A Clinical Study On The Mortality Of COVID-19 Patients With Cardiac Injury

Objectives:Cardiac injury is associated with poor prognosis of 2019 novel coronavirus pneumonia(coronavirus disease 2019,COVID-19,NCP).By analyzing the clinical data of patients with COVID-19 complicated with myocardial injury,we studied the nosocomial characteristics and death prediction factors to improve the ability to diagnose and treat these patients.Methods:Analysis on 128 patients diagnosed with COVID-19 complicated with elevated high-sensitivity troponin I(hs-Tn I)in tongji medical college of HUAZHONG university of science and technology on January 20,2020 to March 10,2020.Compare all patients ’ clinical data and its impact on mortality:(1)General information: age,gender,body temperature,heart rate,respiratory rate,underlying diseases,ACEI/ARB medication history;(2)Laboratory indicators: white blood cell count,hs-Tn I,interleukin 2 receptor(IL-2R),etc.;(3)Complications: Acute myocardial infarction,arrhythmia,hypoproteinemia,disseminated intravascular coagulation(DIC)and other differences.The SPSS24.0 software was used for statistical description and analysis of the experimental data.Normally distributed measurement data is represented by x±s,and comparison between groups is performed by independent sample t test;non-normally distributed measurement data is represented by M(Q1,Q3),and comparison between groups is performed by non-parametric test;Count data is expressed in frequency(%),and the comparison between groups is performed by chi-square test.After obtaining the correlation factors,the logistic binary regression curve was used to analyze the correlation of multiple risk factors of death.We use Graph Pad Prism 6.00 software for data analysis and plotting of peak hs-Tn I.In all comparative data,the difference was statistically significant with a two-sided P<0.05.Results:1.A statistical analysis of the basic data of the study subjects showed that: 128 patients were included in this study,of which 89 were dead and 39 were surviving.Male patients had a higher mortality rate(p<0.05);patients with previous hypertension,cerebrovascular disease,coronary heart disease,COPD,diabetes,digestive system diseases,chronic kidney disease and tumors had no statistically significant difference in mortality(p >0.05);There was no statistically significant difference in the mortality of patients with or without a history of ACEI/ARB medication(p>0.05).2.Laboratory indicators: Inflammation indicators: white blood cell count,neutrophil count,PCT,ferritin,IL-2R,IL-6,IL-8,IL-10,TNF-α increased or lymphocyte count decreased The mortality rate of patients is higher(p<0.05).Biochemical indicators: patients with elevated AST or LDH or elevated creatinine have a higher mortality rate than normal(p<0.05).Heart-related indicators: According to the level of hs-Tn I at the time of admission,it can be divided into mildly elevated(≤100pg/m L),moderately elevated(100 pg/m L<hs-Tn I≤1000 pg/m L)and severely elevated(>1000 pg/m L)In the three groups,patients with mildly elevated hs-Tn I admitted to the hospital had a lower fatality rate than those with moderate and severe increases,while patients with elevated N-terminal pro-B-type natriuretic peptide had a higher fatality rate than normal(p<0.05).During the hospital stay,hs-Tn I was monitored dynamically.The peak level of cardiac troponin in the death group was higher than that in the survival group,but p>0.05.The death rate of peak hs-Tn I severe and moderately elevated group was significantly higher than that of mildly elevated group(p<0.05).Coagulation index: D-dimer>5ug/m L patients had higher mortality than D-dimer Patients with body ≤5ug/m L(p<0.05).The mortality of patients with reduced platelet counts was higher than that of patients with normal counts(p<0.05).3.Complications: The mortality rate of patients with acute renal failure,electrolyte imbalance,and hypoproteinemia is higher than that of patients without the above diseases(p<0.05).There was no significant difference in the mortality of patients with new coronary pneumonia complicated by arrhythmia,acute myocardial infarction,acute liver injury,shock,DIC,gastrointestinal hemorrhage and those without the above complications(p>0.05).4.In the above single factor analysis,the risk factors with P<0.05 were selected as covariates,and whether the patient’s outcome was death as the dependent variable,and multivariate binary logistic regression analysis was performed.The results showed that peak hs-Tn I > 100pg/m L during hospitalization is independent risk factor for death in patients with COVID-19,that is,the higher the level of the above indicators,the higher the risk of death.Conclusion:1.Peak hs-Tn I > 100pg/m L during hospitalization is independent risk factor for death in patients with COVID-19.2.Male patients with COVID-19 had higher mortality risk.3.Death patients with COVID-19 have higher levels of inflammatory factors and are prone to multiple organ dysfunction and coagulation dysfunction.