RT Journal Article
SR Electronic
T1 Death, discharge and arrhythmias among patients with COVID-19 and cardiac injury
JF Canadian Medical Association Journal
JO CMAJ
FD Canadian Medical Association
SP E791
OP E798
DO 10.1503/cmaj.200879
VO 192
IS 28
A1 Daoyuan Si
A1 Beibei Du
A1 Lujia Ni
A1 Bo Yang
A1 Huan Sun
A1 Nan Jiang
A1 Guohui Liu
A1 Stéphane Massé
A1 Lina Jin
A1 Jared Nanthakumar
A1 Abhishek Bhaskaran
A1 Ping Yang
A1 Kumaraswamy Nanthakumar
YR 2020
UL http://www.cmaj.ca/content/192/28/E791.abstract
AB BACKGROUND: Cardiac injury is common in severe coronavirus disease 2019 (COVID-19) and is associated with poor outcomes. We aimed to study predictors of in-hospital death, characteristics of arrhythmias and the effects of QT-prolonging therapy in patients with cardiac injury.METHODS: We conducted a retrospective cohort study involving patients with severe COVID-19 who were admitted to Tongji Hospital in Wuhan, China, between Jan. 29 and Mar. 8, 2020. Among patients who had cardiac injury, which we defined as an elevated level of cardiac troponin I (cTnI), we identified demographic and clinical characteristics associated with mortality and need for invasive ventilation.RESULTS: Among 1284 patients with severe COVID-19, 1159 had a cTnI level measured on admission to hospital, of whom 170 (14.7%) had results that showed cardiac injury. We found that mortality was markedly higher in patients with cardiac injury (71.2% v. 6.6%, p < 0.001). We determined that initial cTnI (per 10-fold increase, hazard ratio [HR] 1.32, 95% confidence interval [CI] 1.06–1.66) and peak cTnI level during illness (per 10-fold increase, HR 1.70, 95% CI 1.38–2.10) were associated with poor survival. Peak cTnI was also associated with the need for invasive ventilation (odds ratio 3.02, 95% CI 1.92–4.98). We found arrhythmias in 44 of the 170 patients with cardiac injury (25.9%), including 6 patients with ventricular tachycardia or fibrillation, all of whom died. We determined that patients who received QT-prolonging drugs had longer QTc intervals than those who did not receive them (difference in medians, 45 ms, p = 0.01), but such treatment was not independently associated with mortality (HR 1.04, 95% CI 0.69–1.57).INTERPRETATION: We found that in patients with COVID-19 and cardiac injury, initial and peak cTnI levels were associated with poor survival, and peak cTnI was a predictor of need for invasive ventilation. Patients with COVID-19 warrant assessment for cardiac injury and monitoring, especially if therapy that can prolong repolarization is started.Trial registration: Chinese Clinical Trial Registry, No. ChiCTR2000031301.See related article at www.cmaj.ca/lookup/doi/10.1503/cmaj.201230