COVID-19 and Myocardial Injury in a Brazilian ICU: High Incidence and Higher Risk of In-Hospital Mortality

Abstract Background The incidence of myocardial injury (MI) in patients with COVID-19 in Brazil and the prognostic impact of MI have not been elucidated. Objectives To describe the incidence of MI in patients with COVID-19 in the intensive care unit (ICU) and to identify variables associated with its occurrence. The secondary objective was to assess high-sensitivity troponin I as a predictor of in-hospital mortality. Methods Retrospective, observational study conducted between March and April 2020 with cases of confirmed COVID-19 admitted to the ICU. Numerical variables were compared by using Student t test or Mann-Whitney U test. The chi-square test was used for categorical variables. Multivariate analysis was performed with variables associated with MI and p<0.2 to determine predictors of MI. The ROC curve was used to determine the troponin value capable of predicting higher in-hospital mortality. Survival functions were estimated by use of the Kaplan-Meier method from the cut-off point indicated in the ROC curve. Results This study assessed 61 patients (63.9% of the male sex, mean age of 66.1±15.5 years). Myocardial injury was present in 36% of the patients. Systemic arterial hypertension (HAS) [OR 1.198; 95%CI: 2.246-37.665] and body mass index (BMI) [OR 1.143; 95%CI: 1.013-1.289] were independent risk predictors. High-sensitivity troponin I >48.3 ng/mL, which was determined in the ROC curve, predicts higher in-hospital mortality [AUC 0.786; p<0.05]. Survival in the group with high-sensitivity troponin I >48.3 ng/mL was lower than that in the group with values ≤48.3 ng/dL [20.3 x 43.5 days, respectively; p<0.05]. Conclusion There was a high incidence of MI in severe COVID-19 with impact on higher in-hospital mortality. The independent risk predictors of MI were SAH and BMI. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

摘要
背景 巴西新型冠状病毒肺炎（COVID-19）患者合并心肌损伤（myocardial injury, MI）的发生率，以及心肌损伤对患者预后的影响尚未阐明。
目的 描述重症监护病房（intensive care unit, ICU）内新型冠状病毒肺炎患者的心肌损伤发生率，并明确与其发生相关的变量。本研究的次要目的为评估高敏肌钙蛋白I（high-sensitivity troponin I）作为住院死亡率预测因子的价值。
方法 本研究为回顾性观察性研究，于2020年3月至4月间开展，纳入收治于重症监护病房的确诊新型冠状病毒肺炎病例。数值变量比较采用Student t检验（Student t test）或曼-惠特尼U检验（Mann-Whitney U test），分类变量采用卡方检验（chi-square test）。针对与心肌损伤相关且p<0.2的变量进行多因素分析，以明确心肌损伤的预测因子。采用受试者工作特征曲线（Receiver Operating Characteristic, ROC）确定可预测更高住院死亡率的肌钙蛋白临界值。通过Kaplan-Meier法（Kaplan-Meier method），以受试者工作特征曲线确定的临界值估算生存函数。
结果 本研究共纳入61例患者（男性占63.9%，平均年龄66.1±15.5岁）。其中36%的患者合并心肌损伤。系统性动脉高血压（systemic arterial hypertension, HAS）[优势比（odds ratio, OR）1.198；95%置信区间（95% confidence interval, 95%CI）：2.246~37.665]与体重指数（body mass index, BMI）[OR 1.143；95%CI：1.013~1.289]为独立风险预测因子。经受试者工作特征曲线确定，高敏肌钙蛋白I>48.3 ng/mL可预测更高的住院死亡率[曲线下面积（area under curve, AUC）0.786；p<0.05]。高敏肌钙蛋白I>48.3 ng/mL组的生存时间低于≤48.3 ng/dL组[分别为20.3天与43.5天；p<0.05]。
结论 重型新型冠状病毒肺炎患者心肌损伤发生率较高，且会增加住院死亡风险。心肌损伤的独立风险预测因子为系统性动脉高血压（HAS）与体重指数（BMI）。（Arq Bras Cardiol. 2020; [在线]. 预印刷, PP.0-0）