Bader Mahmoud W, Alaa Adeen Abdulqader M, Hetta Omar E, Aloufi Alwaleed K, Fallata Muhannad H, Alsiraihi Abdulaziz A, Ahmed Mohamed E, Kinsara Abdulhalim J
College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU.
College of Sciences & Health Professions, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU.
Cureus. 2023 Jul 7;15(7):e41527. doi: 10.7759/cureus.41527. eCollection 2023 Jul.
Background The effects of coronavirus disease 2019 (COVID-19) on the cardiovascular system are well established. However, knowledge gaps in the clinical implications of cardiac involvement in COVID-19 patients are yet to be addressed. This study aimed to investigate acute cardiac injury (ACI) risk factors and outcomes associated with COVID-19 infection with cardiac involvement. Methodology In this retrospective study, we included hospitalized patients between March 2020 and May 2022 with confirmed COVID-19 infection and evidence of cardiac involvement. Results In total, 501 patients were included, of whom 396 (79%) had evidence of ACI. The median troponin level was 25.8 (interquartile range (IQR) = 10.8-71). Patients with evidence of ACI were significantly more likely to have diabetes mellitus (75% vs. 60%), cardiovascular disease (48% vs. 37%), chronic lung disease (22.2% vs. 12.4%), and chronic kidney disease (32.3% vs. 16.2%). Additionally, patients with ACI were significantly more likely to have cardiomegaly (60.6% vs. 44.8%) and bilateral lobe infiltrates (77.8% vs. 60%) on X-ray. Patients with ACI were significantly more likely to suffer from complications such as cardiogenic shock (5.3% vs. 0%), pneumonia (80.1% vs. 65.7%), sepsis (24.2% vs. 9.5%), and acute respiratory distress syndrome (33.1% vs. 8.6%). Patients with ACI were also significantly more likely to be admitted to the intensive care unit (ICU) (57% vs. 26.7%) and significantly more likely to die (38.1% vs. 11.4%). The results of the multivariate regression analysis indicated that mortality was significantly higher in patients with elevated troponin levels (adjusted odds ratio = 4.73; 95% confidence interval = 2.49-8.98). Conclusions In COVID-19-infected patients, old age, diabetes mellitus, cardiovascular disease, chronic lung disease, and chronic kidney disease were associated with an increased risk of ACI. The presence of ACI in the context of COVID-19 infection was noted to increase the risk for severe complications, such as cardiogenic shock, ICU admission, sepsis, and death.
2019冠状病毒病（COVID-19）对心血管系统的影响已得到充分证实。然而，COVID-19患者心脏受累的临床意义方面的知识空白仍有待填补。本研究旨在调查合并心脏受累的COVID-19感染患者的急性心脏损伤（ACI）危险因素及预后情况。
在这项回顾性研究中，我们纳入了2020年3月至2022年5月期间确诊为COVID-19感染且有心脏受累证据的住院患者。
共纳入501例患者，其中396例（79%）有ACI证据。肌钙蛋白水平中位数为25.8（四分位间距（IQR）=10.8 - 71）。有ACI证据的患者患糖尿病（75%对60%）、心血管疾病（48%对37%）、慢性肺病（22.2%对12.4%）和慢性肾病（32.3%对16.2%）的可能性显著更高。此外，有ACI的患者X线检查显示心脏扩大（60.6%对44.8%）和双侧肺叶浸润（77.8%对60%）的可能性显著更高。有ACI的患者发生心源性休克（5.3%对0%）、肺炎（80.1%对65.7%）、脓毒症（24.2%对9.5%）和急性呼吸窘迫综合征（33.1%对8.6%）等并发症的可能性显著更高。有ACI的患者入住重症监护病房（ICU）的可能性也显著更高（57%对26.7%），死亡可能性也显著更高（38.1%对11.4%）。多因素回归分析结果表明，肌钙蛋白水平升高的患者死亡率显著更高（调整后的优势比=4.73；95%置信区间=2.49 - 8.98）。
在COVID-19感染患者中，老年、糖尿病、心血管疾病、慢性肺病和慢性肾病与ACI风险增加相关。在COVID-19感染背景下存在ACI会增加发生心源性休克、入住ICU、脓毒症和死亡等严重并发症的风险。
