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COVID-19 Related Cardiovascular Comorbidities and Complications in Critically Ill Patients: A Systematic Review and

Michael Koeppen¹, Peter Rosenberger¹, Harry Magunia¹

¹Department of Anaesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany.

Clinical Medicine Insights. Circulatory, Respiratory and Pulmonary Medicine

|February 18, 2021

Insights

Cardiovascular complications are frequent in critically ill COVID-19 patients admitted to the ICU. This review highlights high prevalence of conditions like hypertension and shock, but notes significant data heterogeneity.

Area of Science:

Critical care medicine
Cardiology
Infectious diseases

Background:

Coronavirus disease 2019 (COVID-19) can lead to severe respiratory distress requiring intensive care unit (ICU) admission.
Cardiovascular comorbidities and complications are increasingly recognized in severe COVID-19 cases.

Purpose of the Study:

To systematically review and meta-analyze the prevalence of cardiovascular comorbidities and complications in ICU-admitted COVID-19 patients.
To synthesize existing data on the cardiovascular impact of COVID-19 in critical care settings.

Main Methods:

Systematic review and meta-analysis of observational studies.
Searched PubMed and Web of Science databases up to November 25, 2020.
Extracted data on cardiovascular comorbidities and complications from 29 studies involving critically ill COVID-19 patients.

Main Results:

Arterial hypertension was the most common comorbidity (50%).
Cardiovascular complications included shock (39%), need for vasopressors (74%), and cardiac injury (30%).
Significant heterogeneity was observed across studies, impacting the quality of evidence.

Conclusions:

Cardiovascular complications are prevalent in critically ill COVID-19 patients.
High heterogeneity in study design and outcome measurement necessitates caution in interpreting results.
Prospective observational studies are needed to clarify the impact of these complications on patient outcomes.

Read full analysis

Abstract

Objective:

This systematic-review and meta-analysis aimed to assess the prevalence of cardiovascular comorbidities and complications in ICU-admitted coronavirus disease 2019 (COVID-19) patients.

Data Sources:

PubMed and Web of Science databases were referenced until November 25, 2020.

Data Extraction:

We extracted retrospective and prospective observational studies on critically ill COVID-19 patients admitted to an intensive care unit. Only studies reporting on cardiovascular comorbidities and complications during ICU therapy were included.

Data Synthesis:

We calculated the pooled prevalence by a random-effects model and determined heterogeneity by Higgins' I ² test.

Results:

Of the 6346 studies retrieved, 29 were included in this review. The most common cardiovascular comorbidity was arterial hypertension (50%; 95% confidence interval [CI], 0.42-058; I ² = 94.8%, low quality of evidence). Among cardiovascular complications in the ICU, shock (of any course) was most common, being present in 39% of the patients (95% CI, 0.20-0.59; I ² = 95.6%; 6 studies). Seventy-four percent of patients in the ICU required vasopressors to maintain target blood pressure (95% CI, 0.58-0.88; I ² = 93.6%; 8 studies), and 30% of patients developed cardiac injury in the ICU (95% CI, 0.19-0.42; I ² = 91%; 14 studies). Severe heterogeneity existed among the studies.

Conclusions:

Cardiovascular complications are common in patients admitted to the intensive care unit for COVID-19. However, the existing evidence is highly heterogeneous in terms of study design and outcome measurements. Thus, prospective, observational studies are needed to determine the impact of cardiovascular complications on patient outcome in critically ill COVID-19 patients.

Keywords:

COVID-19 cardiovascular system critical care heart hemodynamic

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