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Prevalence, Clinical Characteristics and Outcomes of COVID-19 Combined with Cardiac Injury
29 Pages Posted: 28 Apr 2020
More...Abstract
Background: Since December 2019, Coronavirus disease 2019 (COVID-19) has emerged as an international pandemic. COVID-19 patients with cardiac injury might need special attention. However, understanding on this aspect remains unclear.
Methods: This retrospective, single-center study included 304 COVID-19 cases hospitalized from January 11 to March 25, 2020. Confirmed by real-time RT-PCR, cases were analyzed for clinical characteristics and complications, specifically with cardiac injury, determined by the serum biomarker hypersensitive troponin I. The primary endpoint was COVID-19 associated mortality.
Findings: Of the 304 patients, 96 (31∙6%) patients had cardiac injury and 208 (68∙4%) patients presented without cardiac injury. The median age was 65 (interquartile range, IQR, 54-74) years, and 160 (52∙6%) of COVID-19 patients were men. COVID-19 patients with cardiac injury had more comorbidities (76[79∙2%] vs 122[58∙7%], p<0∙001), and they had lower lymphocyte counts (median[IQR], 0∙6[0∙4-1∙0] vs 1∙0[0∙7-1∙3]/L, P<0∙001), while higher C-reactive protein levels (median[IQR], 84∙9[53∙7-173∙8] vs 28∙5[5∙7-82∙2]mg/L, p<0∙001) and procalcitonin levels (median[IQR], 0∙29[0∙10-1∙09] vs 0∙06[0∙04-0∙14]ng/mL, p<0∙001) and more frequent use of noninvasive ventilation (35[36∙5%] vs 27[13∙0%]), invasive mechanical ventilation (20[20∙8%] vs 11[5∙3%]) and antibiotic treatment (65[67∙7%] vs 53[25∙5%]) compared with patients without cardiac injury. The mortality rate in patients with cardiac injury was much higher than those without (63∙5%, 61/96 vs 13∙0%, 27/208, p<0∙001). The Cox regression showed cardiac injury was the strongest independent predictor to mortality from symptom onset in COVID-19 patients (hazard ratio[HR], 3∙37[95% CI, 1∙90-5∙67], p<0∙001).
Interpretation: Cardiac injury is associated with more severe presentation, complex comorbidities and is the strongest independent predictor to mortality in hospitalized patients with COVID-19.
Funding Statement: This study received the following funding: Construction Research Project of Key Laboratory (Cultivation) of Chinese Academy of Medical Sciences(No. 2019PT310025); National Natural Science Foundation of China (No. 81971588 and 81771811); Capital Clinically Characteristic Applied Research Fund (No. Z191100006619021); National Foreign Expert Talent Project(No. G20190001630); Education Reform Project of Peking Union Medical College (No. 10023201900204); Clinical and Translational Fund of Chinese Academy of Medical Sciences (No. 2019XK320063); National Natural Science Foundation of China (No. 81970331).
Declaration of Interests: The authors declare no competing interests.
Ethics Approval Statement: Local ethic approval (Ref: WDRY2020-K094).
Keywords: coronavirus disease 2019; cardiac injury; clinical characteristics; mortality
Suggested Citation: Suggested Citation