Cardiac injury on admission linked to worse outcomes in hospitalized COVID-19 patients

Yiwu Zhou; Lin Lv; Rong Yao

doi:10.2298/VSP210602012Z

Yiwu Zhou Sichuan University, West China Hospital, Department of Emergency Medicine, Emergency Medical Laboratory, Chengdu, Sichuan, China
Lin Lv Sichuan University, West China Hospital, Department of Emergency Medicine, Emergency Medical Laboratory, Chengdu, Sichuan, China
Rong Yao Sichuan University, West China Hospital, Department of Emergency Medicine, Emergency Medical Laboratory, Chengdu, Sichuan, China

DOI: https://doi.org/10.2298/VSP210602012Z

Keywords: patient admission, cardiovascular diseases, COVID-19, disease progression, mortality, prognosis, risk factors, cardiomyopathies

Abstract

Background/Aim. The novel severe acute respiratory syndrome coronavirus 2 (SARS Cov-2) has triggered a pandemic that causes a disease with complex clinical manifestations (coronavirus disease 2019, COVID-19). Soon it became clear that patients who had some comorbidities had a bigger chance of getting the severe form of COVID-19. The aim of the study was to investigate if there was a link between cardiac injury and COVID-19 severity and mortality in patients. Methods. All consecutive patients with laboratory-confirmed COVID-19 were included and followed up until discharge or death from January 30, 2020, to April 5, 2020. Results. A total of 261 COVID-19 patients were included, and 29 (11.1%) had cardiac injury on admission. Patients with cardiac injury were older than those without cardiac injury (72.8 vs 55.8 years old) and more likely to be male (82.8% vs 42.2%). Patients with cardiac injury were also more likely to be smokers (31.0% vs 12.5%), more likely to have chronic cardiovascular disease (24.1% vs 7.8%), chronic pulmonary disease (17.2% vs 3.0%), and chronic kidney disease (10.3% vs 2.2%) compared to patients without cardiac injury. Laboratory findings suggested that patients with cardiac injury were more likely to have leukocyte counts > 10 × 10⁹/L, pronounced lymphopenia, direct bilirubin, myohemoglobin, blood urea nitrogen, C-reactive protein, and pro-B-type natriuretic peptide but lower levels of serum total protein and estimated glomerular filtration rates compared to patients without cardiac injury. Patients with cardiac injury experienced more complications (72.4% vs 47.8%), including acute respiratory distress syndrome (20.7% vs 2.7%), acute kidney injury (10.3 vs 0.4%), severe COVID-19 (58.6% vs 11.6%) and death (55.2% vs 3.9%) compared to patients without cardiac injury. Multivariate analyses showed that cardiac injury was associated with an increased risk of severe COVID-19 [hazard ratio (HR) = 8.71, 95% confidence interval (CI) = 2.37−32.04] and death (HR = 20.84, 95% CI = 1.32−328.22). Conclusion. Cardiac injury on admission was associated with a higher risk of disease progression and death in patients with COVID-19.

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