Myocardial injury is associated with in-hospital mortality of confirmed or suspected COVID-19 in Wuhan, China: A single center retrospective cohort study

Abstract

Background Since December 2019, a cluster of coronavirus disease 2019 (COVID-19) occurred in Wuhan, Hubei Province, China and spread rapidly from China to other countries. In-hospital mortality are high in severe cases and cardiac injury characterized by elevated cardiac troponin are common among them. The mechanism of cardiac injury and the relationship between cardiac injury and in-hospital mortality remained unclear. Studies focused on cardiac injury in COVID-19 patients are scarce.Objectives To investigate the association between cardiac injury and in-hospital mortality of patients with confirmed or suspected COVID-19.Methods Demographic, clinical, treatment, and laboratory data of consecutive confirmed or suspected COVID-19 patients admitted in Wuhan No.1 Hospital from 25 th December, 2019 to 15 th February, 2020 were extracted from electronic medical records and were retrospectively reviewed and analyzed. Univariate and multivariate Cox regression analysis were used to explore the risk factors associated with in-hospital death.Results A total of 110 patients with confirmed (n=80) or suspected (n=30) COVID-19 were screened and 48 patients (female 31.3%, mean age 70.58±13.38 year old) among them with high-sensitivity cardiac troponin I (hs-cTnI) test within 48 hours after admission were included, of whom 17 (17/48, 35.4%) died in hospital while 31 (31/48, 64.6%) were discharged or transferred to other hospital. High-sensitivity cardiac troponin I was elevated in 13 (13/48, 27.1%) patents. Multivariate Cox regression analysis showed pulse oximetry of oxygen saturation (SpO2) on admission (HR 0.704, 95% CI 0.546-0.909, per 1% decrease, p=0.007), elevated hs-cTnI (HR 10.902, 95% 1.279-92.927, p=0.029) and elevated d-dimer (HR 1.103, 95%CI 1.034-1.176, per 1mg/L increase, p=0.003) on admission were independently associated with in-hospital mortality.

Laboratory features in severe vs. non-severe COVID-19 patients, a systematic review and meta-analysis

“…Myocardial damage in COVID-19, especially in severe cases, has been demonstrated previously (20,24), however our analysis did not find significant higher level of myocardial enzymes in severe compared to non-severe cases. We believe more studies on the pathophysiology of such injury may help this issue to be clearer, one possibility could be interstitial infiltration of mononuclear cells instead of direct damage of myocardium in severe cases (25) which it is not in line with the finding of Zheng et al (15).…”

Laboratory features of severe vs. non-severe COVID-19 patients in Asian populations: a systematic review and meta-analysis

“…All included articles were conducted in China [7,[12][13][14][15][20][21][22][23][24][25][26] except one that was performed in Singapore [27]. Twenty-three studies of 17 articles included 3396 (ranging from 12 to 1099) patients who were 720 in severe and 2676 in non-severe groups.…”

The impact of 2019 novel coronavirus on heart injury: A Systematic review and Meta-analysis

“…There were 28 reports of 4189 patients included in 22 studies that provided data describing effects on myocardial injury. 7-29 Nine reported the association of acute cardiac injury with death 13,17,20,21,24,28,[30][31][32] and 4 reported dynamic changes of cardiac biomarkers during hospitalization 20, 32-34 . Three included duplicate information from the same participants [35][36][37] and were not excluded.…”