Myocardial Injury on Admission as a Risk in Critically Ill COVID-19 Patients: a Retrospective in-ICU Study

Qian, Hao; Gao, Peng; Tian, Ran; Yang, Xufei; Guo, Fan; Li, Taisheng; Liu, Zhengyin; Wang, Jinglan; Zhou, Xiang; Qin, Yan; Chang, Long; Song, Yanjun; Yan, Xiaowei; Wu, Wei; Zhang, Shuyang

OBJECTIVE: The aim of this study was to investigate the incidence, clinical presentation, cardiovascular (CV) complications and mortality risk of myocardial injury on admission in critically ill ICU inpatients with COVID-19. DESIGN: A single-center, retrospective, observational study. SETTING: A new-built ICU in Tongji hospital (Sino-French new city campus), Huazhong University of Science and Technology, Wuhan, China. PARTICIPANTS: Seventy-seven critical COVID-19 patients. INTERVENTIONS: Patients were divided into myocardial injury group and non-myocardial injury group according to the on-admission levels of high-sensitivity cardiac troponin I. MEASUREMENTS AND MAIN RESULTS: Demographic data, clinical characteristics, laboratory tests, treatment and clinical outcome were evaluated stratified by the presence of myocardial injury on admission. Compared with non-myocardial injury patients, patients with myocardial injury were older (68.4 ± 10.1 vs. 62.1 ± 13.5 years; P=0.02), had higher prevalence of underlying CV disease (34.1% vs. 11.1%; P=0.02) and in-ICU CV complications (41.5% vs13.9%; P=0.008), higher Acute Physiology and Chronic Health Evaluation II scores (20.3 ± 7.3 vs 14.4 ± 7.4; P=0.001) and Sequential Organ Failure Assessment scores [7, interquartile range (IQR) 5-10 vs. 5,IQR 3-6; P<0.001]. Myocardial injury on admission increased the risk of 28-day mortality [hazard ratio (HR), 2.200; 95% confidence interval (CI) 1.29 to 3.74; P=0.004]. Age ≥ 75 years was another risk factor for mortality (HR, 2.882; 95% CI 1.51 to 5.50; P=0.002). CONCLUSION: Critically ill patients with COVID-19 held high risk of CV complications. Myocardial injury on admission may be a common comorbidity and is associated with severity and a high risk of mortality in this population.