Cardiac injury seen in a fifth of patients hospitalized with COVID-19 in Wuhan

  • JAMA Cardiol

  • Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • In this cohort of 416 patients hospitalized with COVID-19 in Wuhan, China, 1 in 5 had cardiac injury during hospitalization.
  • Those with cardiac injury had increased risk for in-hospital mortality.

Why this matters

  • Findings add to the unfolding story of cardiac injury in COVID-19.

Key results

  • 82 of 416 (19.7%) had cardiac injury.
  • They were older (median, 74 [range, 34-95] years vs 60 [21-90] years without cardiac injury [P<.001 and had comorbidities copd hypertension heart failure>
  • Their laboratory values (medians, interquartile ranges) were higher:
    • White blood cell counts: 9400 (6900-13,800) vs 5500 (4200-7400) cells/μL.
    • C-reactive protein: 10.2 (6.4-17.0) vs 3.7 (1.0-7.3) mg/dL.
    • Myohemoglobin: 128 (68-305) vs 39 (27-65) μg/L.
    • High-sensitivity troponin I: 0.19 (0.08-1.12) vs
    • N-terminal pro-B-type natriuretic peptide: 1689 (698-3327) vs 139 (51-335) pg/mL.
  • Imaging showed higher rates of ground-glass opacities: 64.6% vs 4.5%.
  • More patients with cardiac injury required mechanical ventilation:
    • Noninvasive: 46.3% vs 3.9% (P<.001>
    • Invasive: 22.0% vs 4.2% (P<.001>
  • They also more commonly had coagulation disorders: 7.3% vs 1.8% (P=.02).
  • Mortality risk was higher with cardiac injury:
    • From symptom onset: HR, 4.26 (95% CI, 1.92-9.49).
    • From admission to endpoint: HR, 3.41 (95% CI, 1.62-7.16).
  • In 14 with cardiac injury who had ECG during elevated biomarker period, all were abnormal.

Study design

  • Consecutive inpatient inclusion, January 20-February 10, 2020.
  • Funding: Nature Science Foundation of China; others.

Limitations

  • Some missing data.
  • Clinical observation ongoing in some cases.