{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T10:02:12Z","timestamp":1789552932768,"version":"build-2803163510"},"reference-count":20,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: In-hospital mortality remains high among patients with severe or critical COVID-19. This study aimed to identify independent predictors of in-hospital mortality and assess the prognostic value of myocardial injury in this high-risk population. Materials and Methods: This single-center observational cohort study included 172 adults hospitalized with severe or critical COVID-19 across multiple pandemic waves. Mortality-associated factors were assessed using logistic regression and receiver operating characteristic curve analysis. Myocardial injury was defined as hs-cTnT &gt; 14 ng\/L, measured on days 3\u20135 after admission. Results: Of 172 patients, 60 died during hospitalization (34.9%). In the primary multivariable model, based on 126 complete cases and 37 deaths, age (aOR = 2.55 per 10-year increase; 95% CI, 1.55\u20134.22), pre-existing cardiovascular disease (aOR = 3.06; 95% CI, 1.03\u20139.07), LDH (aOR = 6.31 per doubling; 95% CI, 2.70\u201314.78), and CT pulmonary involvement (aOR = 1.34 per 10% increase; 95% CI, 1.01\u20131.80), were independently associated with in-hospital mortality. In a separate analysis of 121 patients with 35 deaths, myocardial injury remained independently associated with mortality after adjustment for age, cardiovascular disease, and pulmonary involvement (aOR = 5.19; 95% CI, 1.82\u201314.77). Among 131 patients with complete phenotype data, mortality was 6.7% (2\/30) in patients with neither component, 19.6% (11\/56) with isolated respiratory involvement, 50.0% (3\/6) with isolated myocardial injury, and 56.4% (22\/39) with both components. The primary multivariable model had an apparent AUC of 0.898 (95% CI, 0.828\u20130.968). Conclusions: Age, LDH, and myocardial injury were independently associated with in-hospital mortality, while the associations of cardiovascular disease and CT involvement were attenuated in the multiple-imputation sensitivity analysis. Combined assessment of clinical, pulmonary, and cardiac factors may improve risk stratification, but these findings require validation in independent cohorts.<\/jats:p>","DOI":"10.3390\/medicina62091775","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T07:58:59Z","timestamp":1789545539000},"page":"1775","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Myocardial Injury and Predictors of In-Hospital Mortality in Severe or Critical COVID-19: A Single-Center Observational Cohort Study"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-5851-0130","authenticated-orcid":false,"given":"Valentina","family":"Negrea","sequence":"first","affiliation":[{"name":"Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 T\u00e2rgu Mure\u0219, Romania"},{"name":"1st Infectious Diseases Clinic, Mure\u0219 Clinical County Hospital, 540064 T\u00e2rgu Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6467-6275","authenticated-orcid":false,"given":"Septimiu Toader","family":"Voidazan","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, 540142 T\u00e2rgu Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9798-1594","authenticated-orcid":false,"given":"Adina","family":"Hu\u021banu","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 T\u00e2rgu Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-4667-3953","authenticated-orcid":false,"given":"Vlad Adrian","family":"Pop","sequence":"additional","affiliation":[{"name":"1st Infectious Diseases Clinic, Mure\u0219 Clinical County Hospital, 540064 T\u00e2rgu Mure\u0219, Romania"},{"name":"Department of Infectious Diseases, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 T\u00e2rgu Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2880-4337","authenticated-orcid":false,"given":"Anca Meda","family":"V\u0103sie\u0219iu","sequence":"additional","affiliation":[{"name":"1st Infectious Diseases Clinic, Mure\u0219 Clinical County Hospital, 540064 T\u00e2rgu Mure\u0219, Romania"},{"name":"Department of Infectious Diseases, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 T\u00e2rgu Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e069881","DOI":"10.1136\/bmj-2021-069881","article-title":"Clinical Prediction Models for Mortality in Patients with Covid-19: External Validation and Individual Participant Data Meta-Analysis","volume":"378","author":"Rousset","year":"2022","journal-title":"BMJ"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"m3339","DOI":"10.1136\/bmj.m3339","article-title":"Risk Stratification of Patients Admitted to Hospital with Covid-19 Using the ISARIC WHO Clinical Characterisation Protocol: Development and Validation of the 4C Mortality Score","volume":"370","author":"Knight","year":"2020","journal-title":"BMJ"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1001\/jama.2016.0287","article-title":"The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)","volume":"315","author":"Singer","year":"2016","journal-title":"JAMA"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Zhou, K., Chen, Y., Pang, J., Zhang, J., and Lu, J. 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