Correction: Exploring Predictive Risk Factors for Myocardial Injury in Children Treated with Anthracyclines: A Pilot Study.

BACKGROUNDCold ischemia-reperfusion of the liver is an inevitable occurrence in liver transplantation that may also cause damage to the heart. Perioperative myocardial injury during liver transplantation can increase the incidence of postoperative mortality, but there is little research on the incidence of myocardial injury in children who undergo living donor liver transplantation (LDLT). Therefore, this study mainly explores the independent risk factors for myocardial injury in children who undergo LDLT.AIMTo analyze the data of children who underwent LDLT to determine the risk factors for intraoperative myocardial injury.METHODSWe retrospectively analyzed the inpatient records of pediatric patients who underwent LDLT in Tianjin First Central Hospital from January 1, 2020, to January 31, 2022. Recipient-related data and donor-related data were collected. The patients were divided into a myocardial injury group and a nonmyocardial injury group according to the value of the serum cardiac troponin I at the end of surgery for analysis. Univariate analysis and multivariate logistic regression were used to evaluate the risk factors for myocardial injury during LDLT in pediatric patients.RESULTSA total of 302 patients met the inclusion criteria. The myocardial injury group had 142 individuals (47%), and the nonmyocardial injury group included 160 patients (53%). Age, height, and weight were significantly lower in the myocardial injury group (P < 0.001). The pediatric end-stage liver disease (PELD) score, total bilirubin, and international standardized ratio were significantly higher in the myocardial injury group (P < 0.001). The mean arterial pressure, lactate, hemoglobin before reperfusion, duration of the anhepatic phase, cold ischemic time, incidence of postreperfusion syndrome (PRS), and fresh frozen plasma transfusion were significantly different between the two groups (P < 0.05). The postoperative intensive care unit stay and peak total bilirubin values in the first 5 d after LDLT were significantly higher in the myocardial injury group (P < 0.05). The pediatric patients with biliary atresia in the nonmyocardial injury group who underwent LDLT had a considerably higher one-year survival rate than those in the myocardial injury group (P = 0.015). Multivariate logistic regression revealed the following independent risk factors for myocardial injury: a high PELD score [odds ratio (OR) = 1.065, 95% confidence interval (CI): 1.013-1.121; P = 0.014], a long duration of the anhepatic phase (OR = 1.021, 95%CI: 1.003-1.040; P = 0.025), and the occurrence of intraoperative PRS (OR = 1.966, 95%CI: 1.111-3.480; P = 0.020).CONCLUSIONA high PELD score, a long anhepatic phase duration, and the occurrence of intraoperative PRS were independent risk factors for myocardial injury during LDLT in pediatric patients with biliary atresia.

Objective: To evaluate the dynamic changes in neutrophil-to-lymphocyte ratio (NLR), interleukin-6 (IL-6), C-reactive protein (CRP), and procalcitonin (PCT) levels in children with Mycoplasma pneumoniae pneumonia (MPP) complicated by myocardial injury and to determine their predictive value both individually and in combination. Methods: 150 children diagnosed with MPP at Jiujiang Maternal and Child Health Hospital between June 2023 and June 2024 were selected. Patients were divided into the myocardial damage group (MD group, n = 65) and the non-myocardial damage group (non-MD group, n = 85), based on the presence of myocardial injury. Ninety hospitalized children without MPP served as the control group (Con group). Myocardial enzyme profile indicators, including lactate dehydrogenase (LDH), α-hydroxybutyrate dehydrogenase (α-HBDH), aspartate aminotransferase (AST), high-sensitivity cardiac troponin I (hs-cTnI), creatine kinase (CK), and creatine kinase-MB (CK-MB), were measured using a chemiluminescent immunoassay analyzer. Serum NLR, IL-6, CRP, and PCT levels were determined using appropriate analyzers. The correlation between these markers and myocardial enzyme indicators was analyzed using Spearman correlation analysis. Multivariate logistic regression was applied to identify risk factors for myocardial injury in MPP patients. Results: Serum levels of NLR, IL-6, CRP, and PCT in the MD and non-MD groups were significantly higher than in the Con group (P &lt; 0.05), with the MD group showing higher levels than the non-MD group (P &lt; 0.05). These markers were positively correlated with myocardial enzyme indicators. Logistic regression identified elevated NLR, IL-6, CRP, PCT, LDH, α-HBDH, AST, hs-cTnI, CK, and CK-MB as risk factors for myocardial injury in MPP patients (P &lt; 0.05). Conclusion: Elevated levels of NLR, IL-6, CRP, PCT, and myocardial enzymes are significant risk factors for myocardial injury in children with MPP, offering valuable insights for prevention and prognosis.

