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Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China.
JAMA Cardiol. 2020 07 01; 5(7):802-810.JC

Abstract

Importance

Coronavirus disease 2019 (COVID-19) has resulted in considerable morbidity and mortality worldwide since December 2019. However, information on cardiac injury in patients affected by COVID-19 is limited.

Objective

To explore the association between cardiac injury and mortality in patients with COVID-19.

Design, Setting, and Participants

This cohort study was conducted from January 20, 2020, to February 10, 2020, in a single center at Renmin Hospital of Wuhan University, Wuhan, China; the final date of follow-up was February 15, 2020. All consecutive inpatients with laboratory-confirmed COVID-19 were included in this study.

Main Outcomes and Measures

Clinical laboratory, radiological, and treatment data were collected and analyzed. Outcomes of patients with and without cardiac injury were compared. The association between cardiac injury and mortality was analyzed.

Results

A total of 416 hospitalized patients with COVID-19 were included in the final analysis; the median age was 64 years (range, 21-95 years), and 211 (50.7%) were female. Common symptoms included fever (334 patients [80.3%]), cough (144 [34.6%]), and shortness of breath (117 [28.1%]). A total of 82 patients (19.7%) had cardiac injury, and compared with patients without cardiac injury, these patients were older (median [range] age, 74 [34-95] vs 60 [21-90] years; P < .001); had more comorbidities (eg, hypertension in 49 of 82 [59.8%] vs 78 of 334 [23.4%]; P < .001); had higher leukocyte counts (median [interquartile range (IQR)], 9400 [6900-13 800] vs 5500 [4200-7400] cells/μL) and levels of C-reactive protein (median [IQR], 10.2 [6.4-17.0] vs 3.7 [1.0-7.3] mg/dL), procalcitonin (median [IQR], 0.27 [0.10-1.22] vs 0.06 [0.03-0.10] ng/mL), creatinine kinase-myocardial band (median [IQR], 3.2 [1.8-6.2] vs 0.9 [0.6-1.3] ng/mL), myohemoglobin (median [IQR], 128 [68-305] vs 39 [27-65] μg/L), high-sensitivity troponin I (median [IQR], 0.19 [0.08-1.12] vs <0.006 [<0.006-0.009] μg/L), N-terminal pro-B-type natriuretic peptide (median [IQR], 1689 [698-3327] vs 139 [51-335] pg/mL), aspartate aminotransferase (median [IQR], 40 [27-60] vs 29 [21-40] U/L), and creatinine (median [IQR], 1.15 [0.72-1.92] vs 0.64 [0.54-0.78] mg/dL); and had a higher proportion of multiple mottling and ground-glass opacity in radiographic findings (53 of 82 patients [64.6%] vs 15 of 334 patients [4.5%]). Greater proportions of patients with cardiac injury required noninvasive mechanical ventilation (38 of 82 [46.3%] vs 13 of 334 [3.9%]; P < .001) or invasive mechanical ventilation (18 of 82 [22.0%] vs 14 of 334 [4.2%]; P < .001) than those without cardiac injury. Complications were more common in patients with cardiac injury than those without cardiac injury and included acute respiratory distress syndrome (48 of 82 [58.5%] vs 49 of 334 [14.7%]; P < .001), acute kidney injury (7 of 82 [8.5%] vs 1 of 334 [0.3%]; P < .001), electrolyte disturbances (13 of 82 [15.9%] vs 17 of 334 [5.1%]; P = .003), hypoproteinemia (11 of 82 [13.4%] vs 16 of 334 [4.8%]; P = .01), and coagulation disorders (6 of 82 [7.3%] vs 6 of 334 [1.8%]; P = .02). Patients with cardiac injury had higher mortality than those without cardiac injury (42 of 82 [51.2%] vs 15 of 334 [4.5%]; P < .001). In a Cox regression model, patients with vs those without cardiac injury were at a higher risk of death, both during the time from symptom onset (hazard ratio, 4.26 [95% CI, 1.92-9.49]) and from admission to end point (hazard ratio, 3.41 [95% CI, 1.62-7.16]).

Conclusions and Relevance

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.

Authors+Show Affiliations

Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China. Cardiovascular Research Institute, Wuhan University, Wuhan, China. Hubei Key Laboratory of Cardiology, Wuhan University, Wuhan, China.Shanghai Chest Hospital, Department of Cardiology, Shanghai Jiaotong University, Shanghai, China.Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China. Cardiovascular Research Institute, Wuhan University, Wuhan, China. Hubei Key Laboratory of Cardiology, Wuhan University, Wuhan, China.Department of Endocrinology, Renmin Hospital of Wuhan University, Wuhan, China.Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China. Cardiovascular Research Institute, Wuhan University, Wuhan, China. Hubei Key Laboratory of Cardiology, Wuhan University, Wuhan, China.Department of Infectious Diseases, Renmin Hospital of Wuhan University, Wuhan, China.Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China.Shanghai Chest Hospital, Department of Cardiology, Shanghai Jiaotong University, Shanghai, China.Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China. Cardiovascular Research Institute, Wuhan University, Wuhan, China. Hubei Key Laboratory of Cardiology, Wuhan University, Wuhan, China.Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China. Cardiovascular Research Institute, Wuhan University, Wuhan, China. Hubei Key Laboratory of Cardiology, Wuhan University, Wuhan, China.Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China. Cardiovascular Research Institute, Wuhan University, Wuhan, China. Hubei Key Laboratory of Cardiology, Wuhan University, Wuhan, China.Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China. Cardiovascular Research Institute, Wuhan University, Wuhan, China. Hubei Key Laboratory of Cardiology, Wuhan University, Wuhan, China.Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China. Cardiovascular Research Institute, Wuhan University, Wuhan, China. Hubei Key Laboratory of Cardiology, Wuhan University, Wuhan, China.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

