Remdesivir, dexamethasone and angiotensin-converting enzyme inhibitors use and mortality outcomes in COVID-19 patients with concomitant troponin elevation

BACKGROUND There are indications that viral myocarditis,demand ischemia,and renin-angio-tensin-aldosterone system pathway activation play essential roles in troponin elevation in coronavirus disease 2019(COVID-19)patients.Antiviral medications and steroids are used to treat viral myocarditis,but their effect in patients with elevated troponin,possibly from myocarditis,has not been studied.AIM To evaluate the effect of dexamethasone,remdesivir,and angiotensin-converting enzyme(ACE)inhibitors(ACEI)on mortality in COVID-19 patients with elevated troponin.METHODS Our retrospective observational study involved 1788 COVID-19 patients at seven hospitals in Southern California,United States.We did a backward selection Cox multivariate regression analysis to determine predictors of mortality in our study population.Additionally,we did a Kaplan Meier survival analysis in the subset of patients with elevated troponin,comparing survival in patients that received dexamethasone,remdesivir,and ACEI with those that did not.RESULTS The mean age was 66 years(range 20-110),troponin elevation was noted in 11.5%of the patients,and 29.9%expired.The patients'age[hazard ratio(HR)=1.02,P<0.001],intensive care unit admission(HR=5.07,P<0.001),and ventilator use(HR=0.68,P=0.02)were significantly associated with mortality.In the subset of patients with elevated troponin,there was no statistically significant difference in survival in those that received remdesivir(0.07),dexamethasone(P=0.63),or ACEI(P=0.8)and those that did not.CONCLUSION Although elevated troponin in COVID-19 patients has been associated with viral myocarditis and ACE II receptors,conventional viral myocarditis treatment,including antiviral and steroids,and ACEI did not show any effect on mortality in these patients.

Living with liver disease in the era of COVID-19-the impact of the epidemic and the threat to high-risk populations

The cardinal symptoms of severe acute respiratory syndrome coronavirus 2 infection as the pandemic began in 2020 were cough,fever,and dyspnea,thus characterizing the virus as a predominantly pulmonary disease.While it is apparent that many patients presenting acutely to the hospital with coronavirus disease 2019(COVID-19)infection have complaints of respiratory symptoms,other vital organs and systems are also being affected.In fact,almost half of COVID-19 hospitalized patients were found to have evidence of some degree of liver injury.Incidence and severity of liver injury in patients with underlying liver disease were even greater.According to the Centers of Disease Control and Prevention,from August 1,2020 to May 31,2022 there have been a total of 4745738 COVID-19 hospital admissions.Considering the gravity of the COVID-19 pandemic and the incidence of liver injury in COVID-19 patients,it is imperative that we as clinicians understand the effects of the virus on the liver and conversely,the effect of underlying hepatobiliary conditions on the severity of the viral course itself.In this article,we review the spectrum of novel studies regarding COVID-19 induced liver injury,compiling data on the effects of the virus in various age and high-risk groups,especially those with preexisting liver disease,in order to obtain a comprehensive understanding of this disease process.We also provide an update of the impact of the new Omicron variant and the changing nature of COVID-19 pathogenesis.