Anthracycline-induced cardiotoxicity poses a threat to the long-term heart health of childhood cancer survivors; however, early risk assessment remains challenging due to limited predictive tools. While risk prediction models have been developed for chemotherapy-related hematological toxicity in pediatric cancer patients, research efforts addressing anthracycline-induced cardiotoxicity in this population remain limited. To fill this gap, we conducted a pilot study to develop a risk prediction model for anthracycline-induced cardiotoxicity in children. Using a paired-sample design, we analyzed data collected throughout treatment from 18 children receiving anthracycline-based chemotherapy. Patient demographics, clinical features, and treatment regimen served as input (explanatory) variables, while plasma concentration of high-sensitivity cardiac troponin T was used as the outcome (response), representing anthracycline-induced myocardial injury. Of the initial 33 potential variables, the top 18 were selected based on their importance scores in relation to myocardial injury. This set was further refined to 13 by removing redundancies using the caret package in R to develop a preliminary logistic regression model. A Leave-One-Patient-Out Cross-Validation identified four key predictors for the final model: sex, age at diagnosis, total cyclophosphamide dose (mg), and days since the first anthracycline dose. All were significantly associated with myocardial injury. The final logistic regression model achieved an accuracy of 85%, a sensitivity of 80%, a specificity of 88%, an area under the curve of 0.89, and a Youden's index of 0.68 for predicting myocardial injury risk. These preliminary findings suggest the potential of our predictive model to stratify risk of anthracycline-induced myocardial injury in the pediatric population.

BackgroundRecent studies indicated that the prognosis of patients with gastrointestinal tumors is frequently influenced by its complications, notably myocardial injury. The main object is to investigate the occurrence and risk factors of myocardial injury in patients with gastrointestinal tumor.Methods1126 patients who received gastrointestinal tumor related surgery from May 2018 to June 2020 in the Sixth Affiliated Hospital of Sun Yat-sen University were retrospectively collected and divided into the non-myocardial injury group and the myocardial injury group (high-sensitive cardiac troponin I (hs-cTnI) ≥ 0.028 ng/ml). The occurrence and risk factors of myocardial injury in patients with gastrointestinal tumor are analyzed. The influence of myocardial injury on the ICU detention time in gastrointestinal tumor patients is also studied.ResultsIn total, 78 (6.93%) patients developed myocardial injuries. Compared with patients in the non-myocardial injury group, patients in the myocardial injury group have a higher prevalence of cardiovascular risk factors (including advanced age and higher smoking ratio), a higher prevalence of comorbidities (such as previous coronary artery disease, hypertension, atrium fibrillation and diabetes), and a higher rate of premedication (such as anticoagulation, β-blocker, Angiotensin-converting enzyme inhibitor/Angiotensin II receptor blocker, and diuretic) (all with P-value < 0.05). In addition, patients in the myocardial injury group also presented with a higher revised cardiac risk index (Lee index), higher neutrophil granulocyte ratio, lower hemoglobin, and higher likelihood of impaired cardiac structure and function (all with P-value < 0.05). There was a trend of statistical significance in the ICU detention time between the myocardial injury group and the non-myocardial injury group (1[1,3] vs. 2[1,10], P = 0.064). In this study, there were 7 patients presented with clinical symptoms in the myocardial injury group (chest discomfort in 4 cases, non-compressive precordial chest pain in 1 case, dyspnea in 2 cases). In the multivariate analysis, advanced age, increased Lee index score, increased neutrophil granulocyte ratio, decreased left ventricular ejection fraction (LVEF), increased interventricular septum were independent risk factors for myocardial injury.ConclusionIn conclusion, advanced age, increased Lee index, increased neutrophil granulocyte ratio, decreased left ventricular ejection fraction, and increased ventricular septum were independent risk factors for preoperative myocardial injury in patients with gastrointestinal tumors. The proportion of clinical symptoms in gastrointestinal tumor patients with myocardial injury was low, indicating the necessity to closely monitor the cardiac status of individuals with gastrointestinal tumors.

