Effects of Buprenorphine, Methadone and Substance-Use on COVID-19 Morbidity and Mortality (preprint)

ObjectivesSubstance use disorder has been associated with increased morbidity in COVID-19 infection. However, less is known about the impact of active substance use and medications for opioid use disorder (MOUD) on COVID-19 outcomes. We conducted a retrospective cohort study to evaluate the impact of substance use, namely cannabis, cocaine, alcohol, sedative and opioid use as well as buprenorphine or methadone = on COVID-19 morbidity and mortality. MethodsUsing electronic-health record data at a large urban hospital system, patients who tested positive for COVID-19 between January 1, 2020 to December 31, 2021 were included. Substance use was identified from urine toxicology and MOUD prescriptions within 90 days prior to admission. COVID-19 outcomes included mortality, ICU admission, need for ventilatory support, number and duration of hospitalizations. Multivariable logistic regression was performed controlling for variables such as age, sex, medical comorbidity, tobacco use, and social disadvantage. ResultsAmong COVID-19 positive patients (n=17,423), sedative, cannabis, cocaine, and opioid use was associated with statistically significant increases in need for ICU care, need for ventilatory support, number of hospitalizations and duration of hospitalization. Substance use was not associated with an increase in all-cause mortality. There were no statistically significant differences between methadone, buprenorphine and other opioids on COVID-19 outcomes. ConclusionsActive substance use were associated with increased morbidity in COVID-19 infection. MOUD was not associated with worse COVID-19 outcomes compared to OUD. Future studies focused on MOUD treatments that reduce morbidity may help improve clinical outcomes in COVID-19.

SARS-CoV-2 spike protein induces the cytokine release syndrome by stimulating T cells to produce more IL-2 (preprint)

Cytokine release syndrome (CRS) is one of the leading causes of mortality in COVID-19 patients caused by the SARS-CoV-2 coronavirus. However, the mechanism of CRS induced by SARS-CoV-2 is vague. This study shows that dendritic cells loaded with spike protein of SARS-CoV-2 stimulate T cells to release much more IL-2, which subsequently cooperates with spike protein to facilitate peripheral blood mononuclear cells to release IL-1{beta}, IL-6, and IL-8. These effects are achieved via IL-2 stimulation of NK cells to release TNF- and IFN-{gamma}, as well as T cells to release IFN-{gamma}. Mechanistically, IFN-{gamma} and TNF- enhance the transcription of CD40, and the interaction of CD40 and its ligand stabilizes the membrane expression of TLR4 which serves as a receptor of spike protein on the surface of monocytes. As a result, there is a constant interaction between spike protein and TLR4, leading to continuous activation of NF-{kappa}B. Furthermore, TNF- also activates NF-{kappa}B signaling in monocytes, which further cooperates with IFN-{gamma} and spike protein to modulate NF-{kappa}B-dependent transcription of CRS-related inflammatory cytokines. Targeting TNF-/IFN-{gamma} in combination with TLR4 may represent a promising therapeutic approach for alleviating CRS in individuals with COVID-19.

Therapeutic Effect of Tocilizumab on Inhibiting Cytokine Release Syndrome in Severe Coronavirus Disease 2019 Patients

