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Cardiovascular drugs and analysis of potential risk factors associated with mortality in severe coronavirus disease
Rukiye Derin Atabey1, Nesim Aladağ2, Abdulcebbar Şipal3
1University of Health Sciences, Van Training and Research Hospital, Department of Cardiovascular Surgery - Van, Turkey.
Insights
Severe COVID-19 patients with chronic renal failure, high ferritin, and need for mechanical ventilation face higher mortality risk. Preexisting cardiovascular disease and related medications did not significantly impact survival in the ICU.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Cardiology
Background:
- Cardiovascular diseases are linked to increased COVID-19 mortality risk.
- Real-world data on mortality risk factors in severe COVID-19 patients remain limited.
- Identifying these factors is crucial for patient management.
Purpose of the Study:
- To identify potential risk factors for mortality in severe COVID-19 patients admitted to the ICU.
- To investigate the role of cardiovascular diseases and medications in severe COVID-19 outcomes.
Main Methods:
- Analysis of consecutive severe COVID-19 pneumonia patients admitted to ICU.
- Comparison of patient characteristics, medical history, comorbidities, and lab results between survivors and nonsurvivors.
- Inclusion of data on medication use and clinical interventions like intubation.
Main Results:
- No significant difference in age, gender, or pre-existing cardiovascular diseases between survivors and nonsurvivors.
- Similar rates of angiotensin-converting enzyme (ACE) inhibitor and angiotensin receptor blocker use.
- Nonsurvivors showed higher peak C-reactive protein (CRP), procalcitonin, fibrinogen, d-dimer levels, and chronic renal failure rates.
- Intubated patients had a higher risk of death.
Conclusions:
- Pre-existing cardiovascular diseases and related medications were not significant predictors of mortality in severe ICU COVID-19 patients.
- Chronic renal failure, high peak ferritin, and invasive mechanical ventilation are significant predictors of mortality.
- These identified risk factors should inform risk stratification for severe COVID-19 patients in the ICU.
Objectives:
Cardiovascular diseases are also considered to increase the risk of death in COVID-19 patients. However, real-world data concerning the risk factors for death in patients with severe COVID-19 still remain vague. This study aimed to identify the potential risk factors associated with mortality in severe COVID-19 patients.
Methods:
All consecutive patients admitted to the intensive care unit (ICU) of our institute for COVID-19 for severe COVID-19 pneumonia from April 1, 2020 to July 20, 2020 were included in the analysis. Patient characteristics, including complete medical history and comorbid diseases, blood test results during admission and on day 7, and clinical characteristics were compared between survivors and nonsurvivors.
Results:
There was no significant difference between survivors and nonsurvivors regarding age, gender, and preexisting cardiovascular diseases. Moreover, the rate of the medications including angiotensin-converting enzyme (ACE) inhibitor and angiotensin receptor blockers did not differ between survivors and nonsurvivors. The peak C-reactive protein (CRP), procalcitonin, fibrinogen, and d-dimer levels and the rate for chronic renal failure were significantly higher in nonsurvivors compared with survivors. Intubated patients had a higher risk of death than the others had.
Conclusions:
This study failed to demonstrate a significant difference in preexisting cardiovascular diseases and cardiovascular medications between survivors and nonsurvivors who were admitted to ICU for severe COVID-19. Our findings indicate that the presence of chronic renal failure, a high peak ferritin concentration, and the need for invasive mechanical ventilation appear predictive for mortality. We propose that these risk factors should be taken into account in defining the risk status of severe COVID-19 patients admitted to the ICU.
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