Acute Myocardial Injury Assessed by High-Sensitive Cardiac Troponin Predicting Severe Outcomes and Death in Hospitalized Patients with COVID-19 Infection.

BACKGROUND: Cardiac injury has been linked to a poor prognosis during COVID-19 disease. Nevertheless, the risk factors associated are yet to be thoroughly investigated. OBJECTIVES: We sought to compare demographical characteristics and in-hospital outcomes in patients infected by the SARS-CoV-2 with and without cardiac injury, to further investigate the prevalence of acute cardiac injury as well as its impact on their outcomes in COVID-19-patients. METHODS: We included in a retrospective analysis, all COVID-19 patients admitted between October first and December first, 2020, at the University Hospital Center of Oujda (Morocco) who underwent a troponin assay which was systematically measured on admission. The study population was divided into two groups: cardiac-injured patients and those without cardiac injury. Clinical, biological data and in-hospital outcomes were compared between the two groups. RESULTS: 298 confirmed COVID-19 cases were included. Our study found that compared to non-cardiac-injured, cardiac-injured patients are older, with higher possibilities of existing comorbidities including hypertension (68 [42.2%] vs 40 [29.2%], P = 0.02), diabetes (81 [50.3%] vs 53 [38.7%] P = 0.044), the need for mechanical ventilation, ICU admission and mortality. A Cox proportional hazards regression analysis shows a significantly increased risk of death among cardiac-injured COVID-19-patients as compared to non-cardiac injured. (HR, 1.620 [CI 95%: 2.562-1.024]). CONCLUSION: Our retrospective cohort found that old age, comorbidities, a previous history of CAD, were significantly associated with acute cardiac injury. COVID-19 patients with acute cardiac injury are at a higher risk of ICU admission, and death.

Diagnostic Accuracy of D-Dimers for Predicting Pulmonary Embolism in COVID-19-Patients.

IMPORTANCE: Proinflammatory and hypercoagulable states with marked elevation seen in D-Dimer levels have been accurately described in patients infected by the SARS- Cov2 even without pulmonary embolism (PE). OBJECTIVES: To compare D-dimers values in patients infected by the novel Coronavirus 2019 (COVID-19) with and without PE and to establish an optimal D-dimer cut-off to predict the occurrence of PE, which guides pulmonary computed tomography angiography (CTPA) indication. METHODS: We retrospectively enrolled all COVID-19-patients admitted between October first and November 22th, 2020, at the University Hospital Center of Mohammed VI, Oujda (Morocco), suspected to have PE and underwent a CTPA. Demographic characteristics and blood test results were compared between PE-positive and PE-negative. The receiver operating characteristics (ROC) curve was constructed to establish an optimal D-Dimer cut-off to predict the occurrence of PE. RESULTS: The study population consisted of 84 confirmed COVID-19-patients. The mean age was 64.93 years (SD 14.19). PE was diagnosed on CTPA in 31 (36.9%) patients. Clinical symptoms and in-hospital outcomes were similar in both groups except that more men had PE (p = .025). The median value of D-dimers in the group of patients with PE was significantly higher (14 680[IQR 33620-3450]ng/mL compared to the group of patients without PE 2980[IQR 6870-1600]ng/mL [P < .001]. A D-dimer at 2600 ng/mL was the optimal cut-off for predicting PE with a sensitivity of 90.3%, and AUC was .773[CI 95%, .667 -.876). CONCLUSION: A D-dimer cut-off value of 2600 ng/mL is a significant predictor of PE in COVID-19-patients with a sensitivity of 90.3%.

D-dimer Level and Diabetes in the COVID-19 Infection.

INTRODUCTION: Diabetes is the most common of comorbidity in patients with SARS-COV-2 pneumonia. Coagulation abnormalities with D-dimer levels are increased in this disease. OBJECTIFS: We aimed to compare the levels of D-dimer in diabetic and non-diabetic patients with COVID 19. A link between D-dimer and mortality has also been established. MATERIALS: A retrospective study was carried out at the University Hospital Center of Oujda (Morocco) from November 01st to December 01st, 2020. Our study population was divided into two groups: a diabetic group and a second group without diabetes to compare clinical and biological characteristics between the two groups. In addition, the receiver operator characteristic curve was used to assess the optimal D-dimer cut-off point for predicting mortality in diabetics. RESULTS: 201 confirmed-COVID-19-patients were included in the final analysis. The median age was 64 (IQR 56-73), and 56% were male. Our study found that D-dimer levels were statistically higher in diabetic patients compared to non-diabetic patients. (1745 vs 845 respectively, P = 0001). D-dimer level > 2885 ng/mL was a significant predictor of mortality in diabetic patients with a sensitivity of 71,4% and a specificity of 70,7%. CONCLUSION: Our study found that diabetics with COVID-19 are likely to develop hypercoagulation with a poor prognosis.

Bilateral Pulmonary Embolism in Patients Recovered From Asymptomatic COVID-19 Infection.

Hypercoagulability state is common in patients with coronavirus disease 2019 (COVID-19), especially those requiring intensive care. Indeed, anticoagulation therapy is recommended for all hospitalized COVID-19-patients. Despite well-conducted thromboprophylaxis, so many patients have developed these life-threatening complications. However, these thrombotic events are not known to occur in asymptomatic COVID-19 patients or in those recovered from active severe acute respiratory syndrome coronavirus 2 infection. This case series of a bilateral pulmonary embolism that occurred in patients recovered from asymptomatic COVID-19 highlights the questions about extending thromboprophylaxis in ambulatory patients with COVID-19.