Povezanost oštećenja srca na prijemu u bolnicu sa lošim ishodom kod obolelih od COVID-19
Sažetak
Uvod/Cilj. Novi korona virus severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) izazvao je pandemiju bolesti sa složenim kliničkim manifestacijama (coronavirus disease 2019, COVID-19). Ubrzo je postalo jasno da su bolesnici sa određenim komorbiditetima imali veću šansu da obole od teškog oblika COVID-19. Cilj rada bio je da se utvrdi povezanost između oštećenja srca (OS) i težine bolesti i mortaliteta kod obolelih od COVID-19. Metode. Svi bolesnici sa laboratorijski potvrđenim COVID-19 bili su uključeni i praćeni do otpusta ili smrti u periodu od 30. januara 2020. do 5. aprila 2020. Rezultati. Ukupno je bilo obuhvaćeno 261 bolesnika sa COVID-19, od kojih je 29 (11,1%) imalo OS pri prijemu. Bolesnici sa OS bili su starijeg životnog doba od bolesnika bez OS (72,8% vs 55,8%) i većina (82,8% vs 42,2%) su bili muškarci. Bolesnici sa OS su češće bili pušači (31,0% vs 12,5%), imali hroničnu kardiovaskularnu bolest (24,1% vs 7,8%), hroničnu bolest pluća (17,2% vs 3,0%) kao i hroničnu bolest bubrega (10,3% vs 2,2%) u poređenju sa bolesnicima bez OS. Prema laboratorijskim analizama, bolesnici sa OS su značajno češće imali vrednosti leukocita više od 10 × 109/L, izraženiju limfopeniju, više vrednosti direktnog bilirubina, miohemoglobina, uree u krvi kao i C-reaktivnog proteina i pro-B-tipa natriuretičkog peptida, ali niže nivoe ukupnih proteina u serumu i procenjene stope glomerularne filtracije, u poređenju sa bolesnicima bez OS. Bolesnici sa OS imali su više komplikacija (72,4% vs 47,8%), uključujući sindrom akutnog respiratornog distresa (20,7% vs 2,7%), akutno oštećenje bubrega (10,3% vs 0,4%), teški oblik COVID-19 (58,6% vs 11,6%) kao i veću smrtnost (55,2% vs 3,9%) u poređenju sa bolesnicima bez OS. Multivarijantne analize su pokazale da je OS povezano sa povišenim rizikom od obolevanja od teškog oblika COVID-19 (HR = 8,71, 95% CI = 2,37–32,04) i smrti [hazard ratio (HR) = 20,84, 95% confidence interval (CI) = 1,32−328,22]. Zaključak. Oštećenje srca na prijemu u bolnicu kod bolesnika sa COVID-19 bilo je povezano sa višim rizikom od progresije bolesti i smrtnog ishoda.
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