Sudden death of COVID-19 patients in Wuhan, China: A retrospective cohort study

Abstract

Background In December 2019, coronavirus disease 2019 (COVID-19) emerged in Wuhan city and rapidly spread throughout China. So far, it has caused ~ 4000 deaths in this country. We aimed to systematically characterize clinical features and determine risk factors of sudden death for COVID-19 patients. Methods Deceased patients with COVID-19 in Tongji hospital from January 22 to March 23, 2020 were extracted. Patients who died within 24 hours after admission were identified as sudden deaths, and the others formed non-sudden deaths. The differences in clinical characteristics between the two groups were estimated. Risk factors associated with sudden deaths were explored by logistic regression. Results 281 deceased patients were enrolled in this study. Sudden death occurred in 28 (10.0%) patients, including 4 (14.3%) admitted to the intensive care unit. Fatigue was more common in sudden deaths (11, 47.8%) than in non-sudden deaths (40, 17.2%). Both the count and percentage of eosinophils were lower in sudden deaths than that in non-sudden deaths ( P = 0.006 and P = 0.004). Compared with non-sudden deaths, sudden deaths had higher plasma levels of procalcitonin, C-reactive protein, D-dimer, alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transferase, lactate dehydrogenase, alkaline phosphatase and N-terminal pro-brain natriuretic peptide. There were not significant differences in gender, age, chest CT image features and comorbidities observed. Conclusions The differences between the two groups suggested more severe systemic inflammation, multi-organ dysfunction, especially impaired liver and heart function in COVID-19 patients who died suddenly after admission. More researches are needed to verify these points.

The Prevalence and Associated Death of Ventricular Arrhythmia and Sudden Cardiac Death in Hospitalized Patients With COVID-19: A Systematic Review and Meta-Analysis

“…Article of Shao reported that the prevalence of SCD was 1.8% in the population with COVID-19 (28). Also, according to Yang et al there was a higher SCD prevalence (10%) in the deceased population with COVID-19 (31).…”

“…Twenty-one studies , which included 13,790 hospitalized patients with COVID-19 with a mean age ranging from 50 to 70.3 years, and with sample sizes ranging from 54 to 4,526, were published from 2020 to 2021 [eight of them published in 2021 (11,15,16,19,(24)(25)(26)31), others in 2020 (12-14, 17, 18, 20-23, 27-30)]. Nine reports were from Asia [eight from China (13,16,18,21,22,28,29,31), one from Iran (19)], seven from USA (11,12,14,15,17,25,30), and five from Europe [three from Italy (20,24,27), one from Netherland (23), one from Germany (26)]. Besides, 15 of them were retrospective studies (11, 13, 15-19, 21-23, 27-31), 5 were prospective studies (12,14,20,25,26), and 1 was cross-section study (24).…”

“…Two articles reported the prevalence of SCD in hospitalized patients with COVID-19 (28,31). Article of Shao reported that the prevalence of SCD was 1.8% in the population with COVID-19 (28).…”

Immune Response in Myocardial Injury: In Situ Hybridization and Immunohistochemistry Techniques for SARS-CoV-2 Detection in COVID-19 Autopsies

“…There is much to be done as thenatural history of this disease has yet to be elucidated and whilst there has been an emphasis on pulmonary findings, there are now increasing reports that Covid-19 may also affect the cardiovascular and other organ systems ( Babapoor-Farrokhran et al, 2020 ; Barton et al, 2020 ). In fact, Yang et al reported death of a small number of patients who died within a short period of time after admission, in other words, sudden death ( Yang et al, 2021 ). Moreover, sudden cardiac arrest and death had been reported as early as 2020 despite improvement of general condition and constitutional symptoms ( Shirazi et al, 2021 ).…”

Immunological and Pathological Peculiarity of Severe Acute Respiratory Syndrome Coronavirus 2 Beta Variant

“…Neutrophil recruitment is highly correlated with the severity of COVID-19. Higher neutrophil counts were observed in critically versus noncritically ill patients and in those who died suddenly after admission versus those who did not ( 61 , 62 ). These observations are consistent with our findings supporting enhanced neutrophil recruitment with the rapid development of lung pathology in beta variant-infected mice.…”