[Clinical characteristics and outcome of 64 patients with severe COVID-19].
Identifieur interne : 000939 ( Main/Corpus ); précédent : 000938; suivant : 000940[Clinical characteristics and outcome of 64 patients with severe COVID-19].
Auteurs : Q. Zhu ; W. Zhang ; Q. Wang ; J H Liu ; C H Wu ; T. Luo ; P. PengSource :
- Zhonghua jie he he hu xi za zhi = Zhonghua jiehe he huxi zazhi = Chinese journal of tuberculosis and respiratory diseases [ 1001-0939 ] ; 2020.
English descriptors
- KwdEn :
- MESH :
Abstract
Objective: To investigate the causes of death in patients with severe COVID-19. Methods: A retrospective analysis was performed on 64 patients with severe COVID-19 admitted to Wuhan Pulmonary Hospital from January 12, 2020 to February 28, 2020. There were 36 males and 28 females, aging from 44 to 85 years[median 68 (62, 72)]. Fifty-two patients (81%) had underlying comorbidities. The patients were divided into the death group (n=40) and the survival group (n=24) according to the treatment outcomes. In the death group, 24 were male, and 16 were female, aging from 49 to 85 years [median 69 (62, 72)], with 31 cases (78%) complicated with underlying diseases. In the survival group, there were 12 males and 12 females, aging from 44 to 82 years[median 66 (61,73)], with 21 cases (88%) with comorbidities. Clinical data of the two groups were collected and compared, including general information, laboratory examinations, imaging features and treatments. For normally distributed data, independent group t test was used; otherwise, Mann Whitney test was used to compare the variables. χ(2) test and Fisher exact test was used when analyzing categorical variables. Results: The median of creatine kinase isozyme (CK-MB) in the death group was 19.0 (17.0,23.0) U/L, which was higher than that in the survival group 16.5 (13.5,19.6) U/L. The median level of cTnI in the death group was 0.03 (0.03, 0.07) μg/L, which was significantly higher than that in the survival group (0.02, 0.03) μg/L, with a statistically significant difference between the two groups (P=0.007). The concentration of myoglobin in the death group was 79.5 (28.7, 189.0) μg/L, which was higher than 33.1 (25.7, 54.5) μg/L in the survival group. The level of D-dimer in the death group was 2.0 (0.6, 5.2) mg/L, which was higher than 0.7 (0.4, 2.0) mg/L in the survival group. The LDH level of the death group was 465.0 (337.5,606.5) U/L, which was higher than that of the survibal group, 341.0 (284.0,430.0) U/L, the difference being statistically significant (P=0.006). The concentration of alanine aminotransferase in the death group was 40.0 (30.0, 48.0) U/L, which was higher than 32.5 (24.0, 40.8) U/L in the survival group, and the difference was statistically significant (P=0.047).Abnormal ECG was found in 16 cases (62%) in the death group, which was significantly higher than that in the survival group (29%), the difference being statistically significant (P=0.024) .The main causes of death were severe pneumonia with acute respiratory distress syndrome (ARDS, n=20), acute heart failure(n=9), atrial fibrillation(n=3) and multiple organ dysfunction syndrome (MODS, n=3). Conclusions: ARDS caused by severe pneumonia and acute heart failure and atrial fibrillation caused by acute viral myocarditis were the main causes of death in severe COVID-19 patients. Early prevention of myocardial injury and treatment of acute viral myocarditis complicated with disease progression may provide insights into treatment and reduction of mortality in patients with severe COVID-19.
