Myocardial injury and risk factors for mortality in patients with COVID-19 pneumonia

Abstract

Background: Coronavirus disease 2019 (COVID-19) pneumonia tends to affect cardiovascular system and cause cardiovascular damage. This study aimed to explore the prevalence of myocardial injury and risk factors for mortality in patients with COVID-19 pneumonia.

Method: Two hundred and twenty-four consecutive patients with confirmed diagnosis of SARS-CoV-2 infection and definite outcomes (discharge or death) were retrospectively analyzed. Laboratory results including myocardial biomarkers, oxygen saturation, inflammatory indicators and coagulation function were compared between survivors and non-survivors. Univariate and multivariate logistic regression model were used to explore risk factors for in-hospital mortality, and a chart with different combinations of risk factors was constructed to predict mortality.

Results: Two hundred and three patients were included in the final analysis, consisting of 145 patients who recovered and 58 patients who died. Compared with survivors, non-survivors were older, with more comorbidities, more severe inflammation and active coagulation function, higher levels of myocardial biomarkers and lower SaO₂. 28 (50%) non-survivors and 9 (6%) survivors developed myocardial injury, which was associated with disease severity at admission. Elevated d-dimer (OR = 9.51, 95% CI [3.61-25.0], P < 0.001), creatinine kinase-myocardial band (OR = 6.93, 95% CI [1.83-26.2], P = 0.004), Troponin I (OR = 10.1, 95% CI [3.1-32.8], P < 0.001) and C-reactive protein (OR = 15.1, 95% CI [1.7-129.3], P = 0.013) were risk factors for mortality. Patients with abnormal levels of d-dimer, Troponin I and CRP were predicted to have significantly higher probability of death.

Conclusions: Our results suggest that SARS-CoV-2 infection may induce myocardial injury and consequently exacerbate the clinical course and worsen prognosis. Abnormal d-dimer, CK-MB, Troponin I and CRP are risk factors for short-term mortality.

Keywords: Biomarkers; Coronavirus disease 2019; Mortality; Myocardial injury; Pneumonia.

Fig. 1

Flowchart of patients admitted with confirmed COVID-19 and with definite outcomes from January 10 to February 29, 2020 and selection of study cohort.

Fig. 2

Percentage of patients with abnormal laboratory results between survivors and non-survivors.

Fig. 3

Temporal change of myocardial biomarkers between survivors and non-survivors. The solid line in orange represents the upper limit of the reference range. (A) N-terminal pro-B-type natriuretic peptide; (B) Lactate dehydrogenase; (C) Creatine kinase; (D) Creatine kinase-myocardial band; (E) Myoglobin; (F) Troponin I; (G) C-reactive protein; (H) D-dimer.