Characteristics and clinical significance of myocardial injury in patients with severe coronavirus disease 2019

Shu, Shi; Qin, Mu; Cai, Yuli; Liu, Tao; Shen, Bo; Yang, Fan; Cao, Sheng; Liu, Xu; Xiang, Yaozu; Zhao, Qian; Huang, He; Yang, Bo; Huang, Congxin

doi:10.1093/eurheartj/ehaa408

Cited by 445 publications

(516 citation statements)

References 20 publications

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“…In our study, there was no difference in the outcome between non-comorbidity group and diabetes only group. Shi et al reported that even thought COVID-19 patients with diabetes had worse outcomes; diabetes was not independently associated with in-hospital death, which was consistent with our results [16]. Besides, most laboratory results were comparable between non-comorbidity group and diabetes only group except CRP, albumin, sodium, urea nitrogen, HDL-C and, of course blood glucose.…”

Section: Discussionsupporting

confidence: 91%

“…Patients of diabetes with comorbidity was 10 years older than the patients who had no comorbidity expect diabetes, furthermore, age ≥65 was associated with greater risk of development of death [4]. As described above, patients with hypertension, CVD were more likely to develop severe cases [4,16,17,20]. Furthermore, our analysis indicated that age, hypertension, CKD, CVD were the risk factors for mortality of COVID-19.…”

Section: Discussionsupporting

confidence: 56%

“…Pre-existing hypertension, CHD, CVD, and CKD had higher frequencies in the diabetic group. Recent studies reported that patients with hypertension cardiovascular, CKD, CVD were more likely to develop severe cases [4,6,[15][16][17] , so we compare the diabetic COVID patients without comorbidity and COVID atients without any comorbidity in order to identify if diabetes without comorbidity was a risk factor of COVID-19. In our study, there was no difference in the outcome between non-comorbidity group and diabetes only group.…”

Section: Discussionmentioning

confidence: 99%

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Diabetic Patients with Comorbidities had Worse Outcomes When Suffered with COVID-19 and Acarbose might have Protective Effects

Luo

et al. 2020

Preprint

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Background: Previous studies showed that diabetes was a common comorbidity of COVID-19, but the effects of diabetes or anti-diabetic drugs on the mortality of COVID-19 have not been well described. To investigate the outcome of different status (with or without comorbidity) and anti-diabetic medication before admission of diabetic patients after SARS-CoV-2 infected, we collected clinical data of COVID-19 patients from Hubei Province and compared between diabetes and non-diabetes.Methods: In this multicenter and retrospective study, we enrolled 1,422 cases of consecutive hospitalized patients from January 21, 2020 to March 25, 2020 at six hospitals in Hubei Province, China. The primary endpoint was in-hospital mortality.Results: Diabetes patients were 10-years older than non-diabetes (p<0.001), had higher prevalence of comorbidities such as hypertension (p<0.001), coronary heart disease (p<0.001), cerebrovascular disease (CVD) (p<0.001), chronic kidney disease (CKD) (p=0.007). The incidence of mortality (p=0.003) were more prevalent among the diabetes group. Further analysis revealed that diabetes patients who took alpha-glucosidase inhibitor (AGI) had lower mortality rate(p<0.01). Multivariable Cox regression showed that male sex, hypertension, CKD, CVD, age were risk factors for the mortality of COVID-19. Survival curve revealed that, compared with diabetes only group, the mortality was increased in diabetes with comorbidities (p=0.009), but had no significant difference in the non-comorbidity group, p=0.59).Conclusions: Patients with diabetes had worse outcome when suffered with COVID-19, however, it was not associated with diabetes itself but the comorbidities. Furthermore, the administration of AGI could reduce the risk of death in patients with diabetes.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 56%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Diabetic Patients with Comorbidities had Worse Outcomes When Suffered with COVID-19 and Acarbose might have Protective Effects

Luo

et al. 2020

Preprint

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“…Previous studied had clearly demonstrated that patients with cardiopulmonary comorbidities had adverse outcomes, including progression into cardiac injury and death [26][27][28]. The potential mechanisms were also proposed based on the observations of several molecular and pathology studies [29][30][31]. Despite the fact that HCQ/CQ were commonly used for rheumatoid arthritis and systemic lupus erythematosus in the general population, there has been major concern with widespread use of these medications for COVID-19 due to possible QTc prolongation and induction of life-threatening arrhythmias.…”

Section: Discussionmentioning

confidence: 99%

Lack of Benefit in COVID-19 Patients Treated with Hydroxychloroquine or Chloroquine: A Systematic Review and Meta-Analysis

