Yang H, Yang L C, Zhang R T, Ling Y P, Ge Q G
Department of Cardiac Surgery, Peking University Third Hospital, Beijing 100191, China.
Department of Cardiology, Peking University Third Hospital, Beijing 100191, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2020 Jun 18;52(3):420-424. doi: 10.19723/j.issn.1671-167X.2020.03.004.
The pathogenesis of myocardial injury upon corona virus disease 2019 (COVID-19) infection remain unknown,evidence of impact on outcome is insufficient, therefore, we aim to investigate the risk factors for death among COVID-19 patients combined with hypertension, coronary heart disease or diabetes in this study.
This was a single-centered, retrospective, observational study. Patients of Sino-French Eco-City section of Tongji Hospital, Wuhan, China attended by Peking University Supporting Medical Team and admitted from Jan. 29, 2020 to Mar. 20, 2020 were included. The positive nucleic acid of COVID-19 virus and combination with hypertension, coronary heart disease or diabetes were in the standard. We collected the clinical data and laboratory examination results of the eligible patients to evaluate the related factors of death.
In the study, 94 COVID-19 patients enrolled were divided into the group of death (13 cases) and the group of survivors (81 cases), the average age was 66.7 years. Compared with the survival group, the death group had faster basal heart rate(103.2 beats/min . 88.4 beats /min, =0.004), shortness of breath(29.0 beats /min . 20.0 beats /min, <0.001), higher neutrophil count(9.2×10/L . 3.8×10/L, <0.001), lower lymphocyte count(0.5×10/L . 1.1×10/L, <0.001), creatine kinase MB(CK-MB, 3.2 μg/L . 0.8 μg/L, <0.001), high sensitivity cardiac troponin Ⅰ(hs-cTnⅠ, 217.2 ng/L . 4.9 ng/L, <0.001), N-terminal pro brain natriuretic peptide(NT-proBNP; 945.0 μg/L . 154.0 μg/L, <0.001), inflammatory factor ferritin(770.2 μg/L . 622.8 μg/L , =0.050), interleukin-2 recepter(IL-2R, 1 586.0 U/mL . 694.0 U/mL, <0.001), interleukin-6(IL-6, 82.3 ng/L 13.0 ng/L, <0.001), interleukin-10(IL-10, 9.8 ng/L . 5.0 ng/L, <0.001)were higher than those in the survival group. Univariate logistic regression analysis showed that the risk factors for death were old age, low non oxygen saturation, low lymphocyte count, myocardial injury, abnormal increase of IL 2R, IL-6, and IL-10. Multivariate regression showed that old age (=1.11, 95%=1.03-1.19, =0.026), low non oxygen saturation(=0.85, 95%=0.72-0.99, =0.041), and abnormal increase of IL-10(＞9.1 ng/L, =101.93, 95%=4.74-2190.71, =0.003)were independent risk factors for COVID-19 patients combined with hypertension, coronary heart disease or diabetes.
In COVID-19 patients combined with hypertension, coronary heart disease or diabetes, the risk factors for death were old age, low non oxygen saturation, low lymphocyte count, myocardial injury, and abnormal increase of IL-2R, IL-6, and IL-10. Old age, low non oxygen saturation and abnormal increase of IL-10 were independent risk factors.
2019年冠状病毒病（COVID-19）感染后心肌损伤的发病机制尚不清楚，对预后影响的证据不足，因此，本研究旨在探讨COVID-19合并高血压、冠心病或糖尿病患者死亡的危险因素。
这是一项单中心、回顾性、观察性研究。纳入2020年1月29日至2020年3月20日由北京大学支援医疗队诊治并收治于武汉同济医院中法生态城院区的患者。符合COVID-19病毒核酸阳性且合并高血压、冠心病或糖尿病的标准。收集符合条件患者的临床资料和实验室检查结果，以评估死亡相关因素。
本研究纳入的94例COVID-19患者分为死亡组（13例）和存活组（81例），平均年龄66.7岁。与存活组相比，死亡组基础心率更快（103.2次/分对88.4次/分，P=0.004）、呼吸急促（29.0次/分对20.0次/分，P<0.001）、中性粒细胞计数更高（9.2×10⁹/L对3.8×10⁹/L，P<0.001）、淋巴细胞计数更低（0.5×10⁹/L对1.1×10⁹/L，P<0.001）、肌酸激酶同工酶（CK-MB，3.2μg/L对0.8μg/L，P<0.001）、高敏心肌肌钙蛋白Ⅰ（hs-cTnⅠ，217.2ng/L对4.9ng/L，P<0.001）、N末端脑钠肽前体（NT-proBNP；945.0μg/L对154.0μg/L，P<0.001）、炎症因子铁蛋白（770.2μg/L对622.8μg/L，P=0.050）、白细胞介素-2受体（IL-2R，1586.0U/mL对694.0U/mL，P<0.001）、白细胞介素-6（IL-6，82.3ng/L对13.0ng/L，P<0.001）、白细胞介素-10（IL-10，9.8ng/L对5.0ng/L，P<0.001）均高于存活组。单因素logistic回归分析显示，死亡的危险因素为高龄、低血氧饱和度、低淋巴细胞计数、心肌损伤、IL-2R、IL-6和IL-10异常升高。多因素回归显示，高龄（β=1.11，95%CI=1.03-1.19，P=0.026）、低血氧饱和度（β=0.85，95%CI=0.72-0.99，P=0.041）和IL-10异常升高（>9.1ng/L，β=101.93，95%CI=4.74-219,.71，P=0.003）是COVID-19合并高血压、冠心病或糖尿病患者的独立危险因素。
在COVID-19合并高血压、冠心病或糖尿病患者中，死亡的危险因素为高龄、低血氧饱和度、低淋巴细胞计数、心肌损伤以及IL-2R、IL-6和IL-1
