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Association of coagulation dysfunction with cardiac injury among hospitalized patients with COVID-19

Liang Chen1, Wei Hu2, Xiaoxiao Guo2

  • 1State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Scientific Reports
|February 25, 2021
PubMed

Insights

Cardiac injury is a common COVID-19 complication linked to poor outcomes. This study found coagulation dysfunction, particularly elevated D-dimer levels, significantly associated with cardiac injury and mortality in hospitalized patients.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Hematology

Background:

  • Cardiac injury is a frequent complication of coronavirus disease 2019 (COVID-19).
  • It is associated with adverse clinical outcomes and increased in-hospital mortality.
  • The relationship between cardiac injury and coagulation dysfunction in COVID-19 requires further elucidation.

Purpose of the Study:

  • To investigate the association between cardiac injury and coagulation dysfunction in patients hospitalized with COVID-19.
  • To identify risk factors for cardiac injury and in-hospital mortality in this cohort.
  • To explore the role of coagulation parameters in the pathogenesis of COVID-19-related cardiac injury.

Main Methods:

  • Retrospective analysis of 181 consecutive hospitalized COVID-19 patients.
  • Assessment of cardiac biomarkers: high-sensitivity troponin I (hs-cTnI), myoglobin, and creatine kinase-myocardial band (CK-MB).
  • Evaluation of clinical characteristics, coagulation parameters (including D-dimer), and in-hospital outcomes (discharge or death).

Main Results:

  • Cardiac injury was present in 23.2% of patients.
  • Old age, high leukocyte count, elevated aspartate transaminase (AST), D-dimer, and serum ferritin were significantly associated with cardiac injury.
  • Old age and elevated D-dimer were independent predictors of in-hospital mortality. Interleukin-6 (IL-6) levels were not significantly different between groups.
  • Progressive cardiac injury showed synchronous alterations with D-dimer levels.

Conclusions:

  • Cardiac injury is a common complication of COVID-19 and an independent risk factor for in-hospital mortality.
  • Coagulation dysfunction, particularly elevated D-dimer, plays a significant role in the pathogenesis of cardiac injury in COVID-19, potentially involving microvascular injury.
  • Risk stratification for cardiac injury and mortality should consider age and coagulation parameters like D-dimer.

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