Objective: To investigate the clinical value of observing perioperative changes of myeloperoxidase (MPO) and neutrophil elastase (NE) in coronary artery circulation in patients underwent valve replacement surgery. Methods: This perspective cohort study was performed in patients who underwent valvular surgery in Nanjing Drum Tower Hospital and Fuwai Hospital from June 2021 to June 2022. Patients were divided into perioperative myocardial injury group and age-, sex- and type of cardiac procedure-matched non-perioperative myocardial injury control group in the ratio of 1∶1. Perioperative myocardial injury was defined as cardiac troponin T (cTnT)>0.8 μg/L on the first postoperative day (POD), and the cTnT level on the second POD increased by more than 10% compared with the cTnT level on the first POD. During the operation, blood samples were collected from the coronary sinus before clamping ascending aorta, and within 5 minutes after de-clamping ascending aorta. Then, the levels of MPO and NE on coronary sinus were continuously measured. The death, severe ventricular arrhythmia, pneumonia, re-intubation, repeat cardiac surgery, extracorporeal membrane oxygenation (ECMO), intra-aortic balloon pump (IABP), continuous renal replacement therapy (CRRT), mechanical ventilation time and the duration of intensive care unit (ICU) were recorded. The levels of MPO and NE and the incidence of clinical outcomes were compared between the myocardial injury group and the control group. The independent risk factors of myocardial injury were analyzed by multivariate logistic regression. Results: A total of 130 patients were enrolled, aged (60.6±7.6) years old, with 59 males (45.4%). There were 65 patients in the myocardial injury group and 65 patients in the control group. During hospitalization, there was no death, ECMO, IABP and CRRT cases in both groups. Compared with the control group, the incidence of severe ventricular arrhythmia (13.8%(9/65) vs. 3.1%(2/65), P=0.03), pneumonia (20.0%(13/65) vs. 3.1%(2/65), P=0.03), re-intubation (6.2%(4/65) vs. 0, P=0.04) was significantly higher in myocardial injury group. The mechanical ventilation time (16.8(10.7, 101.7) h vs. 7.5(4.7, 15.1) h, P<0.01), and the duration of ICU (3.7(2.7, 18.9) vs. 2.7(1.8, 6.9)d, P<0.01) were significantly longer in myocardial injury group compared with the control group. There was no significant difference in the levels of MPO and NE in coronary sinus blood between the two groups before aortic clamping (all P>0.05). However, MPO ((551.3±124.2) μg/L vs. (447.2±135.9) μg/L, P<0.01) and NE ((417.0±83.1)μg/L vs. (341.0±68.3)μg/L, P<0.01) after 5 min aortic de-clamping were significantly higher in myocardial injury group than in the control group. Multivariate logistic regression analysis showed that the levels of NE (OR=1.02, 95%CI: 1.01-1.02, P<0.01), MPO (OR=1.00, 95%CI: 1.00-1.01, P=0.02) and mechanical ventilation time (OR=1.03, 95%CI: 1.01-1.06, P=0.02) were independent risk factors of myocardial injury in patients after surgical valvular replacement. Conclusion: Perioperative myocardial injury is related poor clinical outcomes, perioperative NE and MPO in coronary artery circulation are independent risk factors of perioperative myocardial injury in patients undergoing valve replacement surgery.

