The association between cardiac injury and outcomes in hospitalized patients with COVID-19
The association between cardiac injury and outcomes in hospitalized patients with COVID-19
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DOI：
10.1007/s11739-020-02466-1
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发表时间：
2020-08-09
影响因子：
4.6
通讯作者：
Ashraf, Haleh
中科院分区：
文献类型：
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作者：
Karbalai Saleh, Shahrokh;Oraii, Alireza;Ashraf, Haleh
在这项研究中，我们的目的是评估心脏损伤的发展和短期死亡率之间的关系，以及住院患者的不良住院结局。在这项前瞻性单中心研究中，我们招募了实验室确诊的COVID-19住院患者和具有兼容胸部计算机断层扫描特征的高度可疑患者。心脏损伤定义为血清高敏心肌肌钙蛋白-I水平升高超过第99百分位数（男性：> 26 ng/mL，女性：> 11 ng/mL）。共纳入386名COVID-19住院患者。115例（29.8%）研究人群中存在心脏损伤。与肌钙蛋白水平正常的患者相比，发生心脏损伤的患者的住院死亡率显著升高（40.9% vs 11.1%，p值< 0.001）。结果表明，心脏损伤患者在症状发作后18天的中位随访后生存率显著较低（plog-rank < 0.001）。多变量分析进一步证明，心脏损伤可能增加COVID-19住院患者的短期死亡风险（HR = 1.811，p值= 0. 023）。此外，先前存在的心血管疾病、恶性肿瘤、血氧饱和度<90%、白细胞增多和淋巴细胞减少与发生心脏损伤的风险增加独立相关。COVID-19住院患者心脏损伤的发生与较高的住院死亡率和较差的住院结局显著相关。此外，研究表明，与无心肌损伤的患者相比，心脏损伤的发生与较低的短期生存率相关，并且可能独立地使短期死亡率风险增加近两倍。
In this study, we aimed to assess the association between development of cardiac injury and short-term mortality as well as poor in-hospital outcomes in hospitalized patients with COVID-19. In this prospective, single-center study, we enrolled hospitalized patients with laboratory-confirmed COVID-19 and highly suspicious patients with compatible chest computed tomography features. Cardiac injury was defined as a rise of serum high sensitivity cardiac Troponin-I level above 99th percentile (men: > 26 ng/mL, women: > 11 ng/mL). A total of 386 hospitalized patients with COVID-19 were included. Cardiac injury was present among 115 (29.8%) of the study population. The development of cardiac injury was significantly associated with a higher in-hospital mortality rate compared to those with normal troponin levels (40.9% vs 11.1%,pvalue < 0.001). It was shown that patients with cardiac injury had a significantly lower survival rate after a median follow-up of 18 days from symptom onset (plog-rank < 0.001). It was further demonstrated in the multivariable analysis that cardiac injury could possibly increase the risk of short-term mortality in hospitalized patients with COVID-19 (HR = 1.811,p-value = 0.023). Additionally, preexisting cardiovascular disease, malignancy, blood oxygen saturation < 90%, leukocytosis, and lymphopenia at presentation were independently associated with a greater risk of developing cardiac injury. Development of cardiac injury in hospitalized patients with COVID-19 was significantly associated with higher rates of in-hospital mortality and poor in-hospital outcomes. Additionally, it was shown that development of cardiac injury was associated with a lower short-term survival rate compared to patients without myocardial damage and could independently increase the risk of short-term mortality by nearly two-fold.