work index (GWI) is a novel echocardiographic measure of systolic function that may offer insights on cardiac dysfunction in COVIDâ19. We hypothesized that GWI was associated with disease severity and allâcause death in patients with COVIDâ19. METHODS AND RESULTS: In a multicenter study of patients admitted with COVIDâ19 (n=305), 249 underwent pressureâstrain loop analyses to quantify GWI at a median time of 4âdays after admission. We examined the association of GWI to cardiac biomarkers (troponin and NTâproBNP [Nâterminal proâBâtype natriuretic peptide]), disease severity (oxygen requirement and CRP [Câreactive protein]), and allâcause death. Patients with elevated troponin (n=71) exhibited significantly reduced GWI (1508 versus 1707âmmâHg%; P=0.018). A curvilinear association to NTâproBNP was observed, with increasing NTâproBNP once GWI decreased below 1446âmmâHg%. Moreover, GWI was significantly associated with a higher oxygen requirement (relative increase of 6% per 100âmmâHg% decrease). No association was observed with CRP. Of the 249 patients, 37 died during followâup (median, 58âdays). In multivariable Cox regression, GWI was associated with allâcause death (hazard ratio, 1.08 [95% CI, 1.01â1.15], per 100âmmâHg% decrease), but did not increase Câstatistics when added to clinical parameters. CONCLUSIONS: In patients admitted with COVIDâ19, our findings indicate that NTâproBNP and troponin may be associated with lower GWI, whereas CRP is not. GWI was independently associated with allâcause death, but did not provide prognostic information beyond readily available clinical parameters. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04377035
Treatment with prophylactic oral anticoagulants and the risk of mortality in COVID-19 patients: a nationwide cohort study
Background
Venous thromboembolism has been reported in patients with coronavirus disease 2019 (COVID-19). It remains unclear if premorbid use of prophylactic oral anticoagulation, for reasons other than COVID-19, protects against death in patients with COVID-19. The aim of this study was to estimate if the risk of all-cause mortality, hospital admission or intensive care unit (ICU) admission for individuals with verified SARS-CoV-2 was lower if patients used oral anticoagulant (OAC) therapy prior to a positive COVID-19 status.
Methods
Data were obtained using national health registries. Cohort entry was the day of a positive SARS-CoV-2 test, and individuals were followed for 14â
days or until death or hospital admission. Adjusted Cox proportional hazard regressions and competing risk analyses were used to estimate the risk of all-cause mortality, hospital admission and ICU admission in OAC users compared with patients with no use of OAC.
Results
In this nationwide cohort study a total of 244â522 individuals were included (median age 35â
years (interquartile range 21â52); 124â095 (51%) female), among whom 3710 (1.5%) were OAC users. In the adjusted Cox regression cohort, there was no difference in risk of all-cause mortality in OAC versus non-OAC users. (hazard ratio (HR) 1.13, 95% CI 0.99â1.30). Hospital admission risk (HR 1.11, 95% CI 1.02â1.20) was slightly increased in OAC users, and there was no difference between the groups regarding the risk of ICU admission (HR 0.96, 95% CI 0.74â1.24).
Conclusions
In individuals with confirmed SARS-CoV-2, pre-existing treatment with OAC was not associated with prophylactic benefits in the prevention of hospital admission, ICU admissions or death. Prescription patterns should remain unchanged