AimsIn patients with coronavirus disease 2019 (COVID‐19), the involvement of the cardiovascular system significantly relates to poor prognosis. However, the risk factors for acute myocardial injury have not been sufficiently studied. Thus, we aimed to determine the characteristics of myocardial injury and define the association between routine blood markers and cardiac troponin I, in order to perform a predictive model.Methods and resultsThis retrospective cohort study included patients with confirmed COVID‐19 from Wuhan Tongji Hospital (Wuhan, China). Data were compared between those with and without myocardial injury. Kaplan–Meier analysis and Cox regression models were used to describe the association between myocardial injury and poor prognosis. Simple correlation analyses were used to find factors associated with high‐sensitivity cardiac troponin I levels. Univariate and multivariate logistic regression methods were used to explore the risk factors associated with myocardial injury. The area under the receiver operating characteristic curve was used to determine the predictive value of the model. Of 353 patients included in the study, 79 presented myocardial injury. Patients with myocardial injury had higher levels of inflammation markers, poorer liver and kidney function, and more complications compared with patients without myocardial injury. High‐sensitivity cardiac troponin I levels were significantly associated with neutrophil/lymphocyte ratio, creatinine, d‐dimer, lactate dehydrogenase, and inflammatory cytokines and negatively associated with oxygen saturation. It was significantly associated with poor prognosis after adjusting for age, sex, and complications. Multivariate regression showed that myocardial injury was associated with a high neutrophil/lymphocyte ratio (odds ratio 2.30, 95% CI 1.11–4.75, per standard deviation increase, P = 0.02), creatinine (3.58, 1.35–8.06, P = 0.01), and lactate dehydrogenase (3.39, 1.42–8.06, P = 0.01) levels. Using a predictive model, the area under the receiver operating characteristic curve was 0.92 (0.88–0.96).ConclusionsIn patients with COVID‐19, neutrophil/lymphocyte ratio, creatinine, and lactate dehydrogenase are blood markers that could help identify patients with a high risk of myocardial injury at an early stage.

BACKGROUND Myocardial injury is a common complication in elderly patients with sepsis and is associated with poor prognosis. This study aimed to identify clinical characteristics and independent risk factors for myocardial injury in elderly sepsis patients admitted to the Emergency Intensive Care Unit (EICU). MATERIAL AND METHODS A retrospective analysis was conducted on 160 elderly patients with sepsis admitted to the EICU, categorized into myocardial injury and non-myocardial injury groups. Demographic data, inflammatory markers, echocardiographic parameters, and blood urea nitrogen-to-albumin ratio (BAR) values were compared. Logistic regression identified independent risk factors, and ROC curve analysis assessed the predictive value of BAR. RESULTS Of 160 patients, 106 (63.1%) had myocardial injury, with an average age of 77.56±7.49 years. Myocardial injury was associated with lower ejection fraction (EF), and elevated procalcitonin, lactate, and BAR levels (P<0.05). Logistic regression identified septic shock (RR=2.612, P=0.003), elevated BAR (RR=2.272, P=0.035) and lactate levels (RR=1.145, P=0.010) as independent risk factors for myocardial injury. In contrast, increased EF (RR=0.932, P=0.007) was identified as protective against myocardial injury, with lower EF associated with a higher risk. ROC analysis showed that BAR had moderate predictive value (AUC=0.653, P<0.01), with sensitivity of 76.4% and specificity of 53.2% at an optimal cutoff of 0.33. CONCLUSIONS Septic shock, reduced EF, and elevated BAR and lactate levels are independent risk factors for myocardial injury in elderly patients with sepsis. BAR serves as an early marker for myocardial injury, aiding in risk assessment and management in the EICU.

