Hyper-Inflammatory Response Involves in Cardiac Injury Among Patients With Coronavirus Disease 2019

Abstract

Background Coronavirus disease 2019 (COVID-19) is still ongoing throughout the world and has resulted in considerable fatality. Inflammation and cardiac injury are commonly observed in these cases. However, the association between the hyper-inflammatory response and cardiac injury among patients with COVID-19 remains unknown. Methods The study was designed based on severe and critically ill patients with COVID-19. Information on demographics and baseline clinical characteristics as well as laboratory examinations were collected from the electronic medical records and analyzed. Results There were 32.4% (n = 107) of patients presenting with cardiac injury. The median age was 67 years, and 48.8% (n = 161) of patients were men. Hypertension was the most common in 161 (48.8%) patients, followed by diabetes (16.7%, n = 55) and coronary heart disease (13.3%, n = 44). Moreover, compared to cases without cardiac injury, those with cardiac injury were older, had higher proportions of coronary heart disease, had significantly elevated leukocyte counts and concentrations of N-terminal pro-B-Type natriuretic peptide, high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor (TNF)-α, interleukin-2 receptor (IL-2R), IL-6, and IL-8, but lower lymphocyte counts. A significant positive correlation was observed between high-sensitivity troponin I and hs-CRP, TNF-α, IL-2R, IL-6 and IL-8. Stepwise logistic regression analysis showed that hs-CRP, TNF-α and IL-6 were independent risk factors for cardiac injury. Conclusions Pro-inflammatory cytokines were associated with cardiac injury among severe and critically ill patients with COVID-19, suggesting that hyper-inflammatory response may involve in cardiac injury.

Epidemiology, risk factors and prognosis of cardiovascular disease in the Coronavirus Disease 2019 (COVID-19) pandemic era: a systematic review

“…Elevated levels of cytokines -such as C-reactive protein (CRP), tumor necrosis factor (TNF)-α, interleukin-2 re-ceptor (IL-2R), IL-1β, IL-6, IL-8 -have been observed in hospitalized COVID-19 patients [45]. Studies included in this review considered that CRP, TNF-α, and IL-6 were risk factors that independently predicted cardiac injury in severe and critically ill patients with COVID-19 [6,10].…”

“…Ta-ble 1 (Ref. [10,12,27,[29][30][31]34,39,45,55] summarizes the results of the above studies. Table 2 (Ref.…”

“…Table 2 (Ref. [10,12,27,[29][30][31]34,39,45,55] refers to the levels of evidence of included studies. The majority of the studies were level II or III in evidence quality (88%) [19].…”

High-dose vitamin C ameliorates cardiac injury in COVID-19 pandemic: a retrospective cohort study

“…A growing body of evidence revealed that patients with severe illness might have a high inflammatory burden, which predicted adverse clinical events in individuals suffering from COVID-19 infection; particularly, in patients in case of cardiac injury [ 2 , 4 ]. Crucial evidence of our previous results indicated that inflammatory markers were dramatically increased, indicating an independent link in the development of myocardial damage in the pandemic [ 5 ]. Therefore, myocardial injury may be a consequence of hyperinflammation among patients suffering from COVID-19 pneumonia.…”

High-dose intravenous vitamin C attenuates hyperinflammation in severe coronavirus disease 2019

“…All inpatients were tested positive for SARS-CoV-2 viral RNA by use of real-time reverse-transcriptase polymerase-chain reaction (RT-PCR) on throat swab specimens. [5] Severe illness was diagnosed if any of the following conditions was met: (1) respiratory distress with respiratory rate over 30 times per minute; (2) oxygen saturation ≤ 93% while breathing ambient air; (3) arterial blood oxygen partial pressure/fraction of inspired oxygen ≤ 300 mm Hg. The exclusion criteria included hospitalization length-of stay of < 21 days, incomplete medical records, pregnancy.…”