The relationship between cardiac injury, inflammation and coagulation in predicting COVID-19 outcome.
The relationship between cardiac injury, inflammation and coagulation in predicting COVID-19 outcome.
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DOI：
10.1038/s41598-021-85646-z
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发表时间：
2021-03-22
影响因子：
4.6
通讯作者：
Pisa Covid Study Group
中科院分区：
文献类型：
--
作者：
Mengozzi A;Georgiopoulos G;Falcone M;Tiseo G;Pugliese NR;Dimopoulos MA;Ghiadoni L;Barbieri G;Forfori F;Carrozzi L;Santini M;Monzani F;De Marco S;Menichetti F;Virdis A;Masi S;Pisa Covid Study Group
高敏肌钙蛋白T（hsTnT）是SARS-CoV-2感染期间不良结局的强预测因子。然而，其决定因素仍然部分未知。我们旨在评估2019冠状病毒病（COVID-19）中炎症反应/凝血异常的严重程度与hsTnT之间的关系。然后，我们探讨了这些途径在定义死亡率和并发症风险方面的相关性，以及降低此类风险的治疗方法的潜在影响。在这项单中心、前瞻性、观察性研究中，我们招募了266名因SARS-CoV-2肺炎住院的连续患者。主要终点为院内COVID-19死亡率。即使在调整混杂因素后，hsTnT仍与死亡率相关。D-二聚体和CRP与hsTnT的相关性强于PaO 2。hsTnT、D-二聚体和CRP的变化相关，但仅D-二聚体与死亡率相关。此外，低分子量肝素在整个人群中显示出死亡率降低，特别是在hsTnT较高的受试者中。D-二聚体与hsTnT及病死率有较强的相关性。抗凝治疗在死亡率方面显示出更大的益处。这些发现表明，SARS-CoV-2凝血功能障碍在COVID-19中hsTnT升高及其相关死亡率中起主要作用。更好地了解与COVID-19相关的机制可能为这些高危人群的治疗铺平道路。
High sensitivity troponin T (hsTnT) is a strong predictor of adverse outcome during SARS-CoV-2 infection. However, its determinants remain partially unknown. We aimed to assess the relationship between severity of inflammatory response/coagulation abnormalities and hsTnT in Coronavirus Disease 2019 (COVID-19). We then explored the relevance of these pathways in defining mortality and complications risk and the potential effects of the treatments to attenuate such risk. In this single-center, prospective, observational study we enrolled 266 consecutive patients hospitalized for SARS-CoV-2 pneumonia. Primary endpoint was in-hospital COVID-19 mortality. hsTnT, even after adjustment for confounders, was associated with mortality. D-dimer and CRP presented stronger associations with hsTnT than PaO2. Changes of hsTnT, D-dimer and CRP were related; but only D-dimer was associated with mortality. Moreover, low molecular weight heparin showed attenuation of the mortality in the whole population, particularly in subjects with higher hsTnT. D-dimer possessed a strong relationship with hsTnT and mortality. Anticoagulation treatment showed greater benefits with regard to mortality. These findings suggest a major role of SARS-CoV-2 coagulopathy in hsTnT elevation and its related mortality in COVID-19. A better understanding of the mechanisms related to COVID-19 might pave the way to therapy tailoring in these high-risk individuals.
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