Chen

Yao

et al. 2020

Preprint

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Background: Hydroxychloroquine (HCQ) and chloroquine (CQ) have been widely used for the treatment of the coronavirus disease 2019 (COVID-19), despite limited clinical evidence and controversial early reports. The aim of this report was to provide a systematic review of the literature and meta-analysis on the use of HCQ/CQ with respect to safety and clinical efficacy of these medications. Methods: We performed a systematic search of the medical databases and included studies if they focused on patients with COVID-19 who received HCQ or CQ alone, or in combination with other treatments, and were compared with a control group. We analyzed two important clinical objectives; viral clearance rate by reverse transcription-polymerase chain reaction (RT-PCR) negativity and all-cause mortality.Results: A total of 14 studies were included in the quantitative synthesis. The use of HCQ/CQ was associated with higher viral clearance rate compared with control group (OR: 3.12, 95% CI: 2.17-4.49 p<0.0001). In the sensitivity analysis, the effect on viral clearance disappeared (OR 1.44, 95% CI: 0.87-2.37, p=0.155). The use of HCQ/CQ was associated with a higher risk of mortality (OR 1.26, 95% CI: 1.05-1.51, p<0.0001). Due to huge heterogeneity between the studies (I2 = 86%, p < 0.01), we performed a meta regression analysis. Both treatment within 24 hours (p=0.047) and comorbidities [hypertension (p=0.025), diabetes (p=0.049) and chronic lung disease (p=0.0064)] contributed to the heterogeneity. HCQ/CQ daily dose (p=0.61) and age (p=0.62) had no impact on effect size. Higher rate of comorbidities led to a higher risk of mortality by using HCQ/CQ. Overall, the use of HCQ/CQ resulted in longer QTc intervals.Conclusions: Our meta-analysis did not reveal a clinical benefit of HCQ/CQ on in-hospital outcomes for patients with COVID-19. The use of HCQ/CQ did not result in rapid viral clearance on RT-PCR. Moreover, our results showed that higher rate of comorbidities led to a higher risk of mortality by using HCQ/CQ.

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“…Bhatraju et al recently reported that 71% of 24 critically ill COVID-19 patients required vasopressor infusion more than 12 hours after intubation [1]. Many studies have reported that myocardial injury and heart failure are frequent in COVID-19 patients and are common causes of death [2,3]. Spectrum of the COVID-19 cardiovascular syndrome is large with different potential mechanisms supporting acute myocardial injury [4].…”

Section: Introductionmentioning

confidence: 99%

Echocardiographic patterns in critically ill COVID-19 patients.

Vieillard‐Baron

Charron

Tran

et al. 2020

Preprint

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Background: Need for catecholamines is frequent in COVID-19 patients, but the main echocardiographic patterns are unknown. The objective was to report the main echo patterns in critically-ill COVID-19 patients. Methods: Observational and descriptive study in consecutive COVID-19 patients admitted to the ICU between March 12 and May 8, 2020. Systematic critical care echocardiography (CCE) was performed and retrospectively analyzed off-line. Echo values are reported in the overall population and in patients who required catecholamine infusion during the first 2 days following admission (D1-2) or afterwards until day 7 (D3-7). Results: Of the 79 patients (78% male; median age 63 [56-71]; body mass index 29 [26-30]) included, 90% had at least 1 comorbidity. PaO2/FiO2 at admission was 85 [67-162] mmHg. 53% of patients were mechanically ventilated. ICU length of stay was 9 [5-16] days and mortality 34%. 134 echocardiographic studies were performed during the first week in 65 patients. Pulmonary artery acceleration time was decreased (77 [65-97] ms), suggesting pulmonary hypertension. All 39 patients (49%) who required catecholamine infusion underwent CCE and 25.6% had left ventricular (LV) systolic dysfunction, 28.2% acute cor pulmonale (ACP), 7.7% hypovolemia, and 38.5% vasoplegia. Modification of echo patterns was observed at D3-7, with less LV systolic dysfunction and more ACP, which was the most frequent pattern. Computed tomography pulmonary angiography in 6 patients with ACP indicated intrapulmonary thrombus in 4. Conclusion: Different echocardiographic patterns were observed during the first week following ICU admission in COVID-19 patients. ACP was frequent and often related to thrombus in the pulmonary circulation.

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Characteristics and clinical significance of myocardial injury in patients with severe coronavirus disease 2019

Cited by 445 publications

References 20 publications

Diabetic Patients with Comorbidities had Worse Outcomes When Suffered with COVID-19 and Acarbose might have Protective Effects

Diabetic Patients with Comorbidities had Worse Outcomes When Suffered with COVID-19 and Acarbose might have Protective Effects

Lack of Benefit in COVID-19 Patients Treated with Hydroxychloroquine or Chloroquine: A Systematic Review and Meta-Analysis

Echocardiographic patterns in critically ill COVID-19 patients.

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