Early Diagnosis and Clinical Significance of Acute Cardiac Injury - Under the Iceberg: A Retrospective Cohort Study of 619 Non-critically Ill Hospitalized COVID-19 Pneumonia Patients

  1. Yang Xie
  2. Sichun Chen
  3. Xueli Wang
  4. Baige Li
  5. Tianlu Zhang
  6. Xingwei He
  7. Ningling Sun
  8. Luyan Wang
  9. Hesong Zeng
  10. Yin Shen
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Abstract

Rationale

Coronavirus disease 2019 (COVID-19) can cause a viral pneumonia together with other extrapulmonary complications. Acute cardiac related injury (ACRI) is common in hospitalized COVID-19 patients.

Objective

To explain the pathological mechanism of ACRI and improve the treatment strategy by retrospectively observing the factors associated with ACRI and factors affecting the prognosis of ACRI with COVID-19 at an early stage.

Methods

619 COVID-19 patients were from Tongji Hospital, Wuhan. Student’s t test was used for continuous variables while Pearson χ2 test for categorical factors. Univariable and multivariable logistic regression models were applied to estimate odds ratio (OR) with 95% confidence interval (CI).

Results

Among the 619 OOS Level-I hospitalized COVID-19 patients, 102 (16.5%) were defined as ACRI (stage-1: 59 cases, stage-2: 43 cases). 50% of ACRI patients developed into severe cases and 25 patients died(CFR=24.5%), 42 times that of non-ACRI patients. Elderly (OR=2.83, P<0.001), HTN (OR=2.09, P=0.005), γ-globulin (OR=2.08, P=0.004), TCM (OR=0.55, P=0.017), PLT (OR=2.94, P<0.001) and NLR (OR=2.20, P=0.004) were independently correlated with ACRI. SBP ⩾ 140, dyspnea, DM, smoking history were correlated with ACRI-stage2 only. In the prognostic subgroup analysis of ACRI patients, γ-globulin treatment could prolong LOS (29.0 ± 7.2 days Vs 23.5 ± 8.1 days, P=0.004). TCM (OR=0.26, P=0.006), SBP ⩾ 160 (OR= 22.70, P=0.005), male (OR=2.66, P=0.044) were associated with severe illness while corticosteroids treatment (OR=3.34, P=0.033) and male (OR=4.303, P=0.008) with death. Surprisingly, we found the mortality of non-elderly patients is higher than elderly (32.4% VS 20.0%, P=0.164), and both IKF and RASI treatment were not correlated with any prognostic indicators including severe, death and LOS.

Conclusion

This study observed that several non-traditional issues were associated with early cardiac injury in COVID-19 while many traditional cardiovascular risk factors were not. Besides elderly and male, hypertension was confirmed to be the most important risk factor.

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