Cardiac Injury and Death in COVID-19 Patients from Wuhan, China

New research published in JAMA Cardiology looked at the potential association of cardiac injury and mortality in a cohort of patients with coronavirus disease 2019 (COVID-19) from Wuhan, China.

“COVID-19 has resulted in considerable morbidity and mortality worldwide since December 2019,” the researchers wrote. “However, information on cardiac injury in patients affected by COVID-19 is limited.”

The authors included 416 consecutive patients presenting with lab-confirmed COVID-19 between January 20, 2020, and February 10, 2020, in Renmin Hospital at Wuhan University. The study data consisted of clinical lab, treatment, and radiological data. The median age of the patient population was 64 years (age range, 21 to 95 years), with 211 female patients (50.7%). Common COVID-19 symptoms included fever, cough, and shortness of breath.

Cardiac Injury and Increased Mortality

A total of 82 patients had cardiac injury. These patients tended to be older (median 74 years vs. 60 years in non-injury cohort), had more comorbidities, had higher leukocyte counts, higher C-reactive protein levels, procalcitonin, creatinine kinase–myocardial band, myohemoglobin, high-sensitivity troponin I, N-terminal pro-B-type natriuretic peptide, aspartate aminotransferase, and creatinine levels. They also had a higher proportion of multiple mottling and ground-glass opacity. More patients with cardiac injury required non-medical ventilation (18 of 82 [22.0%] vs. 14 of 334 [4.2%]; P<0.001) compared to those without injury. Complications such as acute respiratory distress syndrome, acute kidney injury, electrolyte disturbances, and coagulation disorders were more common in patients with myocardial injury than in those without.

Patients with cardiac injury also had higher rates of mortality compared with those without injury (42 of 82 [51.2%] vs. 15 of 334 [4.5%]; P<0.001), and a Cox regression model showed that patients with cardiac injury were at a higher risk for death both during symptom onset and from admission to endpoint.

“Cardiac injury is a common condition among hospitalized patients with COVID-19 in Wuhan, China, and it is associated with higher risk of in-hospital mortality,” the researchers concluded.