Background and Objectives: Older adults are more susceptible to coronavirus disease 2019 (COVID-19). Interleukin-6 (IL-6) is an important cytokine in the cytokine release syndrome (CRS), and tocilizumab blocks the IL-6 receptor. The objective is to analyze the effect of tocilizumab on CRS in older patients with severe COVID-19. Materials and Methods: Between February 10 and March 21, 2020, a total of 19 patients aged ≥60 years with severe or critical COVID-19 met the study inclusion criteria at the Tongji Hospital in Wuhan City, Hubei Province, China. The patients were divided into two groups: the tocilizumab group, with IL-6 levels, which exceeded the upper limit of normal by >10-fold and non-tocilizumab group. Results: Patients in the tocilizumab group were older (73.20 ± 4.44 vs. 66.21 ± 5.06 years, P = 0.014), had lower lymphocyte counts (0.71 ± 0.18 vs. 1.18 ± 0.59 × 109/L, P = 0.016), and higher high-sensitivity C-reactive protein (hsCRP) levels (94.04 ± 57.24 vs. 51.65 ± 45.37 mg/L, P = 0.035). Increases in ferritin (FER) and hsCRP levels in patients in the tocilizumab group were marked. Except for one patient who died, IL-6, FER, hsCRP levels, and the neutrophil/lymphocyte ratio in the remaining four patients decreased following treatment with tocilizumab. Tocilizumab did not cause any serious adverse reactions. There were no differences in mortality, days until lung computerized tomography improvement, or renal function between the two groups. The total mortality rate was 10.53%. Conclusions: Our results support the therapeutic efficacy and safety of tocilizumab in older patients with severe COVID-19.

Matrix Kendall's tau in High-dimensions: A Robust Statistic for Matrix Factor Model (preprint)

In this article, we first propose generalized row/column matrix Kendall's tau for matrix-variate observations that are ubiquitous in areas such as finance and medical imaging. For a random matrix following a matrix-variate elliptically contoured distribution, we show that the eigenspaces of the proposed row/column matrix Kendall's tau coincide with those of the row/column scatter matrix respectively, with the same descending order of the eigenvalues. We perform eigenvalue decomposition to the generalized row/column matrix Kendall's tau for recovering the loading spaces of the matrix factor model. We also propose to estimate the pair of the factor numbers by exploiting the eigenvalue-ratios of the row/column matrix Kendall's tau. Theoretically, we derive the convergence rates of the estimators for loading spaces, factor scores and common components, and prove the consistency of the estimators for the factor numbers without any moment constraints on the idiosyncratic errors. Thorough simulation studies are conducted to show the higher degree of robustness of the proposed estimators over the existing ones. Analysis of a financial dataset of asset returns and a medical imaging dataset associated with COVID-19 illustrate the empirical usefulness of the proposed method.

Relationship between Lung and Brain Injury in COVID-19 Patients: A Hyperpolarized 129Xe-MRI-based 8-Month Follow-Up

Although the lungs are the primary organ involved, increasing evidence supports the neuroinvasive potential of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This study investigates the potential relationship between coronavirus disease (COVID-19)-related deterioration of brain structure and the degree of damage to lung function. Nine COVID-19 patients were recruited in critical condition from Jin Yin-tan Hospital (Wuhan, China) who had been discharged between 4 February and 27 February 2020. The demographic, clinical, treatment, and laboratory data were extracted from the electronic medical records. All patients underwent chest CT imaging, 129Xe gas lung MRI, and 1H brain MRI. Four of the patients were followed up for 8 months. After nearly 12 months of recovery, we found no significant difference in lung ventilation defect percentage (VDP) between the COVID-19 group and the healthy group (3.8 ±2.1% versus 3.7 ±2.2%) using 129Xe MRI, and several lung-function-related parameters-such as gas–blood exchange time (T)-showed improvement (42.2 ms versus 32.5 ms). Combined with 1H brain MRI, we found that the change in gray matter volume (GMV) was strongly related to the degree of pulmonary function recovery-the greater the increase in GMV, the higher degree of pulmonary function damage.

Contrastive Attention Network with Dense Field Estimation for Face Completion

Most modern face completion approaches adopt an autoencoder or its variants to restore missing regions in face images. Encoders are often utilized to learn powerful representations that play an important role in meeting the challenges of sophisticated learning tasks. Specifically, various kinds of masks are often presented in face images in the wild, forming complex patterns, especially in this hard period of COVID-19. It’s difficult for encoders to capture such powerful representations under this complex situation. To address this challenge, we propose a self-supervised Siamese inference network to improve the generalization and robustness of encoders. It can encode contextual semantics from full-resolution images and obtain more discriminative representations. To deal with geometric variations of face images, a dense correspondence field is integrated into the network. We further propose a multi-scale decoder with a novel dual attention fusion module (DAF), which can combine the restored and known regions in an adaptive manner. This multi-scale architecture is beneficial for the decoder to utilize discriminative representations learned from encoders into images. Extensive experiments clearly demonstrate that the proposed approach not only achieves more appealing results compared with state-of-the-art methods but also improves the performance of masked face recognition dramatically.

