Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
Heart Center, Peking University Peoples Hospital, Beijing, China.
Sci Rep. 2020 Nov 24;10(1):20452. doi: 10.1038/s41598-020-77172-1.
To determine the incidence of acute cardiac injury (ACI), the factors associated with ACI and the in-hospital mortality in patients with COVID-19, especially in severe patients. All consecutive in-patients with laboratory-confirmed COVID-19 from Tongji Hospital in Wuhan during February 1 and March 29, 2020 were included. The demographic, clinical characteristics, laboratory, radiological and treatment data were collected. Univariate and Firth logistic regression analyses were used to identify factors associated with ACI and in-hospital mortality, and Kaplan-Meier method was used to estimate cumulative in-hospital mortality. Among 1031 patients included, 215 (20.7%) had ACI and 501 (48.6%) were severe cases. Overall, 165 patients died; all were from the severe group, and 131 (79.39%) had ACI. ACI (OR = 2.34, P = 0.009), male gender (OR = 2.58, P = 0.001), oximeter oxygen saturation (OR = 0.90, P < 0.001), lactate dehydrogenase (OR = 3.26, P < 0.001), interleukin-6 (IL-6) (OR = 8.59, P < 0.001), high sensitivity C-reactive protein (hs-CRP) (OR = 3.29, P = 0.016), N-terminal pro brain natriuretic peptide (NT-proBNP) (OR = 2.94, P = 0.001) were independent risk factors for the in-hospital mortality in severe patients. The mortality was significantly increased among severe patients with elevated hs-CRP, IL-6, hs-cTnI, and/or NT-proBNP. Moreover, the mortality was significantly higher in patients with elevation of both hs-cTnI and NT proBNP than in those with elevation of either of them. ACI develops in a substantial proportion of patients with COVID-19, and is associated with the disease severity and in-hospital mortality. A combination of hs-cTnI and NT-proBNP is valuable in predicting the mortality.
为了确定 COVID-19 患者（尤其是重症患者）急性心脏损伤（ACI）的发生率、与 ACI 相关的因素以及住院死亡率，我们纳入了 2020 年 2 月 1 日至 3 月 29 日期间在武汉同济医院接受实验室确诊 COVID-19 的所有连续住院患者。收集了人口统计学、临床特征、实验室、影像学和治疗数据。采用单因素和 Firth 逻辑回归分析确定与 ACI 和住院死亡率相关的因素，并采用 Kaplan-Meier 法估计累积住院死亡率。在纳入的 1031 例患者中，215 例（20.7%）有 ACI，501 例（48.6%）为重症病例。总体而言，165 例患者死亡；均来自重症组，其中 131 例（79.39%）有 ACI。ACI（OR=2.34，P=0.009）、男性（OR=2.58，P=0.001）、血氧饱和度（OR=0.90，P<0.001）、乳酸脱氢酶（OR=3.26，P<0.001）、白细胞介素-6（IL-6）（OR=8.59，P<0.001）、高敏 C 反应蛋白（hs-CRP）（OR=3.29，P=0.016）、N 端脑钠肽前体（NT-proBNP）（OR=2.94，P=0.001）是重症患者住院死亡率的独立危险因素。hs-CRP、IL-6、hs-cTnI 和/或 NT-proBNP 升高的重症患者死亡率显著增加。此外，hs-cTnI 和 NT proBNP 同时升高的患者死亡率显著高于其中任一指标升高的患者。COVID-19 患者中 ACI 的发生率相当高，与疾病严重程度和住院死亡率相关。hs-cTnI 和 NT-proBNP 的联合检测对预测死亡率具有重要价值。
