COVID-19 合并心脏损伤患者的死亡、出院和心律失常。
Death, discharge and arrhythmias among patients with COVID-19 and cardiac injury.
机构信息
Department of Cardiology (Si, Du, Sun, Liu, Yang), The Third Hospital of Jilin University, Jilin Provincial Molecular Biology Research Center for Precision Medicine of Major Cardiovascular Disease, Changchun, China; Department of Ultrasound (Ni), The Third Hospital of Jilin University, Changchun, China; Institute of Organ Transplantation (Yang), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Intensive Care Unit (Jiang), The Third Hospital of Jilin University, Changchun, China; The Hull Family Laboratory (Massé, J. Nanthakumar, Bhaskaran, K. Nanthakumar), Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ont.; Department of Epidemiology and Biostatistics (Jin), School of Public Health, Jilin University, Changchun, Jilin, China
Department of Cardiology (Si, Du, Sun, Liu, Yang), The Third Hospital of Jilin University, Jilin Provincial Molecular Biology Research Center for Precision Medicine of Major Cardiovascular Disease, Changchun, China; Department of Ultrasound (Ni), The Third Hospital of Jilin University, Changchun, China; Institute of Organ Transplantation (Yang), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Intensive Care Unit (Jiang), The Third Hospital of Jilin University, Changchun, China; The Hull Family Laboratory (Massé, J. Nanthakumar, Bhaskaran, K. Nanthakumar), Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ont.; Department of Epidemiology and Biostatistics (Jin), School of Public Health, Jilin University, Changchun, Jilin, China.
出版信息
CMAJ. 2020 Jul 13;192(28):E791-E798. doi: 10.1503/cmaj.200879. Epub 2020 Jun 24.
BACKGROUND
Cardiac injury is common in severe coronavirus disease 2019 (COVID-19) and is associated with poor outcomes. We aimed to study predictors of in-hospital death, characteristics of arrhythmias and the effects of QT-prolonging therapy in patients with cardiac injury.
METHODS
We conducted a retrospective cohort study involving patients with severe COVID-19 who were admitted to Tongji Hospital in Wuhan, China, between Jan. 29 and Mar. 8, 2020. Among patients who had cardiac injury, which we defined as an elevated level of cardiac troponin I (cTnI), we identified demographic and clinical characteristics associated with mortality and need for invasive ventilation.
RESULTS
Among 1284 patients with severe COVID-19, 1159 had a cTnI level measured on admission to hospital, of whom 170 (14.7%) had results that showed cardiac injury. We found that mortality was markedly higher in patients with cardiac injury (71.2% v. 6.6%, < 0.001). We determined that initial cTnI (per 10-fold increase, hazard ratio [HR] 1.32, 95% confidence interval [CI] 1.06-1.66) and peak cTnI level during illness (per 10-fold increase, HR 1.70, 95% CI 1.38-2.10) were associated with poor survival. Peak cTnI was also associated with the need for invasive ventilation (odds ratio 3.02, 95% CI 1.92-4.98). We found arrhythmias in 44 of the 170 patients with cardiac injury (25.9%), including 6 patients with ventricular tachycardia or fibrillation, all of whom died. We determined that patients who received QT-prolonging drugs had longer QTc intervals than those who did not receive them (difference in medians, 45 ms, = 0.01), but such treatment was not independently associated with mortality (HR 1.04, 95% CI 0.69-1.57).
INTERPRETATION
We found that in patients with COVID-19 and cardiac injury, initial and peak cTnI levels were associated with poor survival, and peak cTnI was a predictor of need for invasive ventilation. Patients with COVID-19 warrant assessment for cardiac injury and monitoring, especially if therapy that can prolong repolarization is started.
TRIAL REGISTRATION
Chinese Clinical Trial Registry, No. ChiCTR2000031301.
背景
心脏损伤在严重的 2019 年冠状病毒病（COVID-19）中很常见，并且与不良预后相关。我们旨在研究心脏损伤患者住院期间死亡的预测因素、心律失常的特征以及 QT 延长治疗的效果。
方法
我们进行了一项回顾性队列研究，纳入了 2020 年 1 月 29 日至 3 月 8 日期间在中国武汉同济医院住院的重症 COVID-19 患者。在发生心脏损伤的患者中（我们将其定义为心肌肌钙蛋白 I（cTnI）水平升高），我们确定了与死亡率和需要侵入性通气相关的人口统计学和临床特征。
结果
在 1284 例重症 COVID-19 患者中，有 1159 例入院时测量了 cTnI 水平，其中 170 例（14.7%）结果显示心脏损伤。我们发现，心脏损伤患者的死亡率明显更高（71.2% vs. 6.6%，<0.001）。我们发现初始 cTnI（每增加 10 倍，风险比[HR] 1.32，95%置信区间[CI] 1.06-1.66）和疾病期间的峰值 cTnI 水平（每增加 10 倍，HR 1.70，95% CI 1.38-2.10）与不良预后相关。峰值 cTnI 也与需要侵入性通气相关（比值比 3.02，95% CI 1.92-4.98）。我们在 170 例心脏损伤患者中有 44 例（25.9%）发现心律失常，包括 6 例室性心动过速或颤动患者，所有这些患者均死亡。我们发现接受 QT 延长药物治疗的患者的 QTc 间期比未接受治疗的患者长（中位数差异，45 毫秒，=0.01），但这种治疗与死亡率无关（HR 1.04，95% CI 0.69-1.57）。
解释
我们发现，在 COVID-19 合并心脏损伤的患者中，初始和峰值 cTnI 水平与不良预后相关，而峰值 cTnI 是需要侵入性通气的预测因素。患有 COVID-19 的患者需要评估心脏损伤并进行监测，特别是如果开始使用可能延长复极的治疗时。
试验注册
中国临床试验注册中心，注册号 ChiCTR2000031301。
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