Practices and thinking of public libraries in China during COVID-19

As a result of the COVID-19 pandemic, libraries in China closed their doors in early 2020 and moved all their services online. This change has brought unprecedented challenges for the development of library services, while it has also brought opportunities and motivation for the future transformation of libraries. This article uses official WeChat accounts of the National Library of China and more than 30 provincial public libraries as the main information sources to summarize and classify the services provided during the period of closure. It also collates and analyses news items released by these libraries to guide the improvement of the online services of public libraries in the pandemic environment. Finally, it puts forward the author?s reflections and suggestions on the key development directions of libraries in the post-pandemic era in six areas: reading promotion, smart libraries, new media operation, information literacy cultivation, open access and collaborative development.

DeepDRIM: a deep neural network to reconstruct cell-type-specific gene regulatory network using single-cell RNA-Seq Data (preprint)

A bstract Single-cell RNA sequencing is used to capture cell-specific gene expression, thus allowing reconstruction of gene regulatory networks. The existing algorithms struggle to deal with dropouts and cellular heterogeneity, and commonly require pseudotime-ordered cells. Here, we describe DeepDRIM a supervised deep neural network that represents gene pair joint expression as images and considers the neighborhood context to eliminate the transitive interactions. Deep-DRIM yields significantly better performance than the other nine algorithms used on the eight cell lines tested, and can be used to successfully discriminate key functional modules between patients with mild and severe symptoms of coronavirus disease 2019 (COVID-19).

Health-related quality of life of COVID-19 survivors at 6 months after hospital discharge: a cohort study (preprint)

Background: COVID-19 is a multi-systemic disease that is highly contagious and pathogenic. The long-term consequences of it are not yet clear, as is whether society and life can return to a healthy state. Long-term assessment of their health-related quality of life (HRQoL) is essential. This study aimed to investigate HRQoL and its risk factors in COVID-19 survivors at a follow-up of 6-month. Methods: A multicenter cross-sectional survey was conducted among 192 COVID-19 patients with confirmed age ≥ 18 years who were discharged from various hospitals in Wuhan from January to April 2020. The demographic characteristics, clinical characteristics, and laboratory results of the study subjects were obtained from the hospital's medical records. Survivors' HRQoL was assessed using the Short Form 36 (SF-36), cognition was assessed using the ascertain dementia eight-item informant questionnaire (AD8), and survivors' pulmonary function were examined. All participants in this study completed the survey and testing at Hubei Provincial Hospital of Chinese and Western Medicine. SF-36 scores were compared with the Chinese norm, and logistic regression and multivariate analysis were used to investigate the factors affecting HRQoL in COVID-19 survivors. Results: SF-36 showed significant differences in HRQoL between COVID-19 survivors and the general Chinese population ( P< 0.05).Multiple linear regression demonstrated that age was negatively correlated with physical functioning (PF), role-physical limitation (RP) and social functioning (SF) ( P <0.05). Bodily pain (BP), vitality (VT), SF and role-emotional limitation (RE) were negatively correlated with females ( P <0.05). Length from discharge to follow‐up was positively correlated with PF and RP ( P <0.05). Abnormal cognitive function was negatively correlated with PF, RP, general health (GH), VT, SF, RE and mental health (MH) ( P <0.05). Abnormal Carbon Monoxide Diffusing Capacity (DLCO%<80%) was significantly negatively correlated with PF and SF ( P <0.05).In addition, there was a significant negative correlation between Coronary heart disease and RP, GH, VT and RE ( P <0.05).Logistic regression analysis demonstrated that age(OR 1.032) and AD8 scores (OR 1.203)were risk factors associated with a low physical component summary (PCS) score. Length from discharge to follow‐up (OR 0.971) was the protective factor for PCS score. Abnormal cognitive function (OR 1.543) was a significant determinant associated with a mental component summary (MCS)<50 in COVID-19 patients. Conclusions: The HRQoL of COVID-19 survivors remains to be improved at six-month follow-up. Future studies should track HRQoL in older adults, women, patients with abnormal DLCO, and abnormal cognitive function for a long time and provide them with rehabilitation advice and guidance.

