key: cord-0869935-lz2oqqin
authors: Zhou, Bo; She, Jianqing; Wang, Yadan; Ma, Xiancang
title: The clinical characteristics of myocardial injury in severe and very severe patients with 2019 novel coronavirus disease
date: 2020-03-21
journal: J Infect
DOI: 10.1016/j.jinf.2020.03.021
sha: 3eba6ff5d8066f48e74576b8ff894581ebef9714
doc_id: 869935
cord_uid: lz2oqqin

nan

The clinical characteristics of myocardial injury in severe and very severe patients with 2019 novel coronavirus disease Dear Editor,

We read with interest the recent article published by Yang W et al., 1 which described the clinical characteristics and imaging manifestations of hospitalized patients with confirmed COVID-19 infection in Wenzhou, Zhejiang, China. The 2019 Novel coronavirus disease (COVID-19) has drawn global intensive attention. [2] [3] [4] Previous studies suggest that severe COVID-19 may present with acute cardiac injury. [2] [3] [4] However, few have investigated the cardiac lesion markers and their correlation to disease severity. In this letter, we explored the cardiac lesion biomarkers in patients with severe and very severe COVID-19.

We enrolled 34 COVID-19 patients admitted to the West District of Union Hospital of Tongji Medical College from February 5th to February 13rd, 2020. COVID-19 was diagnosed upon admission based on the New Coronavirus Pneumonia Prevention and Control Program (4th edition). 5 Severe COVID-19 was defined as having either one of the flowing criteria: (1) Respiratory distress with respiratory rate more than 30 times/min; (2) Oxygen saturation ≤93% in resting state; (3) PaO2/FiO2 ≤300 mmHg (1 mmHg = 0.133 kPa); ingly, the percentage of very severe patients with elevated cTnI levels was markedly higher, with 8/8 patients exhibiting increased cTnI in very severe group, and only 1/26 patient in severe group ( P value < 0.001). In addition, the abnormal percentage of HBDB and LDH showed no significant difference between 2 groups ( Table 2 ) . Recently, a number of studies have described the epidemiological and clinical characters of COVID-19. [2] [3] [4] A study of 41 patients with COVID-19 has suggested that 12% of the mild and severe cases combined showed increased hyper sensitivity troponin I, suggesting acute myocardial injury. 2 It is also reported that severe acute respiratory syndrome coronavirus (SARS-CoV) 6 and Middle East respiratory syndrome coronavirus (MERS-CoV) 7 have caused critical cardiac lesions. In the present study, we have focused on cardiac lesion biomarkers in severe and very severe patients with COVID-19. We have proved elevation of cTnI, CK, HBDB, and LDH in critical cases. It is important to notify that, in very severe group, 8/8 patients exhibit cTnI above reference level; while 1/26 in severe group. This suggests that elevated cTnI could be a potential indicator for critically ill patients. It is worth notifying that among the 8 critically ill patients enrolled, the kidney and liver function markers are not as significantly disturbed as the cardiac lesion markers, suggesting that most patients enrolled have not been suffering from multiple organ dysfunction syndrome (MODS). Thus, the consistently high cTnI levels in very severe group point to the importance that the heart injury could be a distinct, or even lethal feature in very severe COVID-19. Protecting from myocardial injury could be of vital importance in clinical treatment for reducing the mortality rate. The study was limited by small sample size. And we haven't analyzed the echocardiography and MRI for the patients enrolled. Further analysis is needed to determine the etiology.

We declare no competing interests.

BZ, XM and YW collected the clinical and laboratory data. JS processed statistical analysis. JS and BZ drafted the manuscript. XM and YW revised the final manuscript. XM and YW is responsible for all clinical and laboratory data.

This study was funded by the Clinical Research Award of the First Affiliated Hospital of Xi'an Jiaotong University, China (No.XJTU1AF-CRF-2018-025).

Clinical characteristics and imaging manifestations of the 2019 novel coronavirus disease (COVID-19):a multi-center study in Wenzhou city

Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study

Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China

New coronavirus pneumonia prevention and control program

A novel coronavirus associated with severe acute respiratory syndrome

Middle east respiratory syndrome coronavirus: quantification of the extent of the epidemic, surveillance biases, and transmissibility

We thank all patients involved in the study.