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In-hospital cardiovascular outcomes of COVID-19-associated cytokine storm: a population-level study
Rajveer Sagoo1,2, Navraj S Sagoo1,3, Paul Murdock1
1Sathyamoorthy Lab, Department of Internal Medicine, Burnett School of Medicine at Texas, Christian University, Fort Worth, TX, United States.
Insights
Severe COVID-19 cytokine storm (CS) significantly increases mortality and cardiac arrest risk in hospitalized patients. Advanced CS severity correlates with higher mortality and longer hospital stays, highlighting its critical cardiovascular impact.
Area of Science:
- Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Severe COVID-19 is associated with a hyperinflammatory "Cytokine Storm" (CS).
- Limited large-scale data exist on the cardiovascular impacts of CS in COVID-19 patients.
- Understanding CS severity's influence on cardiovascular outcomes is crucial.
Purpose of the Study:
- To assess the influence of Cytokine Storm (CS) severity on in-hospital cardiovascular outcomes and mortality in COVID-19 patients.
- To analyze the association between different grades of CS and specific cardiovascular complications.
- To evaluate the impact of CS severity on hospital length of stay and cost.
Main Methods:
- Retrospective analysis of the 2021 National Inpatient Sample (NIS) database.
- Inclusion of adult patients (≥18 years) hospitalized with COVID-19 (ICD-10: U07.1).
- Identification and grading of CS (ICD-10: D89.83) into four severity levels; multivariable logistic regression used for outcome assessment.
Main Results:
- A weighted cohort of 1,428,892 COVID-19 patients revealed 1.1% had CS.
- Mortality increased significantly with CS grade, rising from 8.3% in non-CS to 26.9% in grade 4 (aOR 3.334).
- Cardiac arrest (aOR 1.742) and venous thromboembolism (aOR 1.739) also increased with CS severity, while myocardial infarction and arrhythmias showed nuanced patterns. Grade 4 CS patients had longer stays and higher costs.
Conclusions:
- Advanced Cytokine Storm (CS) severity is associated with increased mortality and specific cardiovascular complications in hospitalized COVID-19 patients.
- Nuanced patterns observed in arrhythmias and heart failure underscore the complex interplay between hyperinflammation and cardiac pathophysiology.
- Findings emphasize the need for targeted cardiovascular monitoring and management in severe COVID-19 with CS.
Background:
In severe COVID-19, hyperinflammatory "Cytokine Storm" (CS) can escalate disease severity, yet large-scale data on its cardiovascular impacts remain limited.
Objective:
To assess the influence of CS severity on in-hospital cardiovascular outcomes and mortality in COVID-19 patients.
Methods:
A retrospective analysis of the 2021 National Inpatient Sample (NIS) was performed, including adults (≥18 years) hospitalized with a principal COVID-19 diagnosis (ICD-10: U07.1), while excluding other hyperinflammatory conditions. CS was identified and categorized into four severity grades (ICD-10: D89.83). Multivariable logistic regression was utilized to assess associations between CS severity and in-hospital outcomes.
Results:
In a weighted cohort of 1,428,892 hospitalized adults with COVID-19, 15,290 (1.1%) had CS. Mortality rose from 8.3% in non-CS patients to 26.9% in grade 4 (adjusted odds ratio [aOR] 3.334; 95% CI [2.810-3.956]), accompanied by increases in cardiac arrest (1.7%-4.4%; aOR 1.742; [1.234-2.459]) and venous thromboembolism (4.8%-9.4%; aOR 1.739; [1.369-2.210]) (p all < 0.05). Myocardial Infarction (non-CS: 3.3% vs. Grade 4: 3.1%) and Cardiac Arrhythmias (non-CS: 14.4% vs. grade 4: 14.4%) remained similar across groups but showed decreased adjusted odds in grade 2 (aOR 0.328 [0.221-0.488]; aOR 0.738 [0.641-0.850]) (p all < 0.05). Heart failure incidence declined with advancing CS grade (non-CS: 13.5% vs. grade 4: 12.5%), with grades 1 and 2 showing reduced odds (aOR 0.651; [0.475-0.892]), (aOR 0.702; [0.584-0.845]) (p all < 0.05). Cardiogenic shock, Ischemic CVA, and Transient Ischemic attack were infrequent and excluded from graded analyses. Compared with non-CS patients, those with grade 4 had a longer median length of stay (5 days vs. 11 days) and higher median total cost (US $44,363 vs. US $142,280) (p all < 0.05).
Conclusion:
Within this cohort, advanced CS demonstrated an association with increased mortality and select cardiovascular complications in hospitalized COVID-19 patients; Moreover, certain events, such as arrhythmias and heart failure, showed nuanced patterns, underscoring the complex interplay between hyperinflammation and cardiac pathophysiology.
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