32211816

Citation

Shi, Shaobo, et al. "Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China." JAMA Cardiology, vol. 5, no. 7, 2020, pp. 802-810.
Shi S, Qin M, Shen B, et al. Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China. JAMA Cardiol. 2020;5(7):802-810.
Shi, S., Qin, M., Shen, B., Cai, Y., Liu, T., Yang, F., Gong, W., Liu, X., Liang, J., Zhao, Q., Huang, H., Yang, B., & Huang, C. (2020). Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China. JAMA Cardiology, 5(7), 802-810. https://doi.org/10.1001/jamacardio.2020.0950
Shi S, et al. Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China. JAMA Cardiol. 2020 07 1;5(7):802-810. PubMed PMID: 32211816.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China. AU - Shi,Shaobo, AU - Qin,Mu, AU - Shen,Bo, AU - Cai,Yuli, AU - Liu,Tao, AU - Yang,Fan, AU - Gong,Wei, AU - Liu,Xu, AU - Liang,Jinjun, AU - Zhao,Qinyan, AU - Huang,He, AU - Yang,Bo, AU - Huang,Congxin, PY - 2020/3/27/pubmed PY - 2020/10/2/medline PY - 2020/3/27/entrez SP - 802 EP - 810 JF - JAMA cardiology JO - JAMA Cardiol VL - 5 IS - 7 N2 - Importance: Coronavirus disease 2019 (COVID-19) has resulted in considerable morbidity and mortality worldwide since December 2019. However, information on cardiac injury in patients affected by COVID-19 is limited. Objective: To explore the association between cardiac injury and mortality in patients with COVID-19. Design, Setting, and Participants: This cohort study was conducted from January 20, 2020, to February 10, 2020, in a single center at Renmin Hospital of Wuhan University, Wuhan, China; the final date of follow-up was February 15, 2020. All consecutive inpatients with laboratory-confirmed COVID-19 were included in this study. Main Outcomes and Measures: Clinical laboratory, radiological, and treatment data were collected and analyzed. Outcomes of patients with and without cardiac injury were compared. The association between cardiac injury and mortality was analyzed. Results: A total of 416 hospitalized patients with COVID-19 were included in the final analysis; the median age was 64 years (range, 21-95 years), and 211 (50.7%) were female. Common symptoms included fever (334 patients [80.3%]), cough (144 [34.6%]), and shortness of breath (117 [28.1%]). A total of 82 patients (19.7%) had cardiac injury, and compared with patients without cardiac injury, these patients were older (median [range] age, 74 [34-95] vs 60 [21-90] years; P < .001); had more comorbidities (eg, hypertension in 49 of 82 [59.8%] vs 78 of 334 [23.4%]; P < .001); had higher leukocyte counts (median [interquartile range (IQR)], 9400 [6900-13 800] vs 5500 [4200-7400] cells/μL) and levels of C-reactive protein (median [IQR], 10.2 [6.4-17.0] vs 3.7 [1.0-7.3] mg/dL), procalcitonin (median [IQR], 0.27 [0.10-1.22] vs 0.06 [0.03-0.10] ng/mL), creatinine kinase-myocardial band (median [IQR], 3.2 [1.8-6.2] vs 0.9 [0.6-1.3] ng/mL), myohemoglobin (median [IQR], 128 [68-305] vs 39 [27-65] μg/L), high-sensitivity troponin I (median [IQR], 0.19 [0.08-1.12] vs <0.006 [<0.006-0.009] μg/L), N-terminal pro-B-type natriuretic peptide (median [IQR], 1689 [698-3327] vs 139 [51-335] pg/mL), aspartate aminotransferase (median [IQR], 40 [27-60] vs 29 [21-40] U/L), and creatinine (median [IQR], 1.15 [0.72-1.92] vs 0.64 [0.54-0.78] mg/dL); and had a higher proportion of multiple mottling and ground-glass opacity in radiographic findings (53 of 82 patients [64.6%] vs 15 of 334 patients [4.5%]). Greater proportions of patients with cardiac injury required noninvasive mechanical ventilation (38 of 82 [46.3%] vs 13 of 334 [3.9%]; P < .001) or invasive mechanical ventilation (18 of 82 [22.0%] vs 14 of 334 [4.2%]; P < .001) than those without cardiac injury. Complications were more common in patients with cardiac injury than those without cardiac injury and included acute respiratory distress syndrome (48 of 82 [58.5%] vs 49 of 334 [14.7%]; P < .001), acute kidney injury (7 of 82 [8.5%] vs 1 of 334 [0.3%]; P < .001), electrolyte disturbances (13 of 82 [15.9%] vs 17 of 334 [5.1%]; P = .003), hypoproteinemia (11 of 82 [13.4%] vs 16 of 334 [4.8%]; P = .01), and coagulation disorders (6 of 82 [7.3%] vs 6 of 334 [1.8%]; P = .02). Patients with cardiac injury had higher mortality than those without cardiac injury (42 of 82 [51.2%] vs 15 of 334 [4.5%]; P < .001). In a Cox regression model, patients with vs those without cardiac injury were at a higher risk of death, both during the time from symptom onset (hazard ratio, 4.26 [95% CI, 1.92-9.49]) and from admission to end point (hazard ratio, 3.41 [95% CI, 1.62-7.16]). Conclusions and Relevance: 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. SN - 2380-6591 UR - https://www.unboundmedicine.com/medline/citation/32211816/Association_of_Cardiac_Injury_With_Mortality_in_Hospitalized_Patients_With_COVID_19_in_Wuhan_China_ L2 - https://jamanetwork.com/journals/jamacardiology/fullarticle/10.1001/jamacardio.2020.0950 DB - PRIME DP - Unbound Medicine ER -