Multisystem inflammatory syndrome associated with SARS-CoV-2 infection can lead to myocardial injury and shock in children, likely the result of a severe inflammatory state, and can mimic Kawasaki disease. To describe the characteristics of shock and myocardial injury in children with confirmed or suspeted COVID-19 during the SARS-CoV-2 pandemic in Spain, including clinical presentation, laboratory and imaging findings, treatment, disease course, and outcome. An extensive literature review is provided. Retrospective case series including all children (age 1 month-18 years) admitted to a pediatric intensive care unit in Madrid, Spain, between March 15 and April 30, 2020 with suspected or confirmed SARS-CoV-2 infection and shock. Twelve previously healthy patients with shock, age 5 to 14 years, were included. All required volume resuscitation and 75% required vasoactive/inotropic support. Distributive shock was present on admission in 67% (n = 8), and 4 patients (33%) showed features of cardiogenic shock. Myocardial injury was diagnosed in 67% (n = 8) and ventricular dysfunction in 33% (n = 4). The most common symptoms on presentation were fever (100%), anorexia (100%), diarrhea (75%), and vomiting (75%). Five patients showed signs of Kawasaki disease but none met the criteria for the classic form. Laboratory findings revealed lymphopenia (83%), thrombocytopenia (83%), and increased inflammatory markers (100%). Respiratory status was not significantly impacted. Chest X-ray showed bilateral alveolar infiltrates in 7 (58%) and bilateral pneumonia in 3 (25%). COVID-19 was confirmed in 11 cases (92%). All received empirical therapy against COVID-19, thromboprophylaxis and immunomodulation. Median stay in the PICU and inpatient ward was 4.5 and 10 days, respectively. No patients died. Multisystem inflammatory syndrome in children with COVID-19 can mimic Kawasaki disease and lead to a combination of distributive and cardiogenic shock, probably secondary to a hyperinflammatory state that remains to be precisely defined. Treatment strategies include hemodynamic support, empirical therapies against COVID-19, thromboprophylaxis, and immunomodulation.

Objective To investigatethe clinical significance of myocardial enzymes and C-reactive protein（CRP）in the children with hand, foot and mouth disease（HFMD）and prevent myocardial injury. Methods Serum myocardial enzymes excluding AST,LDH,α-HBDH,CK,CK-MB and CRP were examined in 374 cases of HFMD,and 332 health children were in control group. Results The differences of AST,LDH,CK,CK-MB,α-HBDH and CRP in the HFMD group and control group were statistically significant（P ﹤ 0. 05）;and the differ-ences of AST,LDH,CK,CK-MB,α-HBDH and CRP in the ordinary type group and the severe type of HFMD were statistically significant（P ﹤ 0. 05）. Conclusions There is different degree of myocardial injury in children with HFMD,myocardial enzymes and C-reactive protein could be used as a valuable in-dicator for diagnosis,and predicting the prognosis of myocardial injury in the children with HFMD. Key words: Hand,foot and mouth disease; Myocardial enzymes; C-reactive protein; Myocardi-al injury; Children

To investigate the incidence of myocardial injury in children with rotavirus-induced diarrhea, analyze its risk factors, and develop a predictive model for myocardial injury. A retrospective analysis was conducted on 203 children diagnosed with rotavirus infection at the Suzhou Wujiang District Children's Hospital from January 2021 to December 2023. The children were divided into groups based on the presence or absence of myocardial injury. Basic information and laboratory indicators at admission were collected and compared between the two groups. LASSO regression was used to screen potential risk factors, followed by multivariate logistic regression to evaluate independent factors. A nomogram model was established and validated. Out of 203 children with rotavirus infection, 53 cases (26.1%) showed myocardial injury. Age, severe dehydration, metabolic acidosis, red cell distribution width, and blood sodium were closely associated with myocardial injury in children with rotavirus-induced diarrhea (P<0.05). The area under the receiver operating characteristic curve for the predictive model of myocardial injury was 0.841 (95%CI: 0.777-0.905), with a sensitivity of 73.6% and specificity of 85.3%. The model curve closely fit the ideal diagonal line. Decision curve analysis showed that using the model for prediction resulted in the highest net benefit when the probability threshold was 0.18-0.98. The model developed in this study can predict the risk of myocardial injury in children with rotavirus-induced diarrhea.