DOI: 10.3760/cma.j.cn112147-20200308-00275
PubMed: 32727177
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pubmed:32727177Le document en format XML
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<author><name sortKey="Zhu, Q" sort="Zhu, Q" uniqKey="Zhu Q" first="Q" last="Zhu">Q. Zhu</name>
<affiliation><nlm:affiliation>Department of Tuberculosis, Wuhan Pulmonary Hospital, Wuhan 430030, China.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Zhang, W" sort="Zhang, W" uniqKey="Zhang W" first="W" last="Zhang">W. Zhang</name>
<affiliation><nlm:affiliation>Department of Tuberculosis, Wuhan Pulmonary Hospital, Wuhan 430030, China.</nlm:affiliation>
</affiliation>
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<author><name sortKey="Wang, Q" sort="Wang, Q" uniqKey="Wang Q" first="Q" last="Wang">Q. Wang</name>
<affiliation><nlm:affiliation>Department of Tuberculosis, Wuhan Pulmonary Hospital, Wuhan 430030, China.</nlm:affiliation>
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<author><name sortKey="Liu, J H" sort="Liu, J H" uniqKey="Liu J" first="J H" last="Liu">J H Liu</name>
<affiliation><nlm:affiliation>Department of Tuberculosis, Wuhan Pulmonary Hospital, Wuhan 430030, China.</nlm:affiliation>
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<author><name sortKey="Wu, C H" sort="Wu, C H" uniqKey="Wu C" first="C H" last="Wu">C H Wu</name>
<affiliation><nlm:affiliation>Department of Tuberculosis, Wuhan Pulmonary Hospital, Wuhan 430030, China.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Luo, T" sort="Luo, T" uniqKey="Luo T" first="T" last="Luo">T. Luo</name>
<affiliation><nlm:affiliation>Department of Tuberculosis, Wuhan Pulmonary Hospital, Wuhan 430030, China.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Peng, P" sort="Peng, P" uniqKey="Peng P" first="P" last="Peng">P. Peng</name>
<affiliation><nlm:affiliation>Department of Tuberculosis, Wuhan Pulmonary Hospital, Wuhan 430030, China.</nlm:affiliation>
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<sourceDesc><biblStruct><analytic><title xml:lang="en">[Clinical characteristics and outcome of 64 patients with severe COVID-19].</title>
<author><name sortKey="Zhu, Q" sort="Zhu, Q" uniqKey="Zhu Q" first="Q" last="Zhu">Q. Zhu</name>
<affiliation><nlm:affiliation>Department of Tuberculosis, Wuhan Pulmonary Hospital, Wuhan 430030, China.</nlm:affiliation>
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<author><name sortKey="Zhang, W" sort="Zhang, W" uniqKey="Zhang W" first="W" last="Zhang">W. Zhang</name>
<affiliation><nlm:affiliation>Department of Tuberculosis, Wuhan Pulmonary Hospital, Wuhan 430030, China.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Wang, Q" sort="Wang, Q" uniqKey="Wang Q" first="Q" last="Wang">Q. Wang</name>
<affiliation><nlm:affiliation>Department of Tuberculosis, Wuhan Pulmonary Hospital, Wuhan 430030, China.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Liu, J H" sort="Liu, J H" uniqKey="Liu J" first="J H" last="Liu">J H Liu</name>
<affiliation><nlm:affiliation>Department of Tuberculosis, Wuhan Pulmonary Hospital, Wuhan 430030, China.</nlm:affiliation>
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<author><name sortKey="Wu, C H" sort="Wu, C H" uniqKey="Wu C" first="C H" last="Wu">C H Wu</name>
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<author><name sortKey="Luo, T" sort="Luo, T" uniqKey="Luo T" first="T" last="Luo">T. Luo</name>
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<author><name sortKey="Peng, P" sort="Peng, P" uniqKey="Peng P" first="P" last="Peng">P. Peng</name>
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<series><title level="j">Zhonghua jie he he hu xi za zhi = Zhonghua jiehe he huxi zazhi = Chinese journal of tuberculosis and respiratory diseases</title>
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<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Aged (MeSH)</term>
<term>Aged, 80 and over (MeSH)</term>
<term>Betacoronavirus (MeSH)</term>
<term>Coronavirus Infections (MeSH)</term>
<term>Female (MeSH)</term>
<term>Humans (MeSH)</term>
<term>Male (MeSH)</term>
<term>Middle Aged (MeSH)</term>
<term>Pandemics (MeSH)</term>
<term>Pneumonia, Viral (MeSH)</term>
<term>Prognosis (MeSH)</term>
