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

Abstract

<jats:p>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. T test was used for continuous variables while Chi-square 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&lt;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&lt;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. 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.</jats:p>

The role of pre-existing chronic disease in cardiac complications from SARS-CoV-2 infection: A systematic review and meta-analysis

“…The definition of cardiac complications varied between studies, ranging from acute cardiac injury to fulminant myocarditis. 20 studies measured cardiac outcomes on the day of admission [3,29,32,34,35,37–41,43–48,50-52,57], and one at the time of patient death [33], with the remaining eight studies not specifying the time of assessment [4,36,42,49,53–55]. The studies were conducted in 10 countries in four geographical locations (U.S.A. [32,33,41,48,49], the Middle East [34,50,52], Europe [4,35–40,44,45,47], and the People’s Republic of China [3,29,42,43,46,51,53–57]) with a total of 3553 COVID-19 patients developing cardiac complications and 13,225 COVID-19 patients without cardiac complications.…”

A meta-analysis on the role of pre-existing chronic disease in the cardiac complications of SARS-CoV-2 infection

“…Heterogeneity: χ 25 2 = 120.58 (P < .001), I 2 = 79% Abrams et al, 2020Arentz et al, 2020Barman et al, 2020CAPACITY COVID, 2020Duerr et al, 2020Ferrante et al, 2020Guo et al, 2020Lairez et al, 2020Lala et al, 2020Lombardi et al, 2020Lorente−Ros et al, 2020Ma et al, 2020Pagnesi et al, 2020Raad et al, 2020Sala et al, 2020Shah et al, 2020Shahrokh et al, 2020Shi et al, 2020Song et al, 2020Szekely et al, 2020Toraih et al, 2020Wei et al, 2020Xie et al, 2020Xu G et al, 2020Xu H et al, 2020 iScience Article different multivariate models in the analyses, also contributing to heterogeneity. However, adjusted ORs relevant to our outcome were not readily available from the included studies.…”

“…Total (fixed effect) Total (random effects) Heterogeneity: χ 26 2 = 40.03 (P = .04), I 2 = 35% Abrams et al, 2020Arentz et al, 2020Barman et al, 2020Bertini et al, 2020CAPACITY COVID, 2020Duerr et al, 2020Ferrante et al, 2020Ghio et al, 2020Guo et al, 2020Lairez et al, 2020Lala et al, 2020Lombardi et al, 2020Lorente−Ros et al, 2020Ma et al, 2020Pagnesi et al, 2020Raad et al, 2020Shah et al, 2020Shahrokh et al, 2020Shi et al, 2020Song et al, 2020Szekely et al, 2020Wei et al, 2020Xie et al, 2020Xu G et al, 2020Xu H et al, 2020 OR (95% CI) Fixed effect models apply when I 2 < 50% and random effects models apply when I 2 > 50%.…”

“…As large heterogeneity was detected amongst the total combined study cohort, the cohort was subdivided based on general global region in an attempt to account for this, based on the fact that different countries have different clinical practices and experiences with the pandemic. Cohorts were divided into studies with cohorts primarily situated in the U.S.A (Abrams et al, 2020;Arentz et al, 2020;Lala et al, 2020;Raad et al, 2020;Shah et al, 2020), the Middle East (Barman et al, 2020;Shahrokh et al, 2020;Szekely et al, 2020), Europe (Bertini et al, 2020;Linschoten and Asselbergs, 2020;Duerr et al, 2020;Ferrante et al, 2020;Ghio et al, 2020;Lairez et al, 2020;Lombardi et al, 2020;Lorente-Ros et al, 2020;Pagnesi et al, 2020; ll OPEN ACCESS 2 iScience 24, 102264, April 23, 2021 iScience Article Sala et al, 2020), and China (Guo et al, 2020;Shi et al, 2020;Li et al, 2020c;Ma et al, 2020;Song et al, 2020;Toraih et al, 2020;Wei et al, 2020;Xie et al, 2020;Xu et al, 2020aXu et al, , 2020b.…”