ABSTRACT

Background

Limited data on myoglobin and infectious diseases are available. In this study, we evaluate the potential role of myoglobin in predicting poor outcome in patients with Sars-Cov2 pneumonia.

Methods

One hundred and twenty-one Sars-Cov 2 patients with an average age of 69.9 ± 13.2 years, and symptoms duration of 8.8 ± 7.9 days were enrolled in the study. At the admission, the serum levels of myoglobin, erythrocyte sedimentation rate, C reactive protein (CRP), procalcitonin, ferritin, creatine phosphokinase, creatinine, fibrinogen, d-dimers, lactic dehydrogenase, troponin (Tn-I), creatine kinase myocardial band (CK-MB), complement fractions C3 and C4, immunoglobulins, interleukin 6 were evaluated. We also assessed the patients’ complete clinical history and performed a thorough physical examination including age, disease history, and medications.

Results

Twenty-four (20%) patients died, and 18 (15%) patients required intensive care. The mean time between symptoms onset and death was 12.4 days ± 9.1. Univariate analysis of the patients’ data highlighted some independent risk factors for mortality in COVID-19, including higher neutrophils rate (HR: 1.171), lower lymphocyte rate (HR: 0.798), high CK-MB serum levels (HR: 1.6), high Tn-I serum levels (HR: 1.03), high myoglobin serum levels (HR: 1.014), Alzheimer (HR 5.8), and higher CRP values (HR: 1.011). Cox regression analysis model revealed that higher serum values of myoglobin (HR 1.003; 95%CI: 1.001–1.006; p = 0.01), and CRP (HR 1.012; 95% CI: 1.001–1.023; p = 0.035) could be predictors of mortality in COVID-19 patients. The value of the myoglobin level for predicting 28 days-mortality using ROC curve was 121.8 ng/dL. Lower survival rate was observed in patients with serum levels of myoglobin>121.8 ng/dL (84% vs 20% respectively, p = 0.0001).

Conclusion

Our results suggest that higher serum levels of myoglobin could be a considerable and effective predictor of poor outcomes in COVID-19 patients; a careful follow-up in these patients is strongly suggested. The possibility of enhancing these findings in other cohorts of COVID-19 patients could validate the clinical value of myoglobin as a biomarker for worse prognosis in COVID-19.

中文翻译：

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较高的血清肌红蛋白水平可能作为 Sars-Cov 2 住院患者预后较差的预测因子。单中心回顾性研究

摘要

背景

关于肌红蛋白和传染病的数据有限。在这项研究中，我们评估了肌红蛋白在预测 Sars-Cov2 肺炎患者预后不良方面的潜在作用。

方法

121 名 Sars-Cov 2 患者平均年龄为 69.9 ± 13.2 岁，症状持续时间为 8.8 ± 7.9 天。入院时，血清肌红蛋白水平、红细胞沉降率、C反应蛋白（CRP）、降钙素原、铁蛋白、肌酸磷酸激酶、肌酐、纤维蛋白原、d-二聚体、乳酸脱氢酶、肌钙蛋白（Tn-I）、肌酸激酶心肌带(CK-MB)、补体部分 C3 和 C4、免疫球蛋白、白细胞介素 6 进行了评估。我们还评估了患者的完整临床病史，并进行了全面的体格检查，包括年龄、疾病史和药物治疗。

结果

24 名 (20%) 患者死亡，18 名 (15%) 患者需要重症监护。症状发作和死亡之间的平均时间为 12.4 天 ± 9.1。对患者数据的单变量分析突出了 COVID-19 死亡的一些独立危险因素，包括较高的中性粒细胞率 (HR: 1.171)、较低的淋巴细胞率 (HR: 0.798)、高 CK-MB 血清水平 (HR: 1.6)、高 Tn-I 血清水平 (HR: 1.03)、高肌红蛋白血清水平 (HR: 1.014)、阿尔茨海默氏症 (HR 5.8) 和更高的 CRP 值 (HR: 1.011)。Cox 回归分析模型显示，较高的血清肌红蛋白值（HR 1.003；95% CI：1.001–1.006；p = 0.01）和 CRP（HR 1.012；95% CI：1.001–1.023；p = 0.035）可能是COVID-19 患者的死亡率。使用 ROC 曲线预测 28 天死亡率的肌红蛋白水平值为 121.8 ng/dL。

结论

我们的研究结果表明，较高的血清肌红蛋白水平可能是 COVID-19 患者预后不良的重要且有效的预测因素；强烈建议对这些患者进行仔细的随访。在其他 COVID-19 患者队列中增强这些发现的可能性可以验证肌红蛋白作为 COVID-19 预后较差的生物标志物的临床价值。