The relationship between cardiac injury, inflammation and coagulation in predicting COVID-19 outcome

Mengozzi, Alessandro; Georgiopoulos, Georgios; Falcone, Marco; Tiseo, Giusy; Pugliese, Nicola Riccardo; Dimopoulos, Meletios A.; Ghiadoni, Lorenzo; Barbieri, Greta; Forfori, Francesco; Carrozzi, Laura; Santini, Massimo; Monzani, Fabio; De Marco, Salvatore; Menichetti, Francesco; Virdis, Agostino; Masi, Stefano

High sensitivity troponin T (hsTnT) is a strong predictor of adverse outcome during SARS-CoV-2 infection. However, its determinants remain partially unknown. We aimed to assess the relationship between severity of inflammatory response/coagulation abnormalities and hsTnT in Coronavirus Disease 2019 (COVID-19). We then explored the relevance of these pathways in defining mortality and complications risk and the potential effects of the treatments to attenuate such risk. In this single-center, prospective, observational study we enrolled 266 consecutive patients hospitalized for SARS-CoV-2 pneumonia. Primary endpoint was in-hospital COVID-19 mortality. hsTnT, even after adjustment for confounders, was associated with mortality. D-dimer and CRP presented stronger associations with hsTnT than PaO(2). Changes of hsTnT, D-dimer and CRP were related; but only D-dimer was associated with mortality. Moreover, low molecular weight heparin showed attenuation of the mortality in the whole population, particularly in subjects with higher hsTnT. D-dimer possessed a strong relationship with hsTnT and mortality. Anticoagulation treatment showed greater benefits with regard to mortality. These findings suggest a major role of SARS-CoV-2 coagulopathy in hsTnT elevation and its related mortality in COVID-19. A better understanding of the mechanisms related to COVID-19 might pave the way to therapy tailoring in these high-risk individuals.