Cardiac Injury Patterns and Inpatient Outcomes Among Patients Admitted With COVID-19
Cardiac Injury Patterns and Inpatient Outcomes Among Patients Admitted With COVID-19
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DOI：
10.1016/j.amjcard.2020.07.040
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发表时间：
2020-10-15
影响因子：
2.8
通讯作者：
Parikh, Sachin
中科院分区：
文献类型：
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作者：
Raad, Mohamad;Dabbagh, Mohammed;Parikh, Sachin
尽管某些风险因素与2019冠状病毒病（COVID-19）患者的发病率和死亡率增加相关，但心脏损伤和高敏肌钙蛋白I（hs-cTnI）浓度的影响尚未得到很好的描述。在这项大型回顾性纵向队列研究中，我们分析了从3月9日至4月15日连续入院的1，044名COVID-19患者的病例。心脏损伤定义为hs-cTnI浓度>第99百分位数。描述了心脏损伤和不同hs-cTnI临界值患者的患者特征、实验室数据和结局。主要结局是死亡率，次要结局是住院时间、是否需要重症监护室护理或机械通气，以及它们的不同组成部分。最终分析的队列包括1，020例患者。中位年龄为63岁，511例（50%）患者为女性，403例（40%）患者为白色。390例（38%）患者就诊时有心脏损伤。这些患者年龄较大（中位年龄70岁），心血管疾病负担较高，此外血清炎症标志物浓度较高。他们还表现出我们的主要和次要结局的风险增加，风险随着hs-cTnI浓度的升高而增加。在控制了共病、炎症标志物、急性肾损伤和急性呼吸窘迫综合征的多变量回归分析后，hs-cTnI峰值浓度仍与死亡率显著相关。在相同的多变量回归模型中，就诊时hs-cTnI浓度与结局无显著相关性，就诊时hs-cTnI浓度检测不到并不能完全排除机械通气或死亡的风险。总之，心脏损伤在因COVID-19入院的患者中很常见。心脏损伤程度和hs-cTnI峰值浓度与不良结局相关。(c)2020爱思唯尔公司All rights reserved.
Although certain risk factors have been associated with increased morbidity and mortality in patients admitted with Coronavirus Disease 2019 (COVID-19), the impact of cardiac injury and high-sensitivity troponin-I (hs-cTnI) concentrations are not well described. In this large retrospective longitudinal cohort study, we analyzed the cases of 1,044 consecutively admitted patients with COVID-19 from March 9 until April 15. Cardiac injury was defined by hs-cTnI concentration >99th percentile. Patient characteristics, laboratory data, and outcomes were described in patients with cardiac injury and different hs-cTnI cut-offs. The primary outcome was mortality, and the secondary outcomes were length of stay, need for intensive care unit care or mechanical ventilation, and their different composites. The final analyzed cohort included 1,020 patients. The median age was 63 years, 511 (50% patients were female, and 403 (40% were white. 390 (38%) patients had cardiac injury on presentation. These patients were older (median age 70 years), had a higher cardiovascular disease burden, in addition to higher serum concentrations of inflammatory markers. They also exhibited an increased risk for our primary and secondary outcomes, with the risk increasing with higher hs-cTnI concentrations. Peak hs-cTnI concentrations continued to be significantly associated with mortality after a multivariate regression controlling for comorbid conditions, inflammatory markers, acute kidney injury, and acute respiratory distress syndrome. Within the same multivariate regression model, presenting hs-cTnI concentrations were not significantly associated with outcomes, and undetectable hs-cTnI concentrations on presentation did not completely rule out the risk for mechanical ventilation or death. In conclusion, cardiac injury was common in patients admitted with COVID-19. The extent of cardiac injury and peak hs-cTnI concentrations were associated with worse outcomes. (c) 2020 Elsevier Inc. All rights reserved.