Download This Paper
Preprints with The Lancet is part of SSRN´s First Look, a place where journals identify content of interest prior to publication. Authors have opted in at submission to The Lancet family of journals to post their preprints on Preprints with The Lancet. The usual SSRN checks and a Lancet-specific check for appropriateness and transparency have been applied. Preprints available here are not Lancet publications or necessarily under review with a Lancet journal. These preprints are early stage research papers that have not been peer-reviewed. The findings should not be used for clinical or public health decision making and should not be presented to a lay audience without highlighting that they are preliminary and have not been peer-reviewed. For more information on this collaboration, see the comments published in The Lancet about the trial period, and our decision to make this a permanent offering, or visit The Lancet´s FAQ page, and for any feedback please contact preprints@lancet.com.
Attribution of Myocardial Injury in Critically Ill Patients with Coronavirus Disease 2019
33 Pages Posted: 18 May 2020
More...Abstract
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
Suggested Citation: Suggested Citation