Keller Karsten, Sagoschen Ingo, Konstantinides Stavros, Gori Tommaso, Münzel Thomas, Hobohm Lukas
Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
J Med Virol. 2023 Mar;95(3):e28646. doi: 10.1002/jmv.28646.
Myocarditis as cardiac involvement in coronavirus disease 2019 (COVID-19)-infection is well known. Real-world data about incidence in hospitalized COVID-19-patients and risk factors for myocarditis in COVID-19-patients are sparse. We used the German nationwide inpatient sample to analyze all hospitalized patients with confirmed COVID-19-diagnosis in Germany in 2020 and stratified them for myocarditis. Overall, 176 137 hospitalizations (52.3% males, 53.6% aged ≥70 years) with confirmed COVID-19-infection were coded in Germany in 2020 and among them, 226 (0.01%) had myocarditis (incidence: 1.28 per 1000 hospitalization-cases). Absolute numbers of myocarditis increased, while relative numbers decreased with age. COVID-19-patients with myocarditis were younger (64.0 [IQR: 43.0/78.0] vs. 71.0 [56.0/82.0], p < 0.001). In-hospital case-fatality was 1.3-fold higher in COVID-19-patients with than without myocarditis (24.3% vs. 18.9%, p = 0.012). Myocarditis was independently associated with increased case-fatality (OR: 1.89 [95% CI: 1.33-2.67], p < 0.001). Independent risk factors for myocarditis were age <70 years (OR: 2.36 [95% CI: 1.72-3.24], p < 0.001), male sex (1.68 [95% CI: 1.28-2.23], p < 0.001), pneumonia (OR: 1.77 [95% CI: 1.30-2.42], p < 0.001), and multisystemic inflammatory COVID-19-infection (OR: 10.73 [95% CI: 5.39-21.39], p < 0.001). The incidence of myocarditis in hospitalized COVID-19-patients in Germany was 1.28 cases per 1000 hospitalizations in 2020. Risk factors for myocarditis in COVID-19 were young age, male sex, pneumonia, and multisystemic inflammatory COVID-19-infection. Myocarditis was independently associated with increased case-fatality.
心肌炎作为2019冠状病毒病（COVID-19）感染的心脏受累表现已广为人知。关于COVID-19住院患者中心肌炎发病率及COVID-19患者发生心肌炎的危险因素的真实世界数据较为匮乏。我们利用德国全国住院患者样本分析了2020年德国所有确诊为COVID-19的住院患者，并对心肌炎患者进行了分层。总体而言，2020年德国有176137例确诊为COVID-19感染的住院病例（男性占52.3%，年龄≥70岁者占53.6%），其中226例（0.01%）发生了心肌炎（发病率：每1000例住院病例中有1.28例）。心肌炎的绝对病例数随年龄增长而增加，而相对病例数则随年龄增长而减少。发生心肌炎的COVID-19患者更年轻（64.0[四分位间距：43.0/78.0] vs. 71.0[56.0/82.0]，p<0.001）。合并心肌炎的COVID-19患者院内病死率比未合并心肌炎的患者高1.3倍（24.3% vs. 18.9%，p=0.012）。心肌炎与病死率增加独立相关（比值比：1.89[95%置信区间：1.33 - 2.67]，p<0.001）。心肌炎的独立危险因素包括年龄<70岁（比值比：2.36[95%置信区间：1.72 - 3.24] p<0.001）、男性（1.68[95%置信区间：1.28 - 2.23]，p<0.001）、肺炎（比值比：1.77[95%置信区间：1.30 - 2.42]，p<0.001）以及多系统炎症性COVID-19感染（比值比：10.73[95%置信区间：5.39 - 21.39]，p< 0.001）。2020年德国COVID-19住院患者中心肌炎的发病率为每1000例住院病例中有1.28例。COVID-19患者发生心肌炎的危险因素包括年轻、男性、肺炎以及多系统炎症性COVID-19感染。心肌炎与病死率增加独立相关。
