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

Abstract

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; α-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 α-HBDH levels tended to occur in older patients and patients with hypertension. Both high LDH and α-HBDH on admission were associated with higher mortality. Both high LDH and α-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.

The different clinical characteristics of corona virus disease cases between children and their families in China – the character of children with COVID-19

“…In the present study, we found six children and two adults had high CK-MB, which means that SARS-CoV-2 can cause heart injury. It is reported that the main mechanisms of SARS-CoV-2-induced myocardial injury may be the direct injury of virus, the inflammatory storm and the distribution of ACE2 receptor [20].…”

Comorbid Chronic Diseases and Acute Organ Injuries Are Strongly Correlated with Disease Severity and Mortality among COVID-19 Patients: A Systemic Review and Meta-Analysis

“…Xu et al found that intubated COVID-19 patients had a much higher risk of developing ACI compared to nonintubated patients in the ICU [11]. Wu et al also analyzed ACI-related markers, including TnI, creatine kinase-MB, lactate dehydrogenase (LDH), and α-hydroxybutyrate dehydrogenase, and found that COVID-19 patients who were admitted with increased serum levels of these markers had significantly higher overall mortality rates and shorter survival [8]. Thus, COVID-19 patients who develop signs of ACI should be identified as early as possible, and cardiovascular specialists should be consulted in order to minimize the risk of heart damage-related mortality.…”

“…Previous retrospective studies reported an increased risk of developing more severe complications in COVID-19 patients with certain preexisting chronic diseases [2][3][4]. In addition, the development of acute organ damage and/or dysfunction has also been linked to increased severity and higher mortality rates among COVID-19 patients [2,[5][6][7][8][9][10][11][12][13][14][15][16]. However, to date, no systematic review or meta-analysis has been reported regarding the putative association between various risk factors and prognosis in COVID-19 patients, with the sole exception of acute respiratory distress syndrome (ARDS).…”

Interleukin-6 as a potential biomarker of COVID-19 progression

“…We initially identified 73 articles based on our search strategy, 64 of which were excluded after title, abstract, or full-text reading, because they were review articles, did not report IL-6 levels, or did not classify the condition of COVID-19 patients as non-severe and severe. Finally, only nine studies were included in this meta-analysis [1][2][3][4][5][6][7][8][9]. Although the heterogeneity was considerably high (I 2 = 89%; P < 0.00001), we observed that IL-6 levels were significantly increased in COVID-19-infected patients with severe condition compared with those with non-severe condition (SMD = 0.71, 95%CI −0.31-1.12, P = 0.0005) ( Fig.…”