Hyper-Inflammatory Response Involves in Cardiac Injury Among Patients With Coronavirus Disease 2019
Guozhi Xia1, Di Fan2, Chaoran Ma3
1Department of Cardiology, Second Affiliated Hospital of Xi'an Jiaotong University, No. 157 West 5th Road, Xi'an 710004, Shaanxi, China.
Insights
Severe COVID-19 patients with cardiac injury showed higher inflammatory markers. Key inflammatory cytokines like high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor (TNF)-α, and IL-6 were independent risk factors for cardiac injury.
Area of Science:
- Cardiology
- Infectious Diseases
- Immunology
Background:
- Inflammation is implicated in COVID-19 pathogenesis and cardiac injury.
- Cardiac injury in COVID-19 patients is linked to poorer outcomes.
- Limited data exist on the hyper-inflammatory response and cardiac injury link in COVID-19.
Purpose of the Study:
- To investigate the association between hyper-inflammatory response and cardiac injury in severe COVID-19 patients.
- To identify inflammatory markers associated with cardiac injury in COVID-19.
Main Methods:
- Retrospective analysis of severe and critically ill COVID-19 patients.
- Collection and analysis of clinical characteristics and laboratory data.
- Logistic regression to identify independent risk factors for cardiac injury.
Main Results:
- 32.4% of patients experienced cardiac injury.
- Patients with cardiac injury were older and had higher rates of coronary heart disease.
- Elevated levels of inflammatory cytokines (hs-CRP, TNF-α, IL-6, IL-8, IL-2R) and lower lymphocyte counts were observed in patients with cardiac injury.
- hs-CRP, TNF-α, and IL-6 were identified as independent risk factors for cardiac injury.
Conclusions:
- Cardiac injury in severe COVID-19 is associated with elevated inflammatory cytokines.
- A hyper-inflammatory response may play a role in the development of cardiac injury during COVID-19.
Background:
Inflammation can facilitate development of coronavirus disease 2019 (COVID-19) and cardiac injury is associated with worse clinical outcomes. However, data are relatively scarce on the association between hyper-inflammatory response and cardiac injury among COVID-19 patients.
Methods:
The study was designed based on severe and critically ill patients with COVID-19. Information on clinical characteristics and laboratory examinations was collected from the electronic medical records and analyzed.
Results:
There were 32.4% (n = 107) of patients 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). Compared to cases without cardiac injury, those with cardiac injury were older, had higher proportions of coronary heart disease, and leukocyte counts, significantly elevated 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 inflammatory cytokines. Logistic regression analysis showed that hs-CRP, TNF-α and IL-6 were independent risk factors for cardiac injury.
Conclusions:
Cardiac injury was associated with elevated levels of inflammatory cytokines among severe and critically ill patients with COVID-19, suggesting that hyper-inflammatory response may involve in cardiac injury.
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