key: cord-0838154-0hf5nkbc
authors: Ni, Wentao; Yang, Xiuwen; Liu, Jie; Bao, Jing; Li, Ran; Xu, Yu; Guo, Wei; Hu, Yi; Gao, Zhancheng
title: Acute Myocardial Injury at Hospital Admission is Associated with All-cause Mortality in COVID-19
date: 2020-05-11
journal: J Am Coll Cardiol
DOI: 10.1016/j.jacc.2020.05.007
sha: 85c88f1a43a865193bcd2ee13986eac4310417c2
doc_id: 838154
cord_uid: 0hf5nkbc

nan

The outbreak of novel coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has now become a global pandemic. The SARS-CoV-2 uses angiotensin-converting enzyme 2 (ACE2) as the receptor for entry into host cells. The virus can attack organs with high ACE2 expression such as the heart, kidney, and gastrointestinal tract in addition to the lungs. Acute myocardial injury is common among patients with COVID-19, and fulminant myocarditis and even sudden cardiac death are not rare. Recent studies found that patients with myocardial injury in hospitalization had a significantly higher inhospital mortality rate than those without myocardial injury (1), (2) . However, it is still unclear if myocardial injury at the time of admission indicating early cardiac involvement is also a risk factor for mortality in COVID-19.

To study the association between acute myocardial injury at admission and all-cause mortality risk in COVID-19, we conducted a retrospective single-center cohort study among adult inpatients (> 18 years old) in the Central Hospital of Wuhan, a COVID-designated hospital in Wuhan, China. All patients had been diagnosed with COVID-19 by both nucleic acid testing and chest CT scanning. Patients who died or were discharged between Jan 28, 2020 and Mar 16, 2020 were included in our study. According to the Chinese management guideline for COVID-19 (version 7.0) (3), the discharge criteria is that patients have no fever for at least 3 days, significant relief of respiratory symptoms and improvement on chest CT, and had negative SARS-CoV-2 laboratory test twice in succession. Acute myocardial injury is defined as elevation of Troponin I (TnI) above the 99th percentile upper reference limit (4). This study was approved In summary, our cohort study demonstrated that acute myocardial injury at admission was associated with a higher risk of all-cause mortality in patients with COVID-19, which highlighted the importance of closely monitoring changes of myocardial enzymes, cardiac rhythm and cardiac functions, and thus providing timely interventions, especially when using drugs against SARS-CoV-2 with potential cardiotoxicity, such as chloroquine and lopinavirritonavir. Further studies are urgently needed to confirm the findings and explore the pathogenesis of myocardial injury in COVID-19. with acute myocardial injury at admission had a higher risk of all-cause death than those without acute myocardial injury at admission. P values were calculated by the log-rank test.

Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China

Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19)

National Health Commission of the People's Republic of China. Chinese management guideline for COVID-19 (version 7.0)

Surviving sepsis campaign: guidelines on the management of critically ill adults with coronavirus disease 2019 (COVID-19)