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High risk coronavirus disease 2019: The primary results of the CoronaHeart multi-center cohort study
Patrícia O Guimarães1,2, Francis R de Souza1, Renato D Lopes3
1Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Insights
COVID-19 patients with high-risk features face significant in-hospital death rates. Mortality varies by age and sex, with younger women and older men at higher risk, necessitating tailored surveillance strategies.
Area of Science:
- Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Patients hospitalized with Coronavirus Disease 2019 (COVID-19) often exhibit high-risk features, including cardiovascular complications.
- Limited understanding exists regarding factors that exacerbate mortality risk in this vulnerable patient group.
Purpose of the Study:
- To investigate factors associated with in-hospital mortality among COVID-19 patients with high-risk features.
- To identify demographic and clinical predictors of death in this population.
Main Methods:
- A multicenter cohort study in Brazil included 2546 COVID-19 patients with high-risk features.
- Data were collected on clinical and laboratory variables until hospital discharge or in-hospital death.
Main Results:
- The in-hospital mortality rate was 41.7%, with significant interactions between age and sex.
- Younger women and older men showed distinct mortality patterns.
- Mechanical ventilation, elevated C-reactive protein, cancer, and elevated troponin levels were strongly associated with mortality.
Conclusions:
- COVID-19 patients with high-risk features have a high mortality rate, influenced by age and sex.
- These findings underscore the need for targeted surveillance and early therapeutic interventions in specific patient subgroups.
Background:
Patients with Coronavirus Disease 2019 (COVID-19) may present high risk features during hospitalization, including cardiovascular manifestations. However, less is known about the factors that may further increase the risk of death in these patients.
Methods:
We included patients with COVID-19 and high risk features according to clinical and/or laboratory criteria at 21 sites in Brazil from June 10th to October 23rd of 2020. All variables were collected until hospital discharge or in-hospital death.
Results:
A total of 2546 participants were included (mean age 65 years; 60.3% male). Overall, 70.8% were admitted to intensive care units and 54.2% had elevated troponin levels. In-hospital mortality was 41.7%. An interaction among sex, age and mortality was found (p = 0.007). Younger women presented higher rates of death than men (30.0% vs 22.9%), while older men presented higher rates of death than women (57.6% vs 49.2%). The strongest factors associated with in-hospital mortality were need for mechanical ventilation (odds ratio [OR] 8.2, 95% confidence interval [CI] 5.4-12.7), elevated C-reactive protein (OR 2.3, 95% CI 1.7-2.9), cancer (OR 1.8, 95 %CI 1.2-2.9), and elevated troponin levels (OR 1.8, 95% CI 1.4-2.3). A risk score was developed for risk assessment of in-hospital mortality.
Conclusions:
This cohort showed that patients with COVID-19 and high risk features have an elevated rate of in-hospital mortality with differences according to age and sex. These results highlight unique aspects of this population and might help identifying patients who may benefit from more careful initial surveillance and potential subsequent interventional therapies.
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