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

Xie, Y.; Chen, S.; Wang, X.; Li, B.; Zhang, T.; He, X.; Sun, N.; Wang, L.; Zeng, H.; Shen, Y.

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<0.001) , HTN (OR=2.09, P=0.005), {gamma}-globulin (OR=2.08, P=0.004), TCM (OR=0.55, P=0.017), PLT (OR=2.94, P<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,{gamma}-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.