Long-Term Clinical Sequelae and Immunological Features of COVID-19 Survivors: A Cross-Sectional Study in Wuhan, China (preprint)

Objectives: To describe the clinical sequelae and immunological features of COVID-19 survivors who have been discharged from the hospital for 5-8 months. Methods: This study is a cross-sectional study of confirmed COVID-19 patients aged ≥18 years who were discharged from hospitals in Wuhan from January to April 2020. The demographics, clinical features, and laboratory findings of the participants were collected from medical records in the hospital. The participants from the study completed an investigation of clinical sequelae, blood tests, a pulmonary function examination and an unarmed rehabilitation evaluation at Hubei Provincial Hospital of Traditional Chinese & Western Medicine. A group of volunteers who were free of COVID-19 and lived in Wuhan during the outbreak were recruited as the comparison group.Results: The average age of the 574 COVID-19 survivors was 57.7±11.4 years, and 348 (60.6%) survivors were female. The average number of days from the onset of symptoms was 241.79±16.16. The average number of days from discharge was 194.3±14.4. Clinical sequelae were common, including general symptoms (n=321, 55.9%), respiratory symptoms (n=265, 46.2%), digestive symptoms (n=84, 14.6%), nervous symptoms (n=75,13.1%) and psychosocial symptoms (n=201, 35%). A total of 190 (33.7%) survivors reported reduced exercise capacity. Through the results of pulmonary function examination, anomalies were noted in carbon monoxide diffusion capacity (DLCO)% in 110 cases (32.4%), maximal mid-expiratory flow (MMEF)% in 105 cases (30.7%), forced expired flow at 50% of forced vital capacity (FEF 50 )% in 128 cases (37.4%), and forced expired flow at 75% of forced vital capacity (FEF 75 )% in 240 cases (70.2%). The counts of T lymphocyte, CD4+ T lymphocyte counts, CD8+ T lymphocyte counts, B lymphocyte and NK cell in the survival group was significantly lower than that in the comparison group(all P < 0.05).There were 252 (43.9%) survivors whose total T lymphocyte counts had dropped, 260 (45.3%) whose CD4+T lymphocyte counts had dropped, 231 (40.2%) whose CD8+ T lymphocyte counts had dropped, 119 (20.7%) whose B lymphocyte counts had dropped, and 54 (9.4%) whose NK cell counts had dropped. But there were no statistically significant differences in the incidence of lymphocyte subsets reduction between severe and nonsevere groups (all P > 0.05). The T lymphocyte counts, CD4+ T lymphocyte counts and CD8+ T lymphocyte counts of the patients before discharge were significantly higher than those in the early stage of admission (P < 0.025). There were 319 (55.6%) survivors with positive or weakly positive IgG antibodies and 17 (2.9%) survivors with positive or weakly positive IgM antibodies.Conclusion: Even after 5 to 8 months of discharge, many survivors still have clinical sequelae, and some of them have impaired immune function. Therefore, the long-term rehabilitation of COVID-19 survivors remains a concern.Funding Statement: This study was funded by the National Key R&D Plan of China (2020YFC0841600), Guangdong Provincial Key Laboratory of Research on Emergency in TCM (2017B030314176), R&D plan in key areas of Guangdong Province (2020B1111300005), and National Administration of Traditional Chinese Medicine (2020ZYLCYJ05-11).Declaration of Interests: The authors declare that they have no competing interests.Ethics Approval Statement: This study was approved by the ethical committees of Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China (GPHCM; No. BF2020-205-01). All participants signed informed consent forms.

