Biasco Luigi, Klersy Catherine, Beretta Giulia S, Valgimigli Marco, Valotta Amabile, Gabutti Luca, Bruna Roberto Della, Pagnamenta Alberto, Tersalvi Gregorio, Ruinelli Lorenzo, Artero Andrea, Senatore Gaetano, Jüni Peter, Pedrazzini Giovanni B
Department of Biomedical Sciences, Università della Svizzera Italiana, Via Buffi 13, 6900, Lugano, Switzerland.
Department of Cardiology, Azienda Sanitaria Locale Torino 4, Via Battitore 7, 10070, Ciriè, Italy.
Eur Heart J Open. 2021 Aug 30;1(3):oeab025. doi: 10.1093/ehjopen/oeab025. eCollection 2021 Nov.
Myocardial injury (MINJ) in Coronavirus disease 2019 (COVID-19) identifies individuals at high mortality risk but its clinical relevance is less well established for Influenza and no comparative analyses evaluating frequency and clinical implications of MINJ among hospitalized patients with Influenza or COVID-19 are available.
Hospitalized adults with laboratory confirmed Influenza A or B or COVID-19 underwent highly sensitive cardiac T Troponin (hs-cTnT) measurement at admission in four regional hospitals in Canton Ticino, Switzerland. MINJ was defined as hs-cTnT >14 ng/L. Clinical, laboratory and outcome data were retrospectively collected. The primary outcome was mortality up to 28 days. Cox regression models were used to assess correlations between admission diagnosis, MINJ, and mortality. Clinical correlates of MINJ in both viral diseases were also identified. MINJ occurred in 94 (65.5%) out of 145 patients hospitalized for Influenza and 216 (47.8%) out of 452 patients hospitalized for COVID-19. Advanced age and renal impairment were factors associated with MINJ in both diseases. At 28 days, 7 (4.8%) deaths occurred among Influenza and 76 deaths (16.8%) among COVID-19 patients with a hazard ratio (HR) of 3.69 [95% confidence interval (CI) 1.70-8.00]. Adjusted Cox regression models showed admission diagnosis of COVID-19 [HR 6.41 (95% CI 4.05-10.14)] and MINJ [HR 8.01 (95% CI 4.64-13.82)] to be associated with mortality.
Myocardial injury is frequent among both viral diseases and increases the risk of death in both COVID-19 and Influenza. The absolute risk of death is considerably higher in patients admitted for COVID-19 when compared with Influenza.
2019年冠状病毒病（COVID-19）中的心肌损伤（MINJ）可识别出高死亡风险个体，但对于流感而言，其临床相关性尚未得到充分证实，且尚无评估流感或COVID-19住院患者中MINJ的频率和临床意义的比较分析。
在瑞士提契诺州的四家地区医院，对实验室确诊为甲型或乙型流感或COVID-19的住院成人在入院时进行了高敏心肌肌钙蛋白（hs-cTnT）检测。MINJ定义为hs-cTnT>14 ng/L。回顾性收集临床、实验室和结局数据。主要结局是28天内的死亡率。使用Cox回归模型评估入院诊断、MINJ和死亡率之间的相关性。还确定了两种病毒性疾病中MINJ的临床相关因素。145例流感住院患者中有94例（65.5%）发生MINJ，452例COVID-19住院患者中有216例（47.8%）发生MINJ。高龄和肾功能损害是两种疾病中与MINJ相关的因素。28天时，流感患者中有7例（4.8%）死亡，COVID-19患者中有76例（16.8%）死亡，风险比（HR）为3.69 [95%置信区间（CI）1.70-8.00]。调整后的Cox回归模型显示，COVID-19的入院诊断[HR 6.41（95% CI 4.05-10.14）]和MINJ [HR 8.01（95% CI 4.64-13.82）]与死亡率相关。
两种病毒性疾病中均频繁出现心肌损伤，且增加了COVID-19和流感患者的死亡风险。与流感相比，COVID-19入院患者的绝对死亡风险要高得多。
