Clinical Characteristics and Cardiac Injury Description of 419 Cases of COVID-19 in Shenzhen, China

Abstract

Background: In December 2019, a cluster of acute respiratory illness caused by SARS-CoV-2, now known as Coronavirus Disease 2019 (COVID-19), occurred in Wuhan, Hubei Province, China. We describe and compare the clinical characteristics of inpatients in intensive care unit (ICU) and non-ICU cases with COVID-19, and the features of heart injury were described emphatically.

Methods: We recruited patients who were diagnosed as COVID-19 from Shenzhen Third People's Hospital in China and were divided into two groups, ICU and Non-ICU respectively. The medical history, underlying comorbidities, laboratory findings, chest computed tomographic scans or x-ray, and echocardiography data were obtained from patients’ medical records and compared between two groups. The clinical outcomes (ie, discharges, mortality, length of stay) were monitored up to March 3, 2020. We have shared all the data with WHO.

Findings: 419 patients with COVID-19 were included in this study, of which 383 (91%) were admitted to isolation wards, and 36 (9%) were transferred to the ICU (Table 1). Hypertension (60 [14%]), diabetes (24 [6%]), and cardiovascular disease (18 [4%]) were the most common coexisting conditions. Patients who required ICU care (n = 36) were significantly older than non-ICU patients (median age, 64 years [IQR, 59-69] vs 45 years [IQR, 33-57]; P < 0.05) and were more likely to have underlying comorbidities, including hypertension (14 [39%] vs 46 [12%], diabetes (9 [25%] vs 15 [4%]), and cardiovascular disease (5 [14%] vs 13 [3%]). There were numerous differences in laboratory findings between two groups, including lower red blood cell, lymphocyte count and platelet count, higher white blood cell, prothrombin time, fibrinogen, D-dimer, as well as higher levels of total bilirubin, blood urea nitrogen and creatine kinase. Meanwhile, C-reactive protein, procalcitonin, and interleukin 6 was also higher in ICU patients. were significantly higher in ICU patients. All patients’ chest x-ray and/or chest CT scan show distribution of patchy shadows or ground glass opacity. Echocardiographic findings including enlarged left ventricular (4 [11%]), thickened interventricular septum (11 [31%]), reduced left ventricular ejection fraction (4 [11%]), and pulmonary arterial hypertension (4 [11%]). There were 3(8%) patients presented with right heart enlargement, thickened right ventricular wall and decreased right heart function. Only 2(6%) patients had pericardial effusion and 1(3%) patient had enlarged left atrium.

Interpretation: The mechanism of COVID-19 is still unclear, but it is certain that the infection of new coronavirus can lead to heart damage. Myocardial injury may be related to virus replication, immune factors, drug toxicity, low organ functional reserve, hypoxia, sympathetic excitation, and psychological factors. Progressive thickening of the myocardium in critical cases is common and may be associated with immune reaction.

Funding Statement: None.

Declaration of Interests: The authors state no conflict of interests.

Ethics Approval Statement: The study was approved by the Ethics Committee of Shenzhen Third People’s Hospital and the informed consent was obtained before retrospective data collection.

Keywords: COVID-19; coronavirus; myocarditis; infection; echocardiography