Transmission routes of 2019-nCoV and controls in dental practise

A novel beta-coronavirus (2019, nCoV) caused severe and even fatal pneumonia explored in a seafood market of Wuhan city, Hubei province China, and rapidly spread to other province China and other countries. The 2019-nCoV was different Iron SARS-CoV, but shared the same host receptor the human angiotensin-converting enzymes 2 (ACE2). The natural last of 2019-nCOv may be the bat Rhinolophus affinis as 2019-nCoV stoned 96.2% of whole-genome identity to BatCoV RagTG13. The person to person-person transmission routes of 2019-nCoV included direct transmission, such as cough, sneeze. droplet inhalation transmission, and contact transmission, such as the contact with oral, nasal, and eye mucous membranes, 2019-nCoV can also be transmitted through the Saliva, and the fecal-oral routes may also be a potential person-to-person transmission route The participants in dental practice expose to tremendous risk of 2019-nCov infection due to the face-to-face communication and the exposure to saliva, blood, and Other body fluids, and the handling of sharp instrument. Dental professional play great roles in preventing the transmission of 2019-nCoV. Here we recommend the infection control measures during dental practice to block the person-to-person transmission routes in dental clinics and hospitals.

Global air quality change during the COVID-19 pandemic: Regionally different ozone pollution responses: COVID-19疫情期间全球空气质量变化:臭氧响应的区域间差异

The explosive spread of the 2019 novel coronavirus (COVID-19) provides a unique chance to rethink the relationship between human activity and air pollution. Though related studies have revealed substantial reductions in primary emissions, obvious differences do exist in the responses of secondary pollutants, like ozone (O3) pollution. However, the regional disparities of O3 responses and their causes have still not been fully investigated. To better elucidate the interrelationship between anthropogenic emissions, chemical production, and meteorological conditions, O3 responses caused by lockdowns over different regions were comprehensively explored at a global scale. Observational signals of air-quality change were derived from multi-year surface measurements and satellite retrievals. With similar substantial drops in nitrogen dioxide (NO2), ozone shows rising signals in most areas of both East Asia and Europe, even up to ∼14 ppb, while a non-negligible declining signal exists in North America, by about 2–4 ppb. Furthermore, the drivers behind the different O3 responses are discussed based on meteorological analysis and O3 sensitivity diagnosis. On the one hand, O3 responses to NO2 declines can be affected by the primary dependence on its precursors. On the other hand, it is also highly dependent on meteorological factors, especially temperature. Our study further highlights the great importance of taking into consideration both the regional disparities and synergistic effects of precursor reductions and meteorological influence for scientific mitigation of O3 pollution. 摘要: 疫情期间全球各地一次排放大幅削减, 而臭氧等二次污染的响应则存在着区域间差异.结合地面和卫星观测发现, 同在氮氧化物大幅下降的情况下,臭氧在东亚和欧洲呈现出可达14ppb的上升信号, 而北美则下降为主 (约2-4ppb) .我们结合气象分析和臭氧敏感性进一步讨论了臭氧响应差异性的原因, 一方面受臭氧与前体物间关系的影响;另一方面来自于气象, 尤其是温度.研究明晰了人为排放,化学和气象三者的内在关联, 强调了在臭氧控制过程中考虑前体物削减和气象条件协同的重要性.

