Prognostic significance of cardiac injury in COVID-19 patients with and without coronary artery disease
Prognostic significance of cardiac injury in COVID-19 patients with and without coronary artery disease
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DOI：
10.1097/mca.0000000000000914
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发表时间：
2021-08-01
影响因子：
1.8
通讯作者：
Gungor, Baris
中科院分区：
文献类型：
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作者：
Barman, Hasan Ali;Atici, Adem;Gungor, Baris
目的COVID-19是一种高死亡率疾病，导致临床结局恶化的危险因素尚未明确。本研究的目的是描述COVID-19患者入院时存在伴随心脏损伤的预后重要性。方法在这项多中心回顾性研究中，收集了2020年3月20日至4月20日期间接受COVID-19治疗的连续患者的数据。从电子病历中获得临床特征、实验室检查结果和结局数据。比较有和无心脏损伤患者的住院临床结局。研究共纳入607名COVID-19住院患者;中位年龄为62.5 ± 14.3岁，334名（55%）为男性。在纳入研究的150例（24.7%）患者中检测到心脏损伤。合并心脏损伤者病死率明显高于无心脏损伤者（42% vs.8%; P < 0.01）。在心脏损伤患者中，需要ICU（72% vs. 19%）、发生急性肾损伤（14% vs. 1%）和急性呼吸窘迫综合征（71% vs. 18%）的患者频率也较高。在多变量分析中，年龄、冠状动脉疾病（CAD）、CRP水平升高和心脏损伤的存在[比值比（OR）10.58，95%置信区间（CI）2.42-46.27; P < 0.001]被发现是死亡率的独立预测因素。在亚组分析中，包括无CAD病史的患者，入院时存在心脏损伤也预测死亡率（OR 2.52，95%CI 1.17-5.45; P = 0.018）。结论在COVID-19患者中，包括既往无CAD诊断的患者，入院时心脏损伤与更差的临床结局和更高的死亡风险相关。
Objective COVID-19 is a disease with high mortality, and risk factors for worse clinical outcome have not been well-defined yet. The aim of this study is to delineate the prognostic importance of presence of concomitant cardiac injury on admission in patients with COVID-19. Methods For this multi-center retrospective study, data of consecutive patients who were treated for COVID-19 between 20 March and 20 April 2020 were collected. Clinical characteristics, laboratory findings and outcomes data were obtained from electronic medical records. In-hospital clinical outcome was compared between patients with and without cardiac injury. Results A total of 607 hospitalized patients with COVID-19 were included in the study; the median age was 62.5 +/- 14.3 years, and 334 (55%) were male. Cardiac injury was detected in 150 (24.7%) of patients included in the study. Mortality rate was higher in patients with cardiac injury (42% vs. 8%; P < 0.01). The frequency of patients who required ICU (72% vs. 19%), who developed acute kidney injury (14% vs. 1%) and acute respiratory distress syndrome (71%vs. 18%) were also higher in patients with cardiac injury. In multivariate analysis, age, coronary artery disease (CAD), elevated CRP levels, and presence of cardiac injury [odds ratio (OR) 10.58, 95% confidence interval (CI) 2.42-46.27; P < 0.001) were found to be independent predictors of mortality. In subgroup analysis, including patients free of history of CAD, presence of cardiac injury on admission also predicted mortality (OR 2.52, 95% CI 1.17-5.45; P = 0.018). Conclusion Cardiac injury on admission is associated with worse clinical outcome and higher mortality risk in COVID-19 patients including patients free of previous CAD diagnosis.