Implications of myocardial injury in Mexican hospitalized patients with coronavirus disease 2019 (COVID-19)

Background: Respiratory illnesses is the most common manifestation of Coronavirus disease 2019 (COVID-19); however, myocardial injury has recently emerged as a frequent complication. Methods: An observational, longitudinal, prospective, and multicenter study of hospitalized Mexican patients was made. We assessed the prevalence of myocardial injury and its relationship with complications and mortality. Results: 254 COVID-19 patients were included. Their average age was 53.8 years old, 167 (65.7%) were male and 87 (34.3%) female. According to troponin levels, two populations were generated, those with and without myocardial injury. There was no difference in gender or age between both groups. However, there was a greater proportion of obesity and hypertension in myocardial injury group. Multivariate logistic regression analysis revealed that obesity (OR 2.029, 95% CI 1.039-3.961; p = 0.038), arterial oxygen saturation <90% (OR 2.250, 95% CI 1.216-3.560; p = 0.025), and systolic blood pressure <90 mmHg (OR 2.636, 95% CI 1.530-4.343; p = 0.042), were directly related to higher levels of troponins. Multivariate cox proportional hazards analysis showed that primary endpoint (mortality) was determined by overweight/obesity (OR 1.290, 95% CI 0.115-0.730; p = 0.009), ferritin levels (OR 1.001, 95% CI 1.000-1.001; p < 0.001), myocardial injury (OR 3.764, 95% CI 1.307-10.838; p = 0.014), septic shock (OR 4.104, 95% CI 1.142-14.132; p = 0.024), acute respiratory distress syndrome (OR 3.001, 95% CI 1.008-10.165; p = 0.040), and treatment with Hydroxychloroquine/Azithromycin (OR 0.357, 95% IC 0.133-0.955; p = 0.040). Secondary endpoint (Mechanical ventilation risk) was associated to the same factors. Conclusions: Myocardial injury represents an increased risk of complications and death in Mexican hospitalized patients with COVID-19. (C) 2020 The Author(s). Published by Elsevier B.V.