<term>Retrospective Studies (MeSH)</term>
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<term>Aged, 80 and over</term>
<term>Betacoronavirus</term>
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<front><div type="abstract" xml:lang="en"><b>Objective:</b>
To investigate the causes of death in patients with severe COVID-19. <b>Methods:</b>
A retrospective analysis was performed on 64 patients with severe COVID-19 admitted to Wuhan Pulmonary Hospital from January 12, 2020 to February 28, 2020. There were 36 males and 28 females, aging from 44 to 85 years[median 68 (62, 72)]. Fifty-two patients (81%) had underlying comorbidities. The patients were divided into the death group (<i>n=</i>
40) and the survival group (<i>n=</i>
24) according to the treatment outcomes. In the death group, 24 were male, and 16 were female, aging from 49 to 85 years [median 69 (62, 72)], with 31 cases (78%) complicated with underlying diseases. In the survival group, there were 12 males and 12 females, aging from 44 to 82 years[median 66 (61,73)], with 21 cases (88%) with comorbidities. Clinical data of the two groups were collected and compared, including general information, laboratory examinations, imaging features and treatments. For normally distributed data, independent group <i>t</i>
test was used; otherwise, Mann Whitney test was used to compare the variables. χ(2) test and Fisher exact test was used when analyzing categorical variables. <b>Results:</b>
The median of creatine kinase isozyme (CK-MB) in the death group was 19.0 (17.0,23.0) U/L, which was higher than that in the survival group 16.5 (13.5,19.6) U/L. The median level of cTnI in the death group was 0.03 (0.03, 0.07) μg/L, which was significantly higher than that in the survival group (0.02, 0.03) μg/L, with a statistically significant difference between the two groups (<i>P=</i>
0.007). The concentration of myoglobin in the death group was 79.5 (28.7, 189.0) μg/L, which was higher than 33.1 (25.7, 54.5) μg/L in the survival group. The level of D-dimer in the death group was 2.0 (0.6, 5.2) mg/L, which was higher than 0.7 (0.4, 2.0) mg/L in the survival group. The LDH level of the death group was 465.0 (337.5,606.5) U/L, which was higher than that of the survibal group, 341.0 (284.0,430.0) U/L, the difference being statistically significant (<i>P=</i>
0.006). The concentration of alanine aminotransferase in the death group was 40.0 (30.0, 48.0) U/L, which was higher than 32.5 (24.0, 40.8) U/L in the survival group, and the difference was statistically significant (<i>P=</i>
0.047).Abnormal ECG was found in 16 cases (62%) in the death group, which was significantly higher than that in the survival group (29%), the difference being statistically significant (<i>P=</i>
0.024) .The main causes of death were severe pneumonia with acute respiratory distress syndrome (ARDS, <i>n=</i>
20), acute heart failure(<i>n=</i>
9), atrial fibrillation(<i>n=</i>
3) and multiple organ dysfunction syndrome (MODS, <i>n=</i>
3). <b>Conclusions:</b>
ARDS caused by severe pneumonia and acute heart failure and atrial fibrillation caused by acute viral myocarditis were the main causes of death in severe COVID-19 patients. Early prevention of myocardial injury and treatment of acute viral myocarditis complicated with disease progression may provide insights into treatment and reduction of mortality in patients with severe COVID-19.</div>
</front>
</TEI>
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<DateCompleted><Year>2020</Year>
<Month>08</Month>
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<DateRevised><Year>2020</Year>
<Month>08</Month>
<Day>03</Day>
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<Article PubModel="Print"><Journal><ISSN IssnType="Print">1001-0939</ISSN>
<JournalIssue CitedMedium="Print"><Volume>43</Volume>
<Issue>8</Issue>
<PubDate><Year>2020</Year>
<Month>Aug</Month>
<Day>12</Day>
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<Title>Zhonghua jie he he hu xi za zhi = Zhonghua jiehe he huxi zazhi = Chinese journal of tuberculosis and respiratory diseases</Title>
<ISOAbbreviation>Zhonghua Jie He He Hu Xi Za Zhi</ISOAbbreviation>
</Journal>
<ArticleTitle>[Clinical characteristics and outcome of 64 patients with severe COVID-19].</ArticleTitle>
