Early Diagnosis and Clinical Significance of Acute Cardiac Injury - Under the Iceberg: A Retrospective Cohort Study of 619 Non-critically Ill Hospitalized COVID-19 Pneumonia Patients

  1. Yang Xie
  2. Sichun Chen
  3. Xueli Wang
  4. Baige Li
  5. Tianlu Zhang
  6. Xingwei He
  7. Ningling Sun
  8. Luyan Wang
  9. Hesong Zeng
  10. Yin Shen

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Abstract

Rationale

Coronavirus disease 2019 (COVID-19) can cause a viral pneumonia together with other extrapulmonary complications. Acute cardiac related injury (ACRI) is common in hospitalized COVID-19 patients.

Objective

To explain the pathological mechanism of ACRI and improve the treatment strategy by retrospectively observing the factors associated with ACRI and factors affecting the prognosis of ACRI with COVID-19 at an early stage.

Methods

619 COVID-19 patients were from Tongji Hospital, Wuhan. Student’s t test was used for continuous variables while Pearson χ 2 test for categorical factors. Univariable and multivariable logistic regression models were applied to estimate odds ratio (OR) with 95% confidence interval (CI).

Results

Among the 619 OOS Level-I hospitalized COVID-19 patients, 102 (16.5%) were defined as ACRI (stage-1: 59 cases, stage-2: 43 cases). 50% of ACRI patients developed into severe cases and 25 patients died(CFR=24.5%), 42 times that of non-ACRI patients. Elderly (OR=2.83, P <0.001), HTN (OR=2.09, P =0.005), γ-globulin (OR=2.08, P =0.004), TCM (OR=0.55, P =0.017), PLT (OR=2.94, P <0.001) and NLR (OR=2.20, P =0.004) were independently correlated with ACRI. SBP ⩾ 140, dyspnea, DM, smoking history were correlated with ACRI-stage2 only. In the prognostic subgroup analysis of ACRI patients, γ-globulin treatment could prolong LOS (29.0 ± 7.2 days Vs 23.5 ± 8.1 days, P =0.004). TCM (OR=0.26, P =0.006), SBP ⩾ 160 (OR= 22.70, P =0.005), male (OR=2.66, P =0.044) were associated with severe illness while corticosteroids treatment (OR=3.34, P =0.033) and male (OR=4.303, P =0.008) with death. Surprisingly, we found the mortality of non-elderly patients is higher than elderly (32.4% VS 20.0%, P =0.164), and both IKF and RASI treatment were not correlated with any prognostic indicators including severe, death and LOS.

Conclusion

This study observed that several non-traditional issues were associated with early cardiac injury in COVID-19 while many traditional cardiovascular risk factors were not. Besides elderly and male, hypertension was confirmed to be the most important risk factor.

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  1. ScreenIT

    SciScore for 10.1101/2020.07.06.20147256: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variableStudy definitions: ACRI was affirmed when cTnI level was >0.342 μg/L for males and >0.156 μg/L for females17 or NT-proBNP level was ⩾ 486 pg/mL.

    Table 2: Resources

    Antibodies
    SentencesResources
    Current diagnostic tests for COVID-19 include RT-PCR assay of nasal and pharyngeal swab specimens for nucleic acid, positive serology for anti-COVID-19 specific IgM and/or IgG antibodies.
    anti-COVID-19 specific IgM
    suggested: None
    IgG
    suggested: None
    Software and Algorithms
    SentencesResources
    All analyses were conducted using SAS 9.4 (SAS Institute Inc.
    SAS Institute
    suggested: (Statistical Analysis System, RRID:SCR_008567)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Limitations: This study has some limitations. First, due to the retrospective study design, not all laboratory tests were done in all patients, and the laboratory index testing for each patient was measured at different time. Second, due to special circumstances during the outbreak, arterial blood gas test, electrocardiography and echocardiography data were lacking for many cases, which limits the assessment of the extent of ACRI. Third, we did not monitor the dynamic change of blood pressure, which made this study lack of evidence of new onset hypertension to support our hypothesis. Last, it was a single-center study. The number of samples is not big enough and selection bias may exist, thus further prospective multi-centric clinical studies are warranted to further confirm the findings obtained in the present study.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2020.07.06.20147256v1 on medRxiv