Myocardial injury in severe and critical coronavirus disease 2019 patients
Huiqi Guo1, Yunzhi Shen1, Ning Wu2
1Department of Cardiology, Huashan Hospital Fudan University, Shanghai, China.
Insights
Myocardial injury markers like creatine kinase isoenzyme-MB and myoglobin indicate poor prognosis in severe COVID-19 patients. Elevated levels of these markers, along with N-terminal pro-B-type natriuretic peptide and interleukin-6, predict increased mortality and complications.
Area of Science:
- Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Severe and critical coronavirus disease 2019 (COVID-19) poses significant risks to cardiac health.
- Myocardial injury is a recognized complication in COVID-19 patients, potentially impacting outcomes.
Purpose of the Study:
- To investigate the association between myocardial injury markers and prognosis in severe/critical COVID-19.
- To identify specific biomarkers predicting adverse outcomes such as mortality, arrhythmia, and ventilation duration.
Main Methods:
- Retrospective analysis of 74 severe/critical COVID-19 patients admitted between February and March 2020.
- Collected data included demographics, vital signs, and cardiac injury biomarkers: creatine kinase isoenzyme-MB (CK-MB), myoglobin, N-terminal pro-B-type natriuretic peptide (NT-proBNP), and interleukin-6.
- Statistical analyses included univariate, multivariate linear, and binary logistic regression to identify risk predictors.
Main Results:
- Overall mortality was 62.2%.
- Creatine kinase isoenzyme-MB (CK-MB) and interleukin-6 (IL-6) independently predicted increased mechanical ventilation time.
- Myoglobin predicted malignant arrhythmia, while age, myoglobin, and NT-proBNP predicted mortality.
Conclusions:
- Significant myocardial injury was observed in severe and critical COVID-19 patients.
- Elevated CK-MB, myoglobin, NT-proBNP, IL-6, and older age were independently associated with poor prognosis.
- These biomarkers can help predict adverse outcomes in severe COVID-19, guiding clinical management.
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.
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