<Pagination><MedlinePgn>659-664</MedlinePgn>
</Pagination>
<ELocationID EIdType="doi" ValidYN="Y">10.3760/cma.j.cn112147-20200308-00275</ELocationID>
<Abstract><AbstractText><b>Objective:</b>
To investigate the causes of death in patients with severe COVID-19. <b>Methods:</b>
A retrospective analysis was performed on 64 patients with severe COVID-19 admitted to Wuhan Pulmonary Hospital from January 12, 2020 to February 28, 2020. There were 36 males and 28 females, aging from 44 to 85 years[median 68 (62, 72)]. Fifty-two patients (81%) had underlying comorbidities. The patients were divided into the death group (<i>n=</i>
40) and the survival group (<i>n=</i>
24) according to the treatment outcomes. In the death group, 24 were male, and 16 were female, aging from 49 to 85 years [median 69 (62, 72)], with 31 cases (78%) complicated with underlying diseases. In the survival group, there were 12 males and 12 females, aging from 44 to 82 years[median 66 (61,73)], with 21 cases (88%) with comorbidities. Clinical data of the two groups were collected and compared, including general information, laboratory examinations, imaging features and treatments. For normally distributed data, independent group <i>t</i>
test was used; otherwise, Mann Whitney test was used to compare the variables. χ(2) test and Fisher exact test was used when analyzing categorical variables. <b>Results:</b>
The median of creatine kinase isozyme (CK-MB) in the death group was 19.0 (17.0,23.0) U/L, which was higher than that in the survival group 16.5 (13.5,19.6) U/L. The median level of cTnI in the death group was 0.03 (0.03, 0.07) μg/L, which was significantly higher than that in the survival group (0.02, 0.03) μg/L, with a statistically significant difference between the two groups (<i>P=</i>
0.007). The concentration of myoglobin in the death group was 79.5 (28.7, 189.0) μg/L, which was higher than 33.1 (25.7, 54.5) μg/L in the survival group. The level of D-dimer in the death group was 2.0 (0.6, 5.2) mg/L, which was higher than 0.7 (0.4, 2.0) mg/L in the survival group. The LDH level of the death group was 465.0 (337.5,606.5) U/L, which was higher than that of the survibal group, 341.0 (284.0,430.0) U/L, the difference being statistically significant (<i>P=</i>
0.006). The concentration of alanine aminotransferase in the death group was 40.0 (30.0, 48.0) U/L, which was higher than 32.5 (24.0, 40.8) U/L in the survival group, and the difference was statistically significant (<i>P=</i>
0.047).Abnormal ECG was found in 16 cases (62%) in the death group, which was significantly higher than that in the survival group (29%), the difference being statistically significant (<i>P=</i>
0.024) .The main causes of death were severe pneumonia with acute respiratory distress syndrome (ARDS, <i>n=</i>
20), acute heart failure(<i>n=</i>
9), atrial fibrillation(<i>n=</i>
3) and multiple organ dysfunction syndrome (MODS, <i>n=</i>
3). <b>Conclusions:</b>
ARDS caused by severe pneumonia and acute heart failure and atrial fibrillation caused by acute viral myocarditis were the main causes of death in severe COVID-19 patients. Early prevention of myocardial injury and treatment of acute viral myocarditis complicated with disease progression may provide insights into treatment and reduction of mortality in patients with severe COVID-19.</AbstractText>
</Abstract>
<AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Zhu</LastName>
<ForeName>Q</ForeName>
<Initials>Q</Initials>
<AffiliationInfo><Affiliation>Department of Tuberculosis, Wuhan Pulmonary Hospital, Wuhan 430030, China.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Zhang</LastName>
<ForeName>W</ForeName>
<Initials>W</Initials>
<AffiliationInfo><Affiliation>Department of Tuberculosis, Wuhan Pulmonary Hospital, Wuhan 430030, China.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Wang</LastName>
<ForeName>Q</ForeName>
<Initials>Q</Initials>
<AffiliationInfo><Affiliation>Department of Tuberculosis, Wuhan Pulmonary Hospital, Wuhan 430030, China.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Liu</LastName>
<ForeName>J H</ForeName>
<Initials>JH</Initials>
