ABSTRACT
Aim: Although there are few studies on the predictive value of C-reactive protein-to-albumin ratio (CAR) in coronavirus disease-2019 (COVID-19) patients, to the best of our knowledge, there are no studies specifically conducted in COVID-19 patients with cardiovascular disease (CVD). This study assessed the use of baseline CAR levels to predict death in hospitalized COVID-19 patients with CVD. Methods: This study was designed as a single-center cross-sectional study. Patients diagnosed with COVID-19 who were admitted to the University of Health Sciences Turkey, Bagcilar Training and Research Hospital between April 16 and May 20, 2020 were analyzed retrospectively. The patients were divided into 2 groups: those who died and those who survived, considering the follow-up period. The CAR values of the study population, as well as patients with CVD, were calculated, and the association of CAR with in-hospital mortality was evaluated. Results: The in-hospital mortality rate was 11.1% (49/442 pts) in all populations. Deceased patients had significantly more frequent CVD (p<0.001) and the mortality rate was 34.4% (30/96 pts) in those patients. Median CAR values were higher in nonsurvivors than among survivors (p<0.001). Multivariate analysis demonstrated that CAR was an independent predictor of mortality in patients with CVD [hazard ratio 1.013 (95% confidence interval: 1.002-1.022), p=0.018]. Conclusion: CAR is an inflammatory risk marker that independently predicts mortality in all COVID-19 hospitalized patients and patients with CVD.
ABSTRACT
OBJECTIVE: We aimed to test the efficiency of CHA2DS2-VASc, CHA2DS2-VASc-HS, R2CHA2DS2-VASc score systems on the prediction of mortality in the patients with COVID-19. PATIENTS AND METHODS: The data were collected from 508 hospitalized patients with COVID-19. Comorbidity features including coronary artery disease, peripheral arterial disease, congestive heart failure, hypertension, atrial fibrillation, diabetes mellitus, hyperlipidemia, smoking, chronic obstructive pulmonary disease, cerebrovascular event, cancer status, and renal disease were recorded. The patients were divided as surviving group (n=440) and non-survivors (n=68). RESULTS: The in-hospital mortality rate of the patients with COVID-19 was 13.4%. Factors found to be associated with mortality in univariate analysis were CHA2DS2-VASc, CHA2DS2-VASc-HS, R2CHA2DS2-VASc, cancer state, atrial fibrillation, hemoglobin, lymphocyte count, CRP, albumin and ferritin. Model 1 multivariate cox regression analysis revealed CHA2DS2-VASc, hemoglobin, CRP and ferritin levels to be independently associated with mortality. Factors that were found to be independently associated with in-hospital mortality in Model 2 analysis were CHA2DS2-VASc-HS, R2CHA2DS2-VASc, hemoglobin, CRP and ferritin whereas except hemoglobin in Model 3 analysis, the other variables had been the same. Predictive power of R2CHA2DS2-VASc was better than of both CHA2DS2-VASc (p=0.002) and CHA2DS2-VASc-HS (p=0.034) in determining the in-hospital mortality. Patients with higher R2CHA2DS2-VASc (> 3 points), CHA2DS2-VASc-HS (> 3 points) and CHA2DS2-VASc (> 2 points) scores exhibited the highest mortality rate in survival analysis by using Kaplan-Meier and long-rank tests. CONCLUSIONS: CHA2DS2-VASc, CHA2DS2-VASc-HS, and R2CHA2DS2-VASc were found to be independent predictors of mortality in hospitalized COVID-19 patients. The current study revealed that the predictive ability of R2CHA2DS2-VASc was better than the both of CHA2DS2-VASc and CHA2DS2-VASc-HS score.
Subject(s)
COVID-19/mortality , Comorbidity , Severity of Illness Index , Adult , Aged , Aged, 80 and over , Area Under Curve , COVID-19/pathology , COVID-19/virology , Female , Hemoglobins/analysis , Hospital Mortality , Hospitalization , Humans , Kaplan-Meier Estimate , Lymphocyte Count , Male , Middle Aged , Proportional Hazards Models , ROC Curve , SARS-CoV-2/isolation & purificationABSTRACT
OBJECTIVE: The primary objective of this study was to evaluate the frequency and impact of acute myocardial injury on prognosis in hospitalized COVID-19 patients. PATIENTS AND METHODS: This was a retrospective study that included consecutive hospitalized patients with COVID-19. Clinic-demographic characteristics, laboratory values, and high-sensitivity troponin I were extracted from the electronic database. Mortality and other clinical complications, including respiratory failure requiring invasive mechanical ventilation and acute kidney injury were recorded. Myocardial injury was defined as having a serum troponin I value >19.8 ng/mL. We performed Kaplan-Meier survival analysis and Cox regression to determine survival times and independent predictors of mortality. RESULTS: A total of 324 patients were included. Seventy-seven patients (23.8%) had acute myocardial injury. The primary outcome measure, namely death, occurred in 54.5% and 3.2% of the patients with and without myocardial injury, respectively. Notably, 75.3% of the patients with myocardial injury and 6.5% of the patients without myocardial injury developed ARDS. Overall, 50 out of 324 patients (15.4%) died during the study period. The mortality rate was 54.5% in patients with myocardial injury and 3.2% in patients without myocardial injury. Mean survival times were significantly different between the groups (15.1±0.9 days in patients with myocardial injury and 24.4±0.7 days in patients without myocardial injury, log-rank test p-value <0.001). CONCLUSIONS: The presence of chronic kidney disease and application of invasive mechanical ventilation were found to be independent predictors of in-hospital mortality. The presence of acute myocardial injury was common but not independently associated with mortality among hospitalized COVID-19 patients.