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Early vs. Late Onset Cardiac Injury and Mortality in Hospitalized COVID-19 Patients in Wuhan
Wei Sun1,2,3, Yanting Zhang1,2,3, Chun Wu1,2,3
1Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Insights
Cardiac injury (CI) in COVID-19 patients can occur early or late after admission, increasing the risk of Acute-Respiratory-Distress-Syndrome (ARDS) and in-hospital death. Recurrent or late CI indicates worse outcomes than early CI alone.
Area of Science:
- Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Cardiac injury (CI) is a recognized complication of coronavirus disease 2019 (COVID-19).
- The temporal characteristics and prognostic implications of early versus late CI in COVID-19 patients remain unclear.
Purpose of the Study:
- To investigate the occurrence, characteristics, and association with mortality of early (within 72 hours) and late (after 72 hours) cardiac injury in COVID-19 patients.
- To compare outcomes between patients with early CI, late CI, and no CI.
Main Methods:
- Retrospective analysis of 196 COVID-19 patients admitted to Union Hospital, Wuhan, China.
- Categorization of patients into early CI, late CI, and no CI groups.
- Monitoring of clinical outcomes, including in-hospital mortality, until April 15, 2020.
Main Results:
- 25.0% of patients experienced early CI, and 10.2% experienced late CI.
- Patients with any CI had higher rates of Acute-Respiratory-Distress-Syndrome (ARDS) (87.0% vs. 40.2%) and in-hospital mortality (52.2% vs. 5.5%) compared to those without CI.
- Both late CI (adjusted OR = 5.019) and recurrent early CI (adjusted OR = 7.184) were associated with significantly higher in-hospital mortality compared to early CI without recurrence.
Conclusions:
- Cardiac injury in COVID-19 can manifest early or late post-admission and is linked to ARDS and increased mortality.
- Late CI and recurrent CI portend worse prognoses than isolated early CI.
- Continuous monitoring of cardiac biomarkers is crucial, particularly for patients with early CI or those at risk of clinical deterioration.
Abstract:
Background: Increasing evidence points to cardiac injury (CI) as a common coronavirus disease 2019 (COVID-19) related complication. The characteristics of early CI (occurred within 72 h of admission) and late CI (occurred after 72 h of admission) and its association with mortality in COVID-19 patients is unknown. Methods: This retrospective study analyzed patients confirmed with COVID-19 in Union Hospital (Wuhan, China) from Jan 29th to Mar 15th, 2020. Clinical outcomes (discharge, or death) were monitored to April 15, 2020, the latest date of follow-up. Demographic, clinical, laboratory, as well as treatment and prognosis were collected and analyzed in patients with early, late CI and without CI. Results: A total of 196 COVID-19 patients were included for analysis. The median age was 65 years [interquartile range (IQR) 56-73 years], and 112 (57.1%) were male. Of the 196 COVID-19 patients, 49 (25.0%) patients had early and 20 (10.2%) patients had late CI, 56.6% developed Acute-Respiratory-Distress-Syndrome (ARDS) and 43 (21.9%) patients died. Patients with any CI were more likely to have developed ARDS (87.0 vs. 40.2%) and had a higher in-hospital mortality than those without (52.2 vs. 5.5%, P < 0.001). Among CI subtypes, a significantly higher risk of in-hospital death was found in patients with early CI with recurrence [19/49 patients, adjusted odds ratio (OR) = 7.184, 95% CI 1.472-35.071] and patients with late CI (adjusted OR = 5.019, 95% CI 1.125-22.388) compared to patients with early CI but no recurrence. Conclusions: CI can occur early on or late after, the initial 72 h of admission and is associated with ARDS and an increased risk of in-hospital mortality. Both late CI and recurrent CI after the initial episode were associated with worse outcomes than patients with early CI alone. This study highlights the importance of early examination and periodical monitoring of cardiac biomarkers, especially for patients with early CI or at risk of clinical deterioration.
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