Cao Jiatian, Zheng Yan, Luo Zhe, Mei Zhendong, Yao Yumeng, Liu Zilong, Liang Chao, Yang Hongbo, Song Yanan, Yu Kaihuan, Gao Yan, Zhu Chouwen, Huang Zheyong, Qian Juying, Ge Junbo
Department of Cardiology, Zhongshan Hospital, Fudan University. Shanghai Institute of Cardiovascular Diseases. 180 Feng Lin Road, Shanghai 200032, China.
State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai 200438, China.
Theranostics. 2020 Jul 29;10(21):9663-9673. doi: 10.7150/thno.47980. eCollection 2020.
To explore the involvement of the cardiovascular system in coronavirus disease 2019 (COVID-19), we investigated whether myocardial injury occurred in COVID-19 patients and assessed the performance of serum high-sensitivity cardiac Troponin I (hs-cTnI) levels in predicting disease severity and 30-day in-hospital fatality. We included 244 COVID-19 patients, who were admitted to Renmin Hospital of Wuhan University with no preexisting cardiovascular disease or renal dysfunction. We analyzed the data including patients' clinical characteristics, cardiac biomarkers, severity of medical conditions, and 30-day in-hospital fatality. We performed multivariable Cox regressions and the receiver operating characteristic analysis to assess the association of cardiac biomarkers on admission with disease severity and prognosis. In this retrospective observational study, 11% of COVID-19 patients had increased hs-cTnI levels (>40 ng/L) on admission. Of note, serum hs-cTnI levels were positively associated with the severity of medical conditions (median [interquartile range (IQR)]: 6.00 [6.00-6.00] ng/L in 91 patients with moderate conditions, 6.00 [6.00-18.00] ng/L in 107 patients with severe conditions, and 11.00 [6.00-56.75] ng/L in 46 patients with critical conditions, for trend=0.001). Moreover, compared with those with normal cTnI levels, patients with increased hs-cTnI levels had higher in-hospital fatality (adjusted hazard ratio [95% CI]: 4.79 [1.46-15.69]). The receiver-operating characteristic curve analysis suggested that the inclusion of hs-cTnI levels into a panel of empirical prognostic factors substantially improved the prediction performance for severe or critical conditions (area under the curve (AUC): 0.71 (95% CI: 0.65-0.78) vs. 0.65 (0.58-0.72), =0.01), as well as for 30-day fatality (AUC: 0.91 (0.85-0.96) vs. 0.77 (0.62-0.91), =0.04). A cutoff value of 20 ng/L of hs-cTnI level led to the best prediction to 30-day fatality. In COVID-19 patients with no preexisting cardiovascular disease, 11% had increased hs-cTnI levels. Besides empirical prognostic factors, serum hs-cTnI levels upon admission provided independent prediction to both the severity of the medical condition and 30-day in-hospital fatality. These findings may shed important light on the clinical management of COVID-19.
为探究心血管系统在2019冠状病毒病（COVID-19）中的参与情况，我们调查了COVID-19患者是否发生心肌损伤，并评估了血清高敏心肌肌钙蛋白I（hs-cTnI）水平在预测疾病严重程度和30天院内死亡率方面的表现。我们纳入了244例COVID-19患者，这些患者入住武汉大学人民医院，既往无心血管疾病或肾功能不全。我们分析了包括患者临床特征、心脏生物标志物、病情严重程度和30天院内死亡率在内的数据。我们进行了多变量Cox回归和受试者工作特征分析，以评估入院时心脏生物标志物与疾病严重程度和预后的关联。在这项回顾性观察研究中，11%的COVID-19患者入院时hs-cTnI水平升高（>40 ng/L）。值得注意的是，血清hs-cTnI水平与病情严重程度呈正相关（中位数[四分位间距（IQR）]：91例中度病情患者为6.00[6.00 - 6.00] ng/L，107例重度病情患者为6.00[6.00 - 18.00] ng/L，46例危重症患者为11.00[6.00 - 56.75] ng/L，趋势P = 0.001）。此外，与cTnI水平正常的患者相比，hs-cTnI水平升高的患者院内死亡率更高（调整后风险比[95%CI]：4.79[1.46 - 15.69]）。受试者工作特征曲线分析表明，将hs-cTnI水平纳入经验性预后因素组可显著提高对重度或危重症的预测性能（曲线下面积（AUC）：0.71（95%CI：0.65 - 0.78）对0.65（0.58 - 0.72），P = 0.01），以及对30天死亡率的预测性能（AUC：0.91（0.85 - 0.96）对0.77（0.62 - 0.91），P = 0.04）。hs-cTnI水平的截断值为20 ng/L时对30天死亡率的预测最佳。在无心血管疾病病史的COVID-19患者中，11%的患者hs-cTnI水平升高。除经验性预后因素外，请输入需要翻译的文本入院时血清hs-cTnI水平可为病情严重程度和30天院内死亡率提供独立预测。这些发现可能为COVID-19的临床管理提供重要启示。
