Myocardial injury in severe and critical coronavirus disease 2019 patients
Myocardial injury in severe and critical coronavirus disease 2019 patients
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2019冠状病毒病重症和危重症患者的心肌损伤
DOI：
10.1111/jocs.15164
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发表时间：
2020-11-01
影响因子：
1.6
通讯作者：
Sun, Xiaotian
中科院分区：
文献类型：
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作者：
Guo, Huiqi;Shen, Yunzhi;Sun, Xiaotian
研究背景和目的探讨心肌损伤对2019冠状病毒病（COVID-19）重症或危重症患者预后的影响。方法收集2020年2月10日至2020年3月31日期间2019冠状病毒病（COVID-19）重症和危重症患者的资料，并进行回顾性分析。入院数据包括年龄、心率、平均动脉压和心肌损伤标志物，包括肌酸激酶同工酶-MB（CK-MB）、肌红蛋白、N末端B型利钠肽前体（NT-proBNP）和白细胞介素-6。终点包括死亡率、恶性心律失常发生率和机械通气时间。结果共纳入74例COVID-19患者（平均年龄67.2 ± 14.6岁，男性占66.2%），其中重症42例，危重32例。死亡率为62.2%（n = 46）。CK-MB（比值比= 5.895，p <0.001，95%置信区间：3.097-8.692）和白细胞介素-6（比值比= 0.379; p = 0.005; 95%置信区间：1.051-1.769）是机械通气时间增加的独立危险因素;肌红蛋白（比值比= 7.710; p = 0.045; 95%置信区间：1.051-56.571）是恶性心律失常发生率的独立预测因素;年龄（比值比= 1.077; p = .009; 95%置信区间：1.019-1.139），肌红蛋白（比值比= 9.480; p = 0.032; 95%置信区间：1.211-78.188）和NT-proBNP（比值比= 4.852; p = 0.047; 95%可信区间：0.956-24.627）是死亡率的独立预测因素。结论重症和危重COVID-19患者可观察到明显的心肌损伤。CK-MB、肌红蛋白、NT-proBNP、白细胞介素-6和年龄的增加与不良预后独立相关，包括通气时间延长、恶性心律失常的发生率和死亡率。
Background and Aim of the Study To investigate the effect of myocardial injury on the prognosis of patients with severe or critical coronavirus disease 2019 (COVID-19).Methods Between February 10, 2020 and March 31, 2020, data of severe and critical COVID-19 patients were collected and retrospectively analyzed. Admission data included age, heart rates, mean arterial pressure, and myocardial injury markers including creatine kinase isoenzyme-MB (CK-MB), myoglobin, N-terminal pro-B-type natriuretic peptide (NT-proBNP), and interleukin-6. The endpoints included mortality, the incidence of malignant arrhythmia, and mechanical ventilation time. Univariate regression analysis, multivariate linear regression analysis, and binary logistic analysis were performed to develop the risk predictors in myocardial injury to the prognosis of severe and critical COVID-19 patients.Results Seventy-four COVID-19 patients were included (mean age of 67.2 +/- 14.6 years, male of 66.2%), including 42 severe and 32 critical cases. The mortality was 62.2% (n = 46). CK-MB (odds ratio = 5.895, p < .001, 95% confidence interval: 3.097-8.692) and interleukin-6 (odds ratio = 0.379; p = .005; 95% confidence interval: 1.051-1.769) were independent risk factors of increased mechanical ventilation time; myoglobin (odds ratio = 7.710; p = .045; 95% confidence interval: 1.051-56.571) were the independent predictor of incidence of malignant arrhythmia; age (odds ratio = 1.077; p = .009; 95% confidence interval: 1.019-1.139), myoglobin (odds ratio = 9.480; p = .032; 95% confidence interval: 1.211-78.188), and NT-proBNP (odds ratio = 4.852; p = .047; 95% confidence interval: 0.956-24.627) were the independent predictors of mortality.Conclusions In severe and critical COVID-19 patients, the obvious myocardial injury was observed. Increases of CK-MB, myoglobin, NT-proBNP, interleukin-6, and age were independently associated with poor prognosis including increased ventilation duration, the incidence of malignant arrhythmia, and mortality.