ABSTRACT
武漢大学人民医院に入院した新型コロナウイルス感染症の重症患者148例(男性67例、女性81例、平均57.2±17.7歳)を対象に、心筋バイオマーカーと予後との関連性について検討した。患者148例のうち99例(66.9%)は高血圧症、糖尿病、貧血、腎障害、肝障害、慢性閉塞性肺疾患、心血管疾患、悪性腫瘍等の基礎疾患を有していた。患者を転帰に応じて、生存群96例(男性39.6%、平均51.4±16.1歳)と死亡群52例(男性55.8%、平均68.6±14.8歳)の2群に分類した。血中NT-proBNP(基準範囲は450pg/mL未満)は死亡群(1035.46pg/mL)が生存群(81.15pg/mL)より有意に高く、CK-MBも死亡群(2.62ng/mL)が生存群(0.67ng/mL)より有意に高かった(いずれもP<0.001)。心筋トロポニンcTnIは生存群で0.000であったが、死亡群は0.131ng/mLであった。血清ミオグロビンは死亡群(101.83μg/L)が生存群(26.86μg/L)より有意に高かった(P<0.001)。心血管合併症を呈した19例のうち14例が死亡した。
ABSTRACT
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is erupting and spreading globally. Cardiovascular complications secondary to the infection have caught notice. This study aims to delineate the relationship of cardiac biomarkers and outcomes in severe cases of corona virus disease 2019 (COVID-19). One hundred forty-eight critically ill adult patients with COVID-19 were enrolled. From these patients, the demographic data, symptoms, cardiac biomarkers, treatments, and clinical outcomes were collected. Data were compared between survivors and non-survivors. Four patients in the non-survivor group were selected, and their cardiac biomarkers were collected and analyzed. Among the 148 patients, the incidence of cardiovascular complications was 19 (12.8%). Five of them were survivors (5.2%), and 14 of them were non-survivors (26.9%). Compared with the survivors, the non-survivors had higher levels of high-sensitivity cardiac troponin I, creatine kinase isoenzyme-MB, myoglobin, and N-terminal pro-brain natriuretic peptide (P < 0.05). The occurrence of cardiovascular events began at 11-15 days after the onset of the disease and reached a peak at 14-20 days. COVID-19 not only is a respiratory disease but also causes damage to the cardiovascular system. Cardiac biomarkers have the potential for early warning and prognostic evaluation in patients with COVID-19. It is recommended that cardiac biomarker monitoring in patients with COVID-19 should be initiated at least from the 11th day of the disease course.
Subject(s)
Biomarkers/metabolism , COVID-19/complications , Cardiovascular Diseases/etiology , Cardiovascular Diseases/metabolism , Adult , Aged , Atrial Natriuretic Factor/metabolism , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/virology , Cardiovascular Diseases/epidemiology , Case-Control Studies , China/epidemiology , Creatine Kinase, MB Form/metabolism , Critical Illness/mortality , Critical Illness/nursing , Female , Humans , Incidence , Male , Middle Aged , Prognosis , Protein Precursors/metabolism , SARS-CoV-2/genetics , Survival Rate , Survivors/statistics & numerical data , Troponin I/metabolismABSTRACT
Our aim was to investigate whether SARS-CoV-2 infection raised high risks of late pregnancy complications, and posed health problems in fetuses and neonates. We analyzed the data of COVID-19 pregnant women with COVID-19 during late pregnancy and their neonates. Eleven out of 16 (69%) pregnant women with COVID-19 had ++ or +++ of ketone body in urine. The blood uric acid of pregnant patients was 334 µmol/L (IQR, 269-452). D-dimer and FDP in pregnant patients were 3.32 mg/L (IQR, 2.18-4.21) and 9.6 mg/L (IQR, 5.9-12.4). Results of blood samples collected at birth showed that 16 neonates had leukocytes (15.7 × 109/L (IQR, 13.7-17.2)), neutrophils (11.1 × 109/L (IQR, 9.2-13.2)), CK (401 U/L (IQR, 382-647)), and LDH (445 U/L (IQR, 417-559)). Twenty-four hours after birth, a neonate from COVID-19 woman had fever and positive of SARS-CoV-2 gene. Another woman had strongly positive for SARS-CoV-2 gene (+++) for 4 weeks, and delivered one neonate who had SARS-CoV-2 IgM (46 AU/mL) and IgG (140 AU/mL) on day 1 after birth. In the third trimester, COVID-19 infection in pregnant patients raised high risks of ketonuria, hypercoagulable state, and hyperfibrinolysis, which may lead to severe complications. COVID-19 increased the inflammatory responses of placenta, and fetuses and neonates had potential organ dysregulation and coagulation disorders. There was a potential intrauterine transmission while pregnant women had high titer of SARS-CoV-2, but it is necessary to detect SARS-CoV-2 in the blood cord, placenta, and amniotic fluid to further confirm intrauterine infection of fetuses.