The Clinical Characteristics of Myocardial Injury in Severe and Very Severe Patients with 2019 Novel Coronavirus Disease

Background: Despite previous studies discussing the clinical and epidemiological features of 2019 Novel coronavirus disease (COVID-19), few have investigated the alteration of cardiac lesion markers and how it is correlated to disease severity. This study aims to describe the clinical characteristics of myocardial injury in severe and very severe COVID-19 patients. Methods: We enrolled in-hospital patients with COVID-19 admitted to the West District of Union Hospital of Tongji Medical College in the 7th floor ward from February 5th to February 13rd, 2020. Demographic data were collected upon admission. Laboratory confirmation of COVID-19, blood count, creatine, liver enzymes, and cardiac lesion markers were together tested by the laboratory department. Findings: 34 patients with COVID-19 were included in this study, 8 patients met the criteria for very severe COVID-19, and 26 for severe COVID-19. The median age was 63yrd (inter quartile range {IQR}:58-69) among severe COVID-19 group and 67yrd (IQR: 66-75) among very severe group. We noted significantly increased cTnI (46.8ng/L [IQR: 34.2-299.8] vs. 4.8ng/L [IQR: 34.2-299.8]), CK (199U/L [IQR: 77-285] vs. 88U/L [IQR: 45-125]), HBDB (453U/L [IQR: 347-547] vs. 245U/L [IQR: 207-275]) and LDH (513U/L [IQR: 414-641] vs. 287U/L [IQR: 246-331]) in very severe group as compared to severe group. Importantly, the percentage of very severe patients with elevated cTnI levels was markedly higher, with 8/8 patients exhibiting increased cTnI in very severe group, and only 1/26 patient in severe group (P value<0.001). Interpretation: We have found high percentage of increased cTnI levels in very severe COVID-19. Protecting from myocardial injury could be of vital importance for reducing the mortality rate in very severe COVID-19. Funding Statement: This study was funded by the Clinical Research Award of the First Affiliated Hospital of Xi'an Jiaotong University, China (No.XJTU1AF-CRF-2018-025). Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The study was approved by the ethics committee of the local hospital and data were collected retrospectively.