To review the incidence of, and risk factors for myocardial injury after head and neck surgery to help optimize patient care and develop perioperative cardioprotective strategies. Observational cohort study. Records of 65 patients surgically treated for upper aerodigestive tract squamous cell carcinoma between 2005 and 2006 were reviewed. Information about cardiovascular history, tumor characteristics, details of surgery, and postoperative complications were recorded. Patients had troponin assays on the third postoperative day. Logistic regression was used to identify risk factors for postoperative myocardial injury. The average age at presentation was 62+/-12 years. There were 46 (71%) males and 19 (29%) females. Troponin-positive and -negative groups were matched for age, sex, cardiovascular risks, comorbidity, site, tumor-node-metastasis status, and duration of the operations. Sixteen (25%) patients had postoperative myocardial injury including five clinical myocardial infarctions. Factors identified as independent predictors of postoperative myocardial injury were blood pressure level (odds ratio [OR] 1.17; 95% confidence interval [CI] 1.04-1.31; P<.02), intraoperative heart rate variability (OR 1.33; 95% CI 1.04-1.71; P<.02), and the degree of postoperative inflammatory response (OR 1.07; 95% CI 1.02-1.13; P<.001). Postoperative myocardial injury is a known independent predictor of cardiovascular prognosis. Its incidence in head and neck patients could potentially be reduced through stringent blood pressure management, tight intraoperative heart rate control, and dampening of the postoperative inflammatory response. Troponin testing is a valuable screening tool, and patients who have elevated levels postoperatively should be closely monitored and referred to a cardiologist for optimization of cardiovascular care.

Objective To analyze the clinical characteristics and risk factors of myocardial injury (MI) in patients with sepsis. Methods Totally 160 patients with sepsis in April 2016 to December 2017, divided into the MI group and non-MI group.The clinical data laboratory findings and ultrasonic cardiographic findings were recorded and compared between the two groups. Binary logistic regression analysis was performed to find the independent risk factors of MI in patients with sepsis. Results Total of 160 patients with sepsis 75 (46.9%) patients developed MI.The MI group had older age and more patients with history of hypertension than the non-MI group (P<0.05). In patients with sepsis, diastolic dysfunction accounted for 84.1%, systolic dysfunction accounted for 4.3%, and ventricular wall dyskinesia accounted for 17.3%. Compared with the non-MI group, the MI group had more abnormal wall motion (9.6% vs 25.8%, P=0.012), lower interventricular septal amplitude (0.87±0.16 vs 0.80±0.21, P=0.03) and left ventricular posterior wall amplitude (1.03±0.21 vs 0.96±0.18, P=0.034), and decreased fractional shortening (P=0.033). Binary logistic regression analysis showed that age (RR=1.033, P=0.018) and decreased fractional shortening (RR=0.000, P=0.024) were independent risk factors of MI in patients with sepsis. Conclusions Age and decreased fractional shortening were independent risk factors of myocardial injury in patients with sepsis. Key words: Sepsis; Myocardial injury; Fractional shortening

BackgroundIschemic stroke (IS) causes significant death and disability. Stroke-Heart Syndrome (SHS) involves cardiovascular complications, worsening outcomes. Diabetes mellitus (DM) increases the risk of myocardial injury following IS. This study explores risk factors for myocardial injury in acute ischemic stroke (AIS) with DM patients to improve early identification and prevention.MethodsThis is a retrospective cohort study. Inclusion criteria: neuroimaging-confirmed AIS, admission within 72 h, and measured cardiac troponinT (cTnT) levels. Exclusion criteria included acute hemorrhagic stroke, other cTnT elevation causes, severe organ failure, infections, malignancies, and missing data. Logistic and LASSO regression analyses identified independent risk factors for myocardial injury.ResultsMyocardial injury occurred in 194 patients. Independent risk factors identified were coronary heart disease (CHD), insular cortex lesions, peak brain natriuretic peptide precursor (peak NT-proBNP), C-reactive protein (CRP), and higher National Institutes of Health Stroke Scale (NIHSS) scores. These factors were significantly associated with myocardial injury and ROC analysis showed that the AUC for CHD was 0.621, the AUC for insular cortex lesions was 0.648, the AUC for NIHSS score was 0.726, the AUC for peak NT-proBNP was 0.816 and the AUC for CRP was 0.764. Subgroup analysis suggested that reperfusion therapy was associated with increased myocardial injury risk in various patient subgroups.ConclusionCHD, insular cortex lesions, peak NT-proBNP and CRP levels, and higher stroke severity (NIHSS score) are significant risk factors for myocardial injury in AIS patients with DM.

