Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA; Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
Clin Biochem. 2021 Apr;90:8-14. doi: 10.1016/j.clinbiochem.2021.01.006. Epub 2021 Jan 30.
The spectrum of Coronavirus Disease 2019 (COVID-19) is broad and thus early appropriate risk stratification can be helpful. Our objectives were to define the frequency of myocardial injury using high-sensitivity cardiac troponin I (hs-cTnI) and to understand how to use its prognostic abilities.
Retrospective study of patients with COVID-19 presenting to an Emergency Department (ED) in Italy in 2020. Hs-cTnI was sampled based on clinical judgment. Myocardial injury was defined as values above the sex-specific 99th percentile upper reference limits (URLs). Most data is from the initial hospital value.
426 unique patients were included. Hs-cTnI was measured in 313 (73.5%) patients; 85 (27.2%) had myocardial injury at baseline. Patients with myocardial injury had higher mortality during hospitalization (hazard ratio = 9 [95% confidence interval (CI) 4.55-17.79], p < 0.0001). Multivariable analysis including clinical and laboratory variables demonstrated an AUC of 0.942 with modest additional value of hs-cTnI. Myocardial injury was associated with mortality in patients with low APACHE II scores (<13) [OR (95% CI): 4.15 (1.40, 14.22), p = 0.014] but not in those with scores > 13 [OR (95% CI): 0.48 (0.08, 2.65), p = 0.40]. Initial hs-cTnI < 5 ng/L identified 33% of patients that were at low risk with 97.8% sensitivity (95% CI 88.7, 99.6) and 99.2% negative predictive value. Type 1 myocardial infarction (MI) and type 2 MI were infrequent.
hs-cTnI at baseline is a significant predictor of mortality in COVID-19 patients. A value < 5 ng/L identified patients at low risk.
2019 年冠状病毒病（COVID-19）的范围很广，因此早期进行适当的风险分层可能会有所帮助。我们的目标是使用高敏心肌肌钙蛋白 I（hs-cTnI）定义心肌损伤的频率，并了解如何利用其预后能力。
对 2020 年在意大利一家急诊科就诊的 COVID-19 患者进行回顾性研究。根据临床判断采集 hs-cTnI。心肌损伤定义为超过性别特异性 99 百分位上限（URL）值。大多数数据来自初始医院值。
共纳入 426 例患者。313 例（73.5%）患者检测了 hs-cTnI；85 例（27.2%）患者基线时有心肌损伤。有心肌损伤的患者住院期间死亡率更高（危险比=9 [95%置信区间（CI）4.55-17.79]，p<0.0001）。包括临床和实验室变量的多变量分析显示，hs-cTnI 的 AUC 为 0.942，具有适度的附加价值。心肌损伤与低急性生理与慢性健康状况评分系统（APACHE II）评分（<13）患者的死亡率相关[比值比（95%CI）：4.15（1.40，14.22），p=0.014]，但与评分>13 的患者无关[比值比（95%CI）：0.48（0.08，2.65），p=0.40]。初始 hs-cTnI<5ng/L 可识别 33%的低危患者，其敏感性为 97.8%（95%CI 88.7，99.6），阴性预测值为 99.2%。1 型和 2 型心肌梗死少见。
基线时 hs-cTnI 是 COVID-19 患者死亡的重要预测因子。值<5ng/L 可识别低危患者。
