key: cord-1014130-vzzls7qv authors: Su, Minghua; Peng, Jieru; Wu, Mengjun; Deng, Wuquan; Yang, Yousheng; Peng, Yong G. title: Two consecutive myocardial tissue insults for inpatients with COVID-19 date: 2020-05-26 journal: Crit Care DOI: 10.1186/s13054-020-02981-9 sha: cb7f0db1b8fecb687ffd1f9cf0a19fccdf3ad04e doc_id: 1014130 cord_uid: vzzls7qv nan of creatine kinase was dramatically increased in nonsurvivors (991.85 ± 368.71 vs 48.95 ± 5.51; p < 0.001). The mean consistence of lactate dehydrogenase in nonsurvivors was three times greater than that in survivors (653.94 ± 65.76 vs 281.70 ± 22.77; p = 0.008). The nonsurvivors had a statistically higher value of myoglobin (505.70 ± 91.52 vs 97.13 ± 23.87; p = 0.001) and Troponin I (10.72 ± 9.13 vs 0.08 ± 0.02; p = 0.002) in comparison with survivors. The serum urea nitrogen, creatinine, and high-sensitivity C-reactive protein (hs-CRP) in nonsurvivors was significantly elevated in comparison with survivors (16.54 ± 2.45 vs 2.87 ± 0.58, p < 0.001; 184.68 ± 41.27 vs 63.42 ± 6.21, p < 0.001; 217.47 ± 46.35 vs 27.65 ± 21.83, p = 0.002, respectively). Cardiac biomarkers in non-survivors had double-peak patterns: CK-MB peaked on the 3rd and 10th days after admission, myoglobin on the 3rd and 8th days, and Troponin I on the 5th and 8th days (Fig. 1) . Cardiac biomarkers (CK-MB, myoglobin, and Troponin I) in non-survivors had a double-peak phenomenon during hospitalization, which suggested that myocardial tissue may have suffered two consecutive insults. At the early stage (first peak wave), the white cell count and neutrophil count were almost normal, and the lymphocyte counts decreased [4] . Meanwhile, infections were milder (serum hs-CRP level was low), and serum levels of myoglobin and CK-MB were inversely correlated with hs-CRP. However, at a later stage (second peak wave), the hs-CRP level continued to increase and peaked on the 7th day, which suggested a stronger inflammatory immune response, while these individuals also exhibited multiple organ dysfunction [4] . In addition, the association between myoglobin and CK-MB was moderately positive. Most importantly, in the latest pathological report, the degeneration and necrosis of cardiomyocytes for the non-survivors were confirmed to be caused by inflammatory destruction of cytokine storm [5] . From these results, myocardial injury might be associated with the direct insult of the virus at an early stage and a subsequent attack of the cytokine cascade (sustained inflammatory response) at a later stage. People's Republic of China. 5 Department of Intensive Care Unit, The Fifth Hospital of Wuhan, Wuhan 610091, People's Republic of China A novel coronavirus from patients with pneumonia in China Emerging understandings of 2019-nCoV Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19) Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a Retrospective Cohort Study None. The corresponding author attests that all listed authors meet the authorship criteria and that no others meeting the criteria have been omitted. Ming-Hua Su and Jie-Ru Peng wrote the paper and conducted this study. Meng-Jun Wu, Wu-Quan Deng, You-Sheng Yang, and Yong G. Peng designed the study and reviewed and edited the manuscript. The authors read and approved the final manuscript. Funding Science and Technology Department of Sichuan Province (2018SZ0224) Availability of data and materials All data generated or analyzed during this study are included in this published article. This study was only a retrospective report, so there were no patients or other participants. Not applicable. The authors declare that they have no competing interests.