High-Sensitivity Cardiac Troponin T for the Detection of Myocardial Injury and Risk Stratification in COVID-19
High-Sensitivity Cardiac Troponin T for the Detection of Myocardial Injury and Risk Stratification in COVID-19
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DOI：
10.1093/clinchem/hvab062
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发表时间：
2021-05-08
影响因子：
9.3
通讯作者：
Sandoval, Yader
中科院分区：
文献类型：
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作者：
De Michieli, Laura;Ola, Olatunde;Sandoval, Yader
背景：高敏感性心肌肌钙蛋白（hs-cTn）用于COVID-19风险分层的数据有限。方法：我们对接受hs-cTnT的COVID-19患者进行了一项多中心、回顾性、观察性的美国研究。结果包括短期死亡率（住院和出院后30天）和主要不良事件的复合，包括指数表现期间需要机械通气的呼吸衰竭、心脏骤停和休克和/或指数住院期间或出院后30天内的死亡率。结果：在367例接受hs-cTnT的COVID-19患者中，46%的人发现心肌损伤。他们有更高的死亡风险（20% vs 12%, P < 0.0001；未经调整的HR 4.44, 95% CI 2.13-9.25, P < 0.001）和主要不良事件（35% vs 11%, P < 0.0001；未经调整的OR 4.29, 95% CI 2.50-7.40, P < 0.0001）。心肌损伤与主要不良事件相关（校正OR 3.84, 95% CI 2.00-7.36, P < 0.0001），但与死亡率无关。基线（校正OR 1.003, 95% CI 1.00-1.007, P = 0.047）和最大（校正OR 1.005, 95% CI 1.001-1.009, P = 0.0012） hs-cTnT是主要不良事件的独立预测因子。大多数（95%）增加是由于心肌损伤，其中5% （n = 8）被归类为1型或2型心肌梗死。一个hs-cTnT
BACKGROUND: Limited data exist on high-sensitivity cardiac troponin (hs-cTn) for risk-stratification in COVID-19.METHODS: We conducted a multicenter, retrospective, observational, US-based study of COVID-19 patients undergoing hs-cTnT. Outcomes included short-term mortality (in-hospital and 30-days post-discharge) and a composite of major adverse events, including respiratory failure requiring mechanical ventilation, cardiac arrest, and shock within the index presentation and/or mortality during the index hospitalization or within 30-days post-discharge.RESULTS: Among 367 COVID-19 patients undergoing hs-cTnT, myocardial injury was identified in 46%. They had a higher risk for mortality (20% vs 12%, P < 0.0001; unadjusted HR 4.44, 95% CI 2.13-9.25, P < 0.001) and major adverse events (35% vs. 11%, P < 0.0001; unadjusted OR 4.29, 95% CI 2.50-7.40, P < 0.0001). Myocardial injury was associated with major adverse events (adjusted OR 3.84, 95% CI 2.00-7.36, P < 0.0001) but not mortality. Baseline (adjusted OR 1.003, 95% CI 1.00-1.007, P = 0.047) and maximum (adjusted OR 1.005, 95% CI 1.001-1.009, P = 0.0012) hs-cTnT were independent predictors of major adverse events. Most (95%) increases were due to myocardial injury, with 5% (n = 8) classified as type 1 or 2 myocardial infarction. A single hs-cTnT