Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China
Authors: Shaobo Shi, Mu Qin, Bo Shen, Yuli Cai, Tao Liu, Fan Yang, Wei Gong, Xu Liu, Jinjun Liang, Qinyan Zhao, He Huang, Bo Yang, Congxin Huang
Journal: JAMA Cardiology (2020)

<h3>Importance</h3> Coronavirus disease 2019 (COVID-19) has resulted in considerable morbidity and mortality worldwide since December 2019. However, information on cardiac injury in patients affected by COVID-19 is limited. <h3>Objective</h3> To explore the association between cardiac injury and mortality in patients with COVID-19. <h3>Design, Setting, and Participants</h3> This cohort study was conducted from January 20, 2020, to February 10, 2020, in a single center at Renmin Hospital of Wuhan University, Wuhan, China; the final date of follow-up was February 15, 2020. All consecutive inpatients with laboratory-confirmed COVID-19 were included in this study. <h3>Main Outcomes and Measures</h3> Clinical laboratory, radiological, and treatment data were collected and analyzed. Outcomes of patients with and without cardiac injury were compared. The association between cardiac injury and mortality was analyzed. <h3>Results</h3> A total of 416 hospitalized patients with COVID-19 were included in the final analysis; the median age was 64 years (range, 21-95 years), and 211 (50.7%) were female. Common symptoms included fever (334 patients [80.3%]), cough (144 [34.6%]), and shortness of breath (117 [28.1%]). A total of 82 patients (19.7%) had cardiac injury, and compared with patients without cardiac injury, these patients were older (median [range] age, 74 [34-95] vs 60 [21-90] years;<i>P</