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Attribution of Myocardial Injury in Critically Ill Patients with Coronavirus Disease 2019
33 Pages Posted: 18 May 2020More...
Background: Overall death cause of COVID-19 patients has been reported but attribution of myocardial injury remains undetermined.
Methods: We extracted data from 392 critically ill patients with COVID-19 hospitalized in Tongji hospital, Wuhan, China and analyzed the demographic information, laboratory findings, comorbidities and treatments. The association of myocardial injury with in-hospital mortality was investigated.
Findings: A significantly increased high-sensitive cardiac troponin I (hs-cTnI) was observed in 53.57% critically ill COVID-19 patients. A total of 392 critically ill patients were divided into two groups, hs-cTnI negative group and hs-cTnI positive group. 92.86% patients in positive group need mechanical ventilation, compared to 64.29% in negative patients. The 30-day in-hospital mortality rate of positive patients was dramatically higher than negative patients (83.89% vs 32.24%, p<0.0001). More severe leukocytosis, lymphopenia and boosted creatine kinase and D-dimer were observed in positive patients. High sensitivity C-reactive protein and cytokines were significantly increased in positive patients. Notable decrease of total T cells, CD4+ T cells, CD8+ T cells, natural killer cells were observed in hs-cTnI positive patients compared to negative patients. The positive hs-cTnI was associated with a hazard ratio of 2.34 and 3.15 for 14-day and 30-day mortality, respectively. Age (older than 60 years), spO2 <93%, lower GFR and lymphopenia were associated with increased in-hospital mortality.
Conclusions: Myocardial injury complicated with critically ill COVID-19 patients was closely associated with the worsening prognosis and fatality. Cytokine storm may be responsible for the myocardial injury and in-hospital death of critically ill patients with COVID-19.
Funding Statement: This work is supported by National Natural Science Foundation of China to L. Wang (81600236), to N. Zhou (81570261) and to DW Wang (81630010).
Declaration of Interests: The authors declare that they have no competing interests.
Ethics Approval Statement: This study was approved by the Ethics Commission of Tongji Hospital. Written informed consent was waived due to the rapid emergence of this infectious disease.
Keywords: COVID-19; Cause of death; myocardial injury; cellular immunity; myocarditis; severe acute respiratory syndrome coronavirus 2
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