Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China

Abstract

the final date of follow-up was February 15, 2020. All consecutive inpatients with laboratory-confirmed COVID-19 were included in this study.MAIN OUTCOMES AND MEASURES Clinical laboratory, radiological, and treatment data were collected and analyzed. Outcomes of patients with and without cardiac injury were compared. The association between cardiac injury and mortality was analyzed. RESULTS A total of 416 hospitalized patients with COVID-19 were included in the final analysis; the median age was 64 years (range, 21-95 years), and 211 (50.7%) were female. Common symptoms included fever (334 patients [80.3%]), cough (144 [34.6%]), and shortness of breath (117 [28.1%]). A total of 82 patients (19.7%) had cardiac injury, and compared with patients without cardiac injury, these patients were older (median [range] age, 74 [34-95] vs 60 [21-90] years; P < .001); had more comorbidities (eg, hypertension in 49 of 82 [59.8%] vs 78 of 334 [23.4%]; P < .001); had higher leukocyte counts (median [interquartile range (IQR)], 9400 [6900-13 800] vs 5500 [4200-7400] cells/μL) and levels of C-reactive protein (median [IQR], 10.2 [6.4-17.0] vs 3.7 [1.0-7.3] mg/dL), procalcitonin (median [IQR], 0.27 [0.10-1.22] vs 0.06 [0.03-0.10] ng/mL), creatinine kinase-myocardial band (median [IQR], 3.2 [1.8-6.2] vs 0.9 [0.6-1.3] ng/mL), myohemoglobin (median [IQR], 128 [68-305] vs 39 [27-65] μg/L), high-sensitivity troponin I (median [IQR], 0.19 [0.08-1.12] vs <0.006 [<0.006-0.009] μg/L), N-terminal pro-B-type natriuretic peptide (median [IQR], 1689 [698-3327] vs 139 [51-335] pg/mL), aspartate aminotransferase (median [IQR], 40 [27-60] vs 29 [21-40] U/L), and creatinine (median [IQR], 1.15 [0.72-1.92] vs 0.64 [0.54-0.78] mg/dL); and had a higher proportion of multiple mottling and ground-glass opacity in radiographic findings (53 of 82 patients [64.6%] vs 15 of 334 patients [4.5%]). Greater proportions of patients with cardiac injury required noninvasive mechanical ventilation (38 of 82 [46.3%] vs 13 of 334 [3.9%]; P < .001) or invasive mechanical ventilation (18 of 82 [22.0%] vs 14 of 334 [4.2%]; P < .001) than those without cardiac injury. Complications were more common in patients with cardiac injury than those without cardiac injury and included acute respiratory distress syndrome (48 of 82 [58.5%] vs 49 of 334 [14.7%]; P < .001), acute kidney injury (7 of 82 [8.5%] vs 1 of 334 [0.3%]; P < .001), electrolyte disturbances (13 of 82 [15.9%] vs 17 of 334 [5.1%]; P = .003), hypoproteinemia (11 of 82 [13.4%] vs 16 of 334 [4.8%]; P = .01), and coagulation disorders (6 of 82 [7.3%] vs 6 of 334 [1.8%]; P = .02). Patients with cardiac injury had higher mortality than those without cardiac injury (42 of 82 [51.2%] vs 15 of 334 [4.5%]; P < .001). In a Cox regression model, patients with vs those without cardiac injury were at a higher risk of death, both during the time from symptom onset (hazard ratio, 4.26 [95% CI, 1.92-9.49]) and from admission to end point (hazard ratio, 3.41 [95% CI, 1.62-7.16]).CONCLUSIONS AND RELEVANCE Cardiac injury is a commo...

COVID-19 for the Cardiologist

“…As previously described, the majority of patients have no or mild symptoms (45). In hospitalized patients, respiratory symptoms are common and range in severity from cough (60-80%) or dyspnea (19-40%) to ARDS (17-42%) (51)(52)(53)56,57). ARDS rates were only 3.2% in the largest case series, but this may be an underestimate due to a short average follow up time of 12 days, with the vast majority of patients remaining hospitalized at the end of study (48).…”

“…Evidence of cardiac or kidney injury at admission was variable across studies, but tended to be absent upon hospitalization (48,(51)(52)(53)56). Chest computed tomography at the time of admission was abnormal in 87% of patients with ground glass opacities or local or patchy "shadowing" (48).…”

“…Several studies have identified older age and baseline burden of comorbidity, such as diabetes, hypertension, prior coronary disease and prior lung disease, as predictors of more significant disease progression with higher rates of ARDS, AKI, cardiac injury, ICU admission and death (51)(52)(53)58,59). Increases in markers of inflammation, coagulation, and cardiac injury also correlate with disease severity and rise throughout the course of the disease (53,54,56). In hospitalized populations, the timing of death occurred at a median of 16-19 days after illness onset (53,58).…”

Pathophysiological characteristics and therapeutic approaches for pulmonary injury and cardiovascular complications of coronavirus disease 2019

“…36 . Moreover, in a study of 416 COVID-19 patients, myocardial injury was independently associated with higher risk of in-hospital mortality 27 . Hence, early myocardial injury in COVID-19 leads to a poor prognosis in COVID-19…”

“…For instance, SARS-CoV-2 infection injures the myocardium, leading to elevated levels of myocardial biomarkers (eg, troponin I > 28 pg/mL) and certain abnormalities in electrocardiography and echocardiography 25 . Increasing clinical evidence indicates that virus infection-associated cardiac dysfunction worsen COVID-19 patient's clinical conditions usually in association with the poor prognosis 26,27 . In spite of the observation that myocardial injury occurs frequently in COVID-19 patients 28 In epidemiology, high prevalence of cardiovascular dysfunction has been recently reported in COVID-19 patients, especially those with critical medical conditions 29 .…”