The predicting roles of carcinoembryonic antigen and its underlying mechanism in the progression of coronavirus disease 2019 (preprint)

Background The coronavirus disease 2019 (COVID-19) has induced a worldwide pneumonia with a high infectivity and mortality. However, the predicting biomarkers and their potential mechanism in the progression of COVID-19 are not well known.Objective The aim of this study is to identify the candidate predictors of COVID-19 and investigate their underlying mechanism.Methods The retrospective study was conducted to identify the potential laboratory indicators with prognostic values of COVID-19 disease. Then, the prognostic nomogram was constructed to predict the overall survival of COVID-19 patients. Additionally, the scRNA-seq data of BALF and PBMCs from COVID-19 patients were downloaded to investigate the underlying mechanism of the most important prognostic indicators in lungs and peripherals, respectively.Results 304 hospitalized adult COVID-19 patients in Wuhan Jinyintan Hospital were included in the retrospective study. CEA was the only laboratory indicator with significant difference in the univariate (P < 0.001) and multivariate analysis (P = 0.021). The scRNA-seq data of BALF and PBMCs from COVID-19 patients were downloaded to investigate the underlying mechanism of CEA in lungs and peripherals, respectively. The results revealed the potential roles of CEA were significantly distributed in Type II pneumocytes of BALF and developing neutrophils of PBMCs, participating in the progression of COVID-19 by regulating the cell-cell communication.Conclusion This study identifies the prognostic roles of CEA in COVID-19 patients and implies the potential roles of CEACAM8-CEACAM6 in the progression of COVID-19 by regulating the cell-cell communication of developing neutrophils and Type II pneumocyte.

The changes of the peripheral CD4+ lymphocytes and inflammatory cytokines in Patients with COVID-19.

To investigate the clinical value of changes in the subtypes of peripheral blood lymphocytes and levels of inflammatory cytokines in patients with COVID-19, the total numbers of lymphocytes and CD4+ lymphocytes and the ratio of CD4+/CD8+ lymphocytes were calculated and observed in different groups of patients with COVID-19. The results show that the lymphocytopenia in patients with COVID-19 was mainly manifested by decreases in the CD4+ T lymphocyte number and the CD4+/CD8+ ratio. The decreased number of CD4+ T lymphocytes and the elevated levels of TNF-α and IL-6 were correlated with the severity of COVID-19 disease.

Combined Mode of Courses on Dental Virtual Clerkship During COVID-19 Pandemic for Final-year Undergraduates in Wuhan (preprint)

BackgroundOnline teaching is being widely adopted to achieve medical teaching objectives during the COVID-19 pandemic. To explore the dental virtual clerkship so as to continue the education of final-year dental undergraduate interns, combined mode of courses including small private online course, problem-based learning, online dental practice broadcasting and dental practice based on relatives’ or friends’ oral health management were applied for clerkship education for final-year interns.MethodsCombined courses of virtual clerkship was conducted from March to May, 2020 for final-year interns, while online preclerkship curriculum teaching was conducted for non-final-year students. Using the online students’ engagement scale (OSE), Biggs’ revised two-factor version of the study process questionnaire (R-SPQ-2F), student engagement and study process were evaluated for both. Teaching efficacy were evaluated via teachers' sense of efficacy scale (TSES) as well. ResultsStudents’ engagement was higher in final-year students, especially the emotion and participation categories (P<0.01). In the emotion category, 80.95% identified with putting forth effort on lecture and applying knowledge to life. Study approaches on deep motive and strategy were dominated in final-year interns (P<0.01). Teacher’ sense of efficacy also reflected the positive influence on student virtual clerkship. There was no significant difference among three categories including the sense of student engagement, instructional strategies and classroom management (P>0.05).ConclusionThis combined mode of courses on dental virtual clerkship could be potentially applied during the pandemic or be supplementary for traditional by-chair clerkship after the pandemic.

