Clinical features and risk factors for ICU admission in COVID-19 patients with cardiovascular diseases

Abstract

Previous studies on coronavirus disease 2019 (COVID-19) have focused on the general population. However, cardiovascular disease (CVD) is a common comorbidity that has rarely been investigated in detail. This study aims to describe clinical characteristics and determine risk factors for intensive care unit (ICU) admission of COVID-19 patients with CVD. In this retrospective cohort study, we included 288 adult patients with COVID-19 in Guangzhou Eighth People's Hospital from January 15, 2020 to March 10, 2020. Demographic characteristics, laboratory results, radiographic findings, complications, and treatments were recorded and compared between CVD and non-CVD groups. A binary logistic regression model was used to identify risk factors associated with ICU admission for infected patients with underlying CVD. COVID-19 patients in the CVD group were older and had higher levels of troponin I (TnI), C-reactive protein (CRP), and creatinine. They were also more prone to develop into severe or critically severe cases, receive ICU admission, and require respiratory support treatment. Multivariate regression analysis showed that the following were risk factors for ICU admission in COVID-19 patients with CVD: each 1-year increase in age (odds ratio (OR), 1.08; 95% confidence interval (CI), 1.02-1.17; p = 0.018); respiratory rate over 24 times per min (OR, 25.52; 95% CI, 5.48-118.87; p < 0.0001); CRP higher than 10 mg/L (OR, 8.12; 95% CI, 1.63-40.49; p = 0.011); and TnI higher than 0.03 μg/L (OR, 9.14; 95% CI, 2.66-31.43; p < 0.0001). Older age, CRP greater than 10 mg/L, TnI higher than 0.03 μg/L, and respiratory rate over 24 times per minute were associated with increasing odds of ICU admission in COVID-19 patients with CVD. Investigating and monitoring these factors could assist in the risk stratification of COVID-19 patients with CVD at an early stage.

Keywords: COVID-19; cardiovascular disease; clinical features; intensive care unit; risk factors.

Figure 1.

Representative chest computed tomography (CT) images of COVID-19 pneumonia in a non-cardiovascular disease (CVD) case and a CVD case. Top panel: A 60-year-old man with COVID-19, but not CVD: chest CT images showed ground-glass opacity (GGO) and patchy consolidation with peripheral and subpleural distribution, which had been absorbed at 21 days after hospitalization with treatment. Bottom panel: A 65-year-old man with both COVID19 and CVD: chest CT images showed diffusely subpleural consolidation with a crazy-paving pattern. Diffuse shadowing and consolidation were seen on chest radiography after intensive care unit (ICU) admission with extracorporeal membrane oxygenation (ECMO) support at day 16.