Myocardial injury increases major adverse cardiovascular events and mortality in patients with traumatic hemorrhagic shock, but its prevalence and risk factors remain unclear. This study aimed to assess the prevalence and risk factors of myocardial injury after traumatic hemorrhagic shock. This was an observational, retrospective cohort study of patients with traumatic hemorrhagic shock at a tertiary university hospital from November 2012 to July 2021. Patient characteristics and clinical variables were recorded in 314 patients. The outcome was the occurrence of myocardial injury after traumatic hemorrhagic shock. Risk factors for myocardial injury were identified using logistic regression. The incidence of myocardial injury after the traumatic hemorrhagic shock was 42.4%, and 95.5% of myocardial injuries occurred within the first three days after trauma. In the multivariate analysis, the independent risk factors for myocardial injury after traumatic hemorrhagic shock included heart rate of >100 beats/min (OR [odds ratio], 3.33; 95% confidence interval [CI], 1.56–7.09; p = 0.002), hemoglobin level of <70 g/L (OR, 3.50; 95% CI, 1.15–10.60; p = 0.027), prothrombin time of >15 s (OR, 2.39; 95% CI, 1.12–5.10; p = 0.024), acute kidney injury (OR, 2.75; 95% CI, 1.27–5.93; p = 0.01), and a higher APACHE II score (OR, 1.08; 95% CI, 1.01–1.15; p = 0.018). The area under the receiver operating characteristic curve for the prediction of myocardial injury after a traumatic hemorrhagic shock was 0.67 (95% CI, 0.68–0.79) for a heart rate of >100 beats/min, 0.67 (95% CI, 0.61–0.73) for hemoglobin level of <70 g/L, 0.66 (95% CI, 0.60–0.73) for prothrombin time of >15 s, 0.70 (95% CI, 0.64–0.76) for acute kidney injury, and 0.78 (95% CI, 0.73–0.83) for APACHE II scores. The incidence rate of myocardial injury in traumatic hemorrhagic shock is high, and heart rates of >100 beats/min, hemoglobin levels of <70 g/L, prothrombin times of >15 s, AKI and higher APACHE II scores are independent risk factors for myocardial injury after traumatic hemorrhagic shock. These findings may help clinicians to identify myocardial injury after traumatic hemorrhagic shock early and initiate appropriate treatment.

AimsWhether pulmonary artery (PA) dimension and coronary artery calcium (CAC) score, as assessed by chest computed tomography (CT), are associated with myocardial injury in patients with coronavirus disease 2019 (COVID-19) is not known. The aim of this study was to explore the risk factors for myocardial injury and death and to investigate whether myocardial injury has an independent association with all-cause mortality in patients with COVID-19.Methods and ResultsThis is a single-centre cohort study including consecutive patients with laboratory-confirmed COVID-19 undergoing chest CT on admission. Myocardial injury was defined as high-sensitivity troponin I >20 ng/L on admission. A total of 332 patients with a median follow-up of 12 days were included. There were 68 (20.5%) deaths; 123 (37%) patients had myocardial injury. PA diameter was higher in patients with myocardial injury compared with patients without myocardial injury [29.0 (25th–75th percentile, 27–32) mm vs. 27.7 (25–30) mm, P < 0.001). PA diameter was independently associated with an increased risk of myocardial injury [adjusted odds ratio 1.10, 95% confidence interval (CI) 1.02–1.19, P = 0.01] and death [adjusted hazard ratio (HR) 1.09, 95% CI 1.02–1.17, P = 0.01]. Compared with patients without myocardial injury, patients with myocardial injury had a lower prevalence of a CAC score of zero (25% vs. 55%, P < 0.001); however, the CAC score did not emerge as a predictor of myocardial injury by multivariable logistic regression. Myocardial injury was independently associated with an increased risk of death by multivariable Cox regression (adjusted HR 2.25, 95% CI 1.27–3.96, P = 0.005). Older age, lower estimated glomerular filtration rate, and lower PaO2/FiO2 ratio on admission were other independent predictors for both myocardial injury and death.ConclusionsAn increased PA diameter, as assessed by chest CT, is an independent risk factor for myocardial injury and mortality in patients with COVID-19. Myocardial injury is independently associated with an approximately two-fold increased risk of death.