Corticosteroid therapy for corona virus disease 2019-related acute respiratory distress syndrome: a cohort study with propensity score analysis (preprint)

Background: The impact of corticosteroid therapy on outcomes of patients with Coronavirus disease-2019 (COVID-19) is highly controversial. We aimed to compare the risk of death between COVID-19-related ARDS patients with corticosteroid treatment and those without. Methods In this single-centre retrospective observational study, patients with ARDS caused by COVID-19 between 24 December 2019 and 24 February 2020 were enrolled. The primary outcome was 60-day in-hospital death. The exposure was prescribed systemic corticosteroids or not. Time-dependent Cox regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for 60-day in-hospital mortality. Results A total of 382 patients including 226 (59.2%) patients who received systemic corticosteroids and 156 (40.8%) patients with standard treatment were analyzed. The maximum dose of corticosteroids was 80.0 (IQR 40.0–80.0) mg equivalent methylprednisolone per day, and duration of corticosteroid treatment was 7.0 (4.0–12.0) days in total. In Cox regression analysis using corticosteroid treatment as a time-varying variable, corticosteroid treatment was associated with a significant reduction in risk of in-hospital death within 60 days (HR, 0.48; 95% CI, 0.25, 0.93; p  = 0.0285). The association remained significantly after adjusting for age, sex, Sequential Organ Failure Assessment score at hospital admission, propensity score of corticosteroid treatment, and comorbidities (HR: 0.51; CI: 0.27, 0.99; p  = 0.0471). Corticosteroids were not associated with delayed viral RNA clearance in our cohort. Conclusion In this clinical practice setting, low-to-moderate dose corticosteroid treatment was associated with reduced risk of death in COVID-19 patients who developed ARDS.

Heart injury signs are associated with higher and earlier mortality in coronavirus disease 2019 (COVID-19) (preprint)

Importance: Heart injury can be easily induced by viral infection such as adenovirus and enterovirus. However, whether coronavirus disease 2019 (COVID-19) causes heart injury and hereby impacts mortality has not yet been fully evaluated. Objective: To explore whether heart injury occurs in COVID-19 on admission and hereby aggravates mortality later. Design, Setting, and Participants A single-center retrospective cohort study including 188 COVID-19 patients admitted from December 25, 2019 to January 27, 2020 in Wuhan Jinyintan Hospital, China; follow up was completed on February 11, 2020. Exposures: High levels of heart injury indicators on admission (hs-TNI; CK; CK-MB; LDH; -HBDH). Main Outcomes and Measures: Mortality in hospital and days from admission to mortality (survival days). Results: Of 188 patients with COVID-19, the mean age was 51.9 years (standard deviation: 14.26; range: 21~83 years) and 119 (63.3%) were male. Increased hs-TnI levels on admission tended to occur in older patients and patients with comorbidity (especially hypertension). High hs-TnI on admission ([≥] 6.126 pg/mL), even within the clinical normal range (0~28 pg/mL), already can be associated with higher mortality. High hs-TnI was associated with increased inflammatory levels (neutrophils, IL-6, CRP, and PCT) and decreased immune levels (lymphocytes, monocytes, and CD4+ and CD8+ T cells). CK was not associated with mortality. Increased CK-MB levels tended to occur in male patients and patients with current smoking. High CK-MB on admission was associated with higher mortality. High CK-MB was associated with increased inflammatory levels and decreased lymphocytes. Increased LDH and -HBDH levels tended to occur in older patients and patients with hypertension. Both high LDH and -HBDH on admission were associated with higher mortality. Both high LDH and -HBDH were associated with increased inflammatory levels and decreased immune levels. hs-TNI level on admission was negatively correlated with survival days (r= -0.42, 95% CI= -0.64~-0.12, P=0.005). LDH level on admission was negatively correlated with survival days (r= -0.35, 95% CI= -0.59~-0.05, P=0.022). Conclusions and Relevance: Heart injury signs arise in COVID-19, especially in older patients, patients with hypertension and male patients with current smoking. COVID-19 virus might attack heart via inducing inflammatory storm. High levels of heart injury indicators on admission are associated with higher mortality and shorter survival days. COVID-19 patients with signs of heart injury on admission must be early identified and carefully managed by cardiologists, because COVID-19 is never just confined to respiratory injury.