白细胞介素-6 的基线水平与 SARS-CoV-2 感染后急性冠状动脉综合征发展的风险相关。
Baseline level of interleukin-6 is associated with the risk of acute coronary syndrome development in SARS-CoV-2 infection.
机构信息
Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, Iran.
Trauma and Injury Research Center, Rasoul Akram Hospital, Niayesh St, Satarkhan St, Tehran, 14456, Iran.
出版信息
BMC Cardiovasc Disord. 2024 Oct 12;24(1):550. doi: 10.1186/s12872-024-04234-x.
BACKGROUND
Acute coronary syndrome (ACS) is frequently reported in patients with coronavirus disease 2019 (COVID-19). Cytokine storm induced by interleukin-6 (IL-6) has been suggested to potentially cause myocardial injury in COVID-19. We investigated the association between baseline level of IL-6 and development of ACS in COVID-19 patients.
METHODS
Demographic and clinical data of hospitalized COVID-19 patients from 2020 to 2022 were reviewed. Extracted data including patient characteristics, laboratory biomarkers, and systemic inflammation indexes in patients with or without ACS were reviewed and analyzed. Logistic regression models were applied to analyze predictors of ACS development and receiver-operating characteristic (ROC) curves were used to assess discriminatory power of IL-6 and other risk factors for predicting ACS development.
RESULTS
Among 1,753 COVID-19 patients, 37 cases experienced ACS and 159 patients without main COVID-19 complications were randomly selected as controls. ACS patients were older (p = 0.001) and suffered from more comorbidities including diabetes (43% vs. 18%, p = 0.001), hypertension (40.5% vs. 24.5%, p = 0.050), ischemic heart disease (49% vs. 9%, p = 0.001), and hyperlipidemia (19% vs. 5%, p = 0.010). Also, decreased level of consciousness (31.6% vs. 2.5%, p = 0.001), ICU admission (65% vs. 2%, p = 0.001), and mortality events (70% vs. 0.6%, p = 0.001) were more prevalent in the ACS group. Baseline levels of IL-6 (p = 0.001), D-dimer (p = 0.026), troponin (p = 0.001), blood urea nitrogen (p = 0.002), and creatinine (p = 0.008) were higher in ACS patients but erythrocyte sedimentation rate (p = 0.013), hemoglobin (p = 0.033), and red blood cells (p = 0.028) were lower compared with controls. Also, age (OR: 1.06, p = 0.019), IL-6 (OR: 1.44, p = 0.047), and cardiovascular disease (CVD) (OR: 3.66, p = 0.043) were associated with ACS development. The area under the curve (AUC) of IL-6 and combined predictors respectively was 0.661 (p = 0.002) and 0.829 (p = 0.001).
CONCLUSIONS
High IL-6 concentration at baseline is a strong predictor for ACS development in COVID-19 patients. Also, elderly and concurrent CVD are significantly associated with ACS development.
背景
新冠肺炎（COVID-19）患者常报告发生急性冠状动脉综合征（ACS）。白细胞介素 6（IL-6）引发的细胞因子风暴被认为可能导致 COVID-19 患者的心肌损伤。我们研究了 COVID-19 患者基线 IL-6 水平与 ACS 发展之间的关系。
方法
回顾了 2020 年至 2022 年住院 COVID-19 患者的人口统计学和临床数据。回顾并分析了 ACS 患者和无主要 COVID-19 并发症的 159 名患者的患者特征、实验室生物标志物和全身炎症指标等提取数据。应用逻辑回归模型分析 ACS 发展的预测因素，使用接收者操作特征（ROC）曲线评估 IL-6 及其他危险因素预测 ACS 发展的区分能力。
结果
在 1753 例 COVID-19 患者中，37 例发生 ACS，随机选择 159 例无主要 COVID-19 并发症的患者作为对照。ACS 患者年龄较大（p=0.001），合并症更多，包括糖尿病（43%比 18%，p=0.001）、高血压（40.5%比 24.5%，p=0.050）、缺血性心脏病（49%比 9%，p=0.001）和高脂血症（19%比 5%，p=0.010）。此外，ACS 组患者意识障碍（31.6%比 2.5%，p=0.001）、入住 ICU（65%比 2%，p=0.001）和死亡事件（70%比 0.6%，p=0.001）更为常见。ACS 患者的基线 IL-6（p=0.001）、D-二聚体（p=0.026）、肌钙蛋白（p=0.001）、血尿素氮（p=0.002）和肌酐（p=0.008）水平较高，但红细胞沉降率（p=0.013）、血红蛋白（p=0.033）和红细胞（p=0.028）水平较低。此外，年龄（OR：1.06，p=0.019）、IL-6（OR：1.44，p=0.047）和心血管疾病（CVD）（OR：3.66，p=0.043）与 ACS 发展相关。IL-6 和联合预测因素的曲线下面积（AUC）分别为 0.661（p=0.002）和 0.829（p=0.001）。
结论
COVID-19 患者基线时高 IL-6 浓度是 ACS 发展的有力预测因素。此外，年龄较大和并发 CVD 与 ACS 发展显著相关。
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