Department of Cardiology, University Hospital Ramon y Cajal, Madrid, Spain.
Hospital Ramon y Cajal, Madrid, Spain.
Cardiol J. 2020;27(5):489-496. doi: 10.5603/CJ.a2020.0089. Epub 2020 Jun 26.
Despite being associated with worse prognosis in patients with COVID-19, systematic determination of myocardial injury is not recommended. The aim of the study was to study the effect of myocardial injury assessment on risk stratification of COVID-19 patients.
Seven hundred seven consecutive adult patients admitted to a large tertiary hospital with confirmed COVID-19 were included. Demographic data, comorbidities, laboratory results and clinical outcomes were recorded. Charlson comorbidity index (CCI) was calculated in order to quantify the degree of comorbidities. Independent association of cardiac troponin I (cTnI) increase with outcomes was evaluated by multivariate regression analyses and area under curve. In addition, propensity-score matching was performed to assemble a cohort of patients with similar baseline characteristics.
In the matched cohort (mean age 66.76 ± 15.7 years, 37.3% females), cTnI increase above the upper limit was present in 20.9% of the population and was associated with worse clinical outcomes, including all-cause mortality within 30 days (45.1% vs. 23.2%; p = 0.005). The addition of cTnI to a multivariate prediction model showed a significant improvement in the area under the time-dependent receiver operating characteristic curve (0.775 vs. 0.756, DC-statistic = 0.019; 95% confidence interval 0.001-0.037). Use of renin-angiotensin-aldosterone system inhibitors was not associated with mortality after adjusting by baseline risk factors.
Myocardial injury is independently associated with adverse outcomes irrespective of baseline comorbidities and its addition to multivariate regression models significantly improves their performance in predicting mortality. The determination of myocardial injury biomarkers on hospital admission and its combination with CCI can classify patients in three risk groups (high, intermediate and low) with a clearly distinct 30-day mortality.
尽管 COVID-19 患者的心肌损伤与预后较差相关，但不建议系统地进行心肌损伤评估。本研究旨在研究心肌损伤评估对 COVID-19 患者风险分层的影响。
纳入了 707 例连续住院的成年 COVID-19 患者。记录了人口统计学数据、合并症、实验室结果和临床结局。计算了 Charlson 合并症指数（CCI）以量化合并症的程度。通过多变量回归分析和曲线下面积评估肌钙蛋白 I（cTnI）升高与结局的独立相关性。此外，还进行了倾向评分匹配，以组建基线特征相似的患者队列。
在匹配队列（平均年龄 66.76±15.7 岁，37.3%为女性）中，20.9%的人群 cTnI 升高超过上限，且与更差的临床结局相关，包括 30 天内全因死亡率（45.1%比 23.2%；p=0.005）。将 cTnI 纳入多变量预测模型可显著提高时间依赖性受试者工作特征曲线下面积（0.775 比 0.756，DC 统计量=0.019；95%置信区间 0.001-0.037）。调整基线危险因素后，使用肾素-血管紧张素-醛固酮系统抑制剂与死亡率无关。
心肌损伤与不良结局独立相关，无论基线合并症如何，其加入多变量回归模型可显著提高预测死亡率的性能。入院时测定心肌损伤生物标志物并与 CCI 相结合，可将患者分为三个风险组（高、中、低），30 天死亡率差异明显。
