Department of Cardiology, Phoebe Putney Memorial Hospital, Albany, Georgia; Department of Internal Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia.
Department of Internal Medicine, University of Nevada Reno School of Medicine, Reno, Nevada.
Am J Cardiol. 2020 Nov 15;135:150-153. doi: 10.1016/j.amjcard.2020.08.041. Epub 2020 Aug 28.
This study aimed to determine if cardiac troponin I (cTnI) is an independent predictor of clinical outcomes and whether higher values are associated with worse clinical outcomes in Covid-19 patients. This case-series study was conducted at Phoebe Putney Health System. Participants were confirmed Covid-19 patients admitted to our health system between March 2, 2020 and June 7, 2020. Data were collected from electronic medical records. Patients were divided into 2 groups: with and without elevated cTnI. The cTnI were further divided in 4 tertiles. Multivariable logistic regression analysis was performed to adjust for demographics, baseline comorbidities, and laboratory parameters including D-dimer, ferritin, lactate dehydrogenase, procalcitonin and C-reactive protein. Out of 309 patients, 116 (37.5%) had elevated cTnI. Those with elevated cTnI were older (59.9 vs. 68.2 years, p <0.001), and more likely to be males (53.5% vs. 36.3%, p = 0.003). Elevated cTnI group had higher baseline comorbidities. After multivariable adjustment, overall mortality was significantly higher in elevated cTnI group (37.9% vs. 11.4%, odds ratio:4.45; confidence interval:1.78 to 11.14, p <0.001). Need for intubation, dialysis, and intensive care unit (ICU) transfer was higher in elevated cTnI group. Among those with elevated cTnI, mortality was 23.2% for 50th percentile, 48.4% for 75th percentile, and 55.2% for 100th percentile. Similarly, further increase in cTnI was associated with a higher need for intubation, dialysis, and ICU transfer. In conclusion, myocardial injury occurs in significant proportion of hospitalized Covid-19 patients and is an independent predictor of clinical outcomes, with higher values associated with worse outcomes.
这项研究旨在确定心肌肌钙蛋白 I（cTnI）是否为新冠患者临床结局的独立预测因子，以及较高的 cTnI 值是否与更差的临床结局相关。这项病例系列研究在 Phoebe Putney 健康系统进行。参与者为 2020 年 3 月 2 日至 2020 年 6 月 7 日期间在我们的健康系统住院的确诊新冠患者。数据来自电子病历。患者分为 cTnI 升高组和未升高组。cTnI 进一步分为 4 个三分位组。采用多变量逻辑回归分析调整人口统计学、基线合并症以及包括 D-二聚体、铁蛋白、乳酸脱氢酶、降钙素原和 C 反应蛋白在内的实验室参数。在 309 名患者中，有 116 名（37.5%）cTnI 升高。cTnI 升高的患者年龄更大（59.9 岁 vs. 68.2 岁，p<0.001），且更可能为男性（53.5% vs. 36.3%，p=0.003）。cTnI 升高组基线合并症更多。多变量调整后，cTnI 升高组的总体死亡率显著更高（37.9% vs. 11.4%，比值比：4.45；95%置信区间：1.78 至 11.14，p<0.001）。cTnI 升高组需要插管、透析和转入重症监护病房（ICU）的比例更高。在 cTnI 升高的患者中，第 50 百分位的死亡率为 23.2%，第 75 百分位的死亡率为 48.4%，第 100 百分位的死亡率为 55.2%。同样，cTnI 值的进一步升高与更高的插管、透析和 ICU 转归需求相关。总之，心肌损伤在住院新冠患者中发生率较高，是临床结局的独立预测因子，且与更差的结局相关。
