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Duerr GD, Heine A, Hamiko M, Zimmer S, Luetkens JA, Nattermann J, Rieke G, Isaak A, Jehle J, Held SAE, Wasmuth JC, Wittmann M, Strassburg CP, Brossart P, Coburn M, Treede H, Nickenig G, Kurts C, Velten M. Parameters predicting COVID-19-induced myocardial injury and mortality. Life Sci 2020. [PMID: 32918975 DOI: 10.1016/j.lfs.2020.11840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
UNLABELLED Clinical manifestations of COVID-19 affect many organs, including the heart. Cardiovascular disease is a dominant comorbidity and prognostic factors predicting risk for critical courses are highly needed. Moreover, immunomechanisms underlying COVID-induced myocardial damage are poorly understood. OBJECTIVE To elucidate prognostic markers to identify patients at risk. RESULTS Only patients with pericardial effusion (PE) developed a severe disease course, and those who died could be identified by a high CD8/Treg/monocyte ratio. Ten out of 19 COVID-19 patients presented with PE, 7 (78%) of these had elevated APACHE-II mortality risk-score, requiring mechanical ventilation. At admission, PE patients showed signs of systemic and cardiac inflammation in NMR and impaired cardiac function as detected by transthoracic echocardiography (TTE), whereas parameters of myocardial injury e.g. high sensitive troponin-t (hs-TnT) were not yet increased. During the course of disease, hs-TnT rose in 8 of the PE-patients above 16 ng/l, 7 had to undergo ventilatory therapy and 4 of them died. FACS at admission showed in PE patients elevated frequencies of CD3+CD8+ T cells among all CD3+ T-cells, and lower frequencies of Tregs and CD14+HLA-DR+-monocytes. A high CD8/Treg/monocyte ratio predicted a severe disease course in PE patients, and was associated with high serum levels of antiviral cytokines. By contrast, patients without PE and PE patients with a low CD8/Treg/monocyte ratio neither had to be intubated, nor died. CONCLUSIONS PE predicts cardiac injury in COVID-19 patients. Therefore, TTE should be performed at admission. Immunological parameters for dysfunctional antiviral immunity, such as the CD8/Treg/monocyte ratio used here, supports risk assessment by predicting poor prognosis.
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Affiliation(s)
- G D Duerr
- Department of Cardiovascular Surgery, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - A Heine
- Department of Internal Medicine III for Hematology, Oncology, Rheumatology and Immune-Oncology, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - M Hamiko
- Department of Cardiovascular Surgery, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - S Zimmer
- Department of Internal Medicine II - Cardiology, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - J A Luetkens
- Department of Radiology, Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - J Nattermann
- Department of Internal Medicine I, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - G Rieke
- Department of Internal Medicine I, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - A Isaak
- Department of Radiology, Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - J Jehle
- Department of Internal Medicine II - Cardiology, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - S A E Held
- Department of Internal Medicine III for Hematology, Oncology, Rheumatology and Immune-Oncology, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - J C Wasmuth
- Department of Internal Medicine I, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - M Wittmann
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - C P Strassburg
- Department of Internal Medicine I, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - P Brossart
- Department of Internal Medicine III for Hematology, Oncology, Rheumatology and Immune-Oncology, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - M Coburn
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - H Treede
- Department of Cardiovascular Surgery, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - G Nickenig
- Department of Internal Medicine II - Cardiology, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - C Kurts
- Institute for Experimental Immunology, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany.
| | - M Velten
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany.
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Duerr GD, Heine A, Hamiko M, Zimmer S, Luetkens JA, Nattermann J, Rieke G, Isaak A, Jehle J, Held SAE, Wasmuth JC, Wittmann M, Strassburg CP, Brossart P, Coburn M, Treede H, Nickenig G, Kurts C, Velten M. Parameters predicting COVID-19-induced myocardial injury and mortality. Life Sci 2020; 260:118400. [PMID: 32918975 PMCID: PMC7480277 DOI: 10.1016/j.lfs.2020.118400] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/01/2020] [Accepted: 09/03/2020] [Indexed: 11/02/2022]
Abstract
Clinical manifestations of COVID-19 affect many organs, including the heart. Cardiovascular disease is a dominant comorbidity and prognostic factors predicting risk for critical courses are highly needed. Moreover, immunomechanisms underlying COVID-induced myocardial damage are poorly understood. OBJECTIVE To elucidate prognostic markers to identify patients at risk. RESULTS Only patients with pericardial effusion (PE) developed a severe disease course, and those who died could be identified by a high CD8/Treg/monocyte ratio. Ten out of 19 COVID-19 patients presented with PE, 7 (78%) of these had elevated APACHE-II mortality risk-score, requiring mechanical ventilation. At admission, PE patients showed signs of systemic and cardiac inflammation in NMR and impaired cardiac function as detected by transthoracic echocardiography (TTE), whereas parameters of myocardial injury e.g. high sensitive troponin-t (hs-TnT) were not yet increased. During the course of disease, hs-TnT rose in 8 of the PE-patients above 16 ng/l, 7 had to undergo ventilatory therapy and 4 of them died. FACS at admission showed in PE patients elevated frequencies of CD3+CD8+ T cells among all CD3+ T-cells, and lower frequencies of Tregs and CD14+HLA-DR+-monocytes. A high CD8/Treg/monocyte ratio predicted a severe disease course in PE patients, and was associated with high serum levels of antiviral cytokines. By contrast, patients without PE and PE patients with a low CD8/Treg/monocyte ratio neither had to be intubated, nor died. CONCLUSIONS PE predicts cardiac injury in COVID-19 patients. Therefore, TTE should be performed at admission. Immunological parameters for dysfunctional antiviral immunity, such as the CD8/Treg/monocyte ratio used here, supports risk assessment by predicting poor prognosis.
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Affiliation(s)
- G D Duerr
- Department of Cardiovascular Surgery, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - A Heine
- Department of Internal Medicine III for Hematology, Oncology, Rheumatology and Immune-Oncology, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - M Hamiko
- Department of Cardiovascular Surgery, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - S Zimmer
- Department of Internal Medicine II - Cardiology, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - J A Luetkens
- Department of Radiology, Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - J Nattermann
- Department of Internal Medicine I, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - G Rieke
- Department of Internal Medicine I, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - A Isaak
- Department of Radiology, Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - J Jehle
- Department of Internal Medicine II - Cardiology, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - S A E Held
- Department of Internal Medicine III for Hematology, Oncology, Rheumatology and Immune-Oncology, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - J C Wasmuth
- Department of Internal Medicine I, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - M Wittmann
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - C P Strassburg
- Department of Internal Medicine I, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - P Brossart
- Department of Internal Medicine III for Hematology, Oncology, Rheumatology and Immune-Oncology, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - M Coburn
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - H Treede
- Department of Cardiovascular Surgery, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - G Nickenig
- Department of Internal Medicine II - Cardiology, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - C Kurts
- Institute for Experimental Immunology, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany.
| | - M Velten
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany.
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