Objective: To analyze the clinical characteristics of the severe or critically ill patients with novel coronavirus pneumonia (COVID-19), and evaluate the impact of complicated myocardial injury on the prognosis of these patients. Methods: A retrospective study was conducted in 54 patients who admitted to Tongji hospital from February 3, 2020 to February 24, 2020 and met the criteria of severe or critical conditions of COVID-19. The clinical characteristics and hospital mortality rate were analyzed and compared between the patients with or without myocardial injury, which was defined with 3 times higher serum cardiac troponin value. Results: The age of the 54 patients was 68.0(59.8, 74.3) years. Among all the patients, 24 (44.4%) patients were complicated with hypertension, 13 (24.1%) with diabetes, 8 (14.8%) with coronary heart disease, and 3 (5.6%) with previous cerebral infarction. During hospitalization, 24 (44.4%) of the patients were complicated with myocardial injury and 26 (48.1%) patients died in hospital. In-hospital mortality was significantly higher in patients with myocardial injury than in patients without myocardial injury (14 (60.9%) vs. 8 (25.8%), P=0.013). Moreover, the levels of C-reactive protein (153.6 (80.3, 240.7) ng/L vs. 49.8 (15.9, 101.9) ng/L) and N-terminal pro-B-type natriuretic peptide (852.0 (400.0, 2 315.3) ng/L vs. 197.0 (115.3, 631.0) ng/L) were significantly higher than patients without myocardial injury (all P<0.01). Conclusions: Prevalence of myocardial injury is high among severe or critically ill COVID-19 patients. Severe or critically ill COVID-19 patients with myocardial injury face a significantly higher risk of in-hospital mortality. The study suggests that it is important to monitor and manage the myocardial injury during hospitalization for severe or critically ill COVID-19 patients.
目的： 分析重型/危重型新型冠状病毒肺炎（COVID-19）的临床特征，评估合并心肌损伤对患者预后的影响。 方法： 回顾性分析2020年2月3日至24日于华中科技大学同济医学院附属同济医院中法新城院区收治的54例重型/危重型COVID-19确诊病例，年龄68.0（59.8，74.3）岁，男34例（63.0%），分析其临床特征。并根据是否合并心肌损伤（高敏心肌肌钙蛋白>正常上限3倍以上，并排除急性心肌梗死、心功能不全失代偿、慢性肾功能衰竭）将患者分为合并心肌损伤组和未合并心肌损伤组，比较两组患者临床特征的差异。 结果： 所有患者中合并高血压24例（44.4%），糖尿病13例（24.1%），冠心病8例（14.8%），既往脑梗死3例（5.6%）。住院期间合并心肌损伤24例（44.4%），院内死亡26例（48.1%）。按有无心肌损伤将患者分为合并心肌损伤组（24例）和未合并心肌损伤组（30例）。两组在年龄、性别、合并症等方面差异均无统计学意义（P均<0.05）。但心肌损伤组患者，院内死亡率明显高于未合并心肌损伤组[75.0%（18/24）比26.7%（8/30），P=0.001]。同时心肌损伤组的C反应蛋白[153.6（80.3, 240.7）ng/L比49.8（15.9, 101.9）ng/L]和氨基末端B型利钠肽原[852.0（400.0, 2 315.3）ng/L比197.0（115.3, 631.0）ng/L]水平也明显高于未合并心肌损伤组（P均<0.01）。 结论： 重型/危重型COVID-19多为老年患者，合并症多，发生心肌损伤的比例高。合并心肌损伤的患者具有更高的院内死亡率。因此，应加强住院期间心肌损伤标志物和心功能的监测，重视合并心肌损伤的治疗。.
Keywords: COVID-19; Myocardial injury; Troponin.