<AffiliationInfo><Affiliation>Department of Tuberculosis, Wuhan Pulmonary Hospital, Wuhan 430030, China.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Wu</LastName>
<ForeName>C H</ForeName>
<Initials>CH</Initials>
<AffiliationInfo><Affiliation>Department of Tuberculosis, Wuhan Pulmonary Hospital, Wuhan 430030, China.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Luo</LastName>
<ForeName>T</ForeName>
<Initials>T</Initials>
<AffiliationInfo><Affiliation>Department of Tuberculosis, Wuhan Pulmonary Hospital, Wuhan 430030, China.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Peng</LastName>
<ForeName>P</ForeName>
<Initials>P</Initials>
<AffiliationInfo><Affiliation>Department of Tuberculosis, Wuhan Pulmonary Hospital, Wuhan 430030, China.</Affiliation>
</AffiliationInfo>
</Author>
</AuthorList>
<Language>chi</Language>
<PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType>
</PublicationTypeList>
</Article>
<MedlineJournalInfo><Country>China</Country>
<MedlineTA>Zhonghua Jie He He Hu Xi Za Zhi</MedlineTA>
<NlmUniqueID>8712226</NlmUniqueID>
<ISSNLinking>1001-0939</ISSNLinking>
</MedlineJournalInfo>
<SupplMeshList><SupplMeshName Type="Disease" UI="C000657245">COVID-19</SupplMeshName>
<SupplMeshName Type="Organism" UI="C000656484">severe acute respiratory syndrome coronavirus 2</SupplMeshName>
</SupplMeshList>
<CitationSubset>IM</CitationSubset>
<MeshHeadingList><MeshHeading><DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D000369" MajorTopicYN="N">Aged, 80 and over</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D000073640" MajorTopicYN="Y">Betacoronavirus</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D018352" MajorTopicYN="Y">Coronavirus Infections</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D058873" MajorTopicYN="Y">Pandemics</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D011024" MajorTopicYN="Y">Pneumonia, Viral</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D011379" MajorTopicYN="N">Prognosis</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D012189" MajorTopicYN="N">Retrospective Studies</DescriptorName>
</MeshHeading>
</MeshHeadingList>
<OtherAbstract Type="Publisher" Language="chi"><AbstractText><b>目的:</b>
探讨重症新型冠状病毒肺炎(COVID-19)患者的临床特征及转归。 <b>方法:</b>
回顾性分析2020年1月12日至2月28日武汉肺科医院收治的64例重症COVID-19患者,男36例,女28例,年龄44~85岁,中位年龄为68(62,72)岁;52例(81%)合并基础疾病。按治疗转归分为死亡组40例,男24例,女16例,年龄49~85岁,中位年龄69 (62,72)岁;合并基础疾病31例(78%)。治愈组24例,男12例,女12例,年龄44~82岁,中位年龄66(61,73)岁;合并基础疾病21例(88%)。收集两组患者的临床资料,包括一般情况、实验室检查、影像学检查、治疗方案等,正态分布的计量资料采用独立样本<i>t</i>
检验;非正态分布的计量资料采用Mann-Whitney <i>U</i>
检验;计数资料采用卡方检验或Fisher精确检验。 <b>结果:</b>
入院第一天,死亡组患者肌酸激酶同工酶水平中位数为19.0(17.0,23.0) U/L,高于治愈组的16.5(13.5,19.6) U/L,两组比较差异有统计学意义(<i>P=</i>
0.014)。死亡组肌钙蛋白水平中位数为0.03(0.03,0.07) μg/L,显著高于治愈组的0.03(0.02,0.03) μg/L,两组比较差异有统计学意义(<i>P=</i>
0.007)。死亡组肌红蛋白浓度为79.5(28.7,189.0) μg/L,高于治愈组的33.1(25.7,54.5) μg/L,差异有统计学意义(<i>P=</i>
0.031)。死亡组D-二聚体水平为2.0(0.6,5.2) mg/L,高于治愈组的0.7(0.4,2.0) mg/L,差异有统计学意义(<i>P=</i>
0.020)。死亡组乳酸脱氢酶水平为465.0(337.5,606.5) U/L,高于治愈组的341.0(284.0,430.0) U/L,差异有统计学意义(<i>P=</i>
0.006)。死亡组丙氨酸氨基转移酶浓度为40.0(30.0,48.0) U/L,高于治愈组的32.5(24.0,40.8) U/L,差异有统计学意义(<i>P=</i>
0.047)。47例行心电图检查的患者中,22例(47%)心电图异常,其中死亡组心电图异常16例(62%),治愈组6例(29%),两组比较差异有统计学意义(<i>P=</i>
0.024)。死亡原因:重症肺炎并急性呼吸窘迫综合征(ARDS)20例,病毒性心肌炎导致的急性心功能不全9例,心房纤颤3例,多器官功能障碍综合征3例,其他5例。 <b>结论:</b>
病毒性心肌炎导致的急性心功能不全是导致重症COVID-19患者死亡的原因。早期预防心肌损伤,积极治疗疾病进展过程中并发的急性病毒性心肌炎,可能降低重症COVID-19患者的病死率。.</AbstractText>
</OtherAbstract>
<KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">COVID-19</Keyword>
<Keyword MajorTopicYN="N">Myocardial injury</Keyword>
<Keyword MajorTopicYN="N">Prognosis</Keyword>
<Keyword MajorTopicYN="N">Respiratory Distress Syndrome, Adult</Keyword>
<Keyword MajorTopicYN="N">Viral myocarditis</Keyword>
</KeywordList>
</MedlineCitation>
<PubmedData><History><PubMedPubDate PubStatus="entrez"><Year>2020</Year>
<Month>7</Month>
<Day>31</Day>
<Hour>6</Hour>
<Minute>0</Minute>
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<Month>7</Month>
<Day>31</Day>
<Hour>6</Hour>
<Minute>0</Minute>
</PubMedPubDate>
<PubMedPubDate PubStatus="medline"><Year>2020</Year>
<Month>8</Month>
<Day>4</Day>
<Hour>6</Hour>
<Minute>0</Minute>
</PubMedPubDate>
</History>
<PublicationStatus>ppublish</PublicationStatus>
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