Hyper-Inflammatory Response Involves in Cardiac Injury among Patients with Coronavirus Disease 2019

Xia, Guozhi; Fan, Di; Ma, Chaoran; He, Yanru; Wang, Ming; Zhu, Yaowu; Zheng, Qiangsun

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.