key: cord-0986841-8domh5gc
authors: Zhang, Boyou; Zhang, Jie; Qian, Banglun; Han, Wei; Liu, Yukang; Liu, Wenliang
title: Comment on Han et al: Analysis of heart injury laboratory parameters in 273 COVID‐19 patients in one hospital in Wuhan, China
date: 2020-06-09
journal: J Med Virol
DOI: 10.1002/jmv.26099
sha: 5ba535c7bab08d7e58007fd21253c93b2b1aa7af
doc_id: 986841
cord_uid: 8domh5gc

nan

Unfortunately, there were some obvious limitations in this article, which may reduce the degree of reliability of this study. As a typical retrospective, single-center study, the authors divided patients into three groups depending upon the severity of the disease.

As we all known, a retrospective clinical study requires enough baseline information. However, the authors have not provided the baseline clinical information of the patients. According to the grouping criteria by the severity of clinical symptoms and imaging changes for this study, it is supposed the baseline information was inconsistently between three groups. Some vital baseline information is different between mild patients and severe/critical, such as age, history of cardiovascular diseases, diabetes, and hypertension. 2,3 It is uncertain whether they acted as risk factors or not for a higher morbidity and mortality in COVID-19 now. 4 There is more morbidity of acute respiratory distress syndrome (ARDS) in severe/critical patients with COVID-19 which could induce higher level of the myocardial enzyme. 5 Without the baseline information about the disease of the respiratory system in severe/critical patients, it could not confirm that the higher level of myocardial enzyme caused by virus infections or ARDS. Biomarker elevations may simply reflect systemic illness in a large fraction of critical patients with COVID-19. 6 Maybe a adjust Cox regression model is suitable for more credible analysis after updated sufficient baseline information. In a word, it is necessary to supplement complete baseline information and take it into full consideration in the study at the same time to make the results more reliable and credible.

In addition, the authors had compared and analyzed those four myocardial enzymes between alive and dead patients. The results showed that myocardial enzymes were higher in death patients than alive patients, while the authors concluded that higher myocardial enzymes were associated with the severity and case fatality rate in COVID-19. However, it was just a cross-sectional study and collected data only in one time. We indicate that authors could collect more data at a different time from the patients aiming at analyzing a variation tendency of myocardial enzyme in each patient.

This way, the relationship between fatality rate and the myocardial enzyme level can be more definite and reliable in methodology.

We all known that the doctors faced huge clinical challenge during COVID-19 epidemic period. We all respect the authors' work.

In conclusion, although there were some limitations in the study, it was valuable during the early periods of the epidemic COVID-19. We are looking forward to receiving more detailed data and information from the authors to make the study more perfectly. 

Analysis of heart injury laboratory parameters in 273 COVID-19 patients in one hospital in Wuhan, China

Clinical characteristics of coronavirus disease 2019 in China

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

2020:e200950

Coronavirus disease 2019 (COVID-19) and cardiovascular disease

Progressive myocardial injury is associated with mortality in the acute respiratory distress syndrome

COVID-19 and the heart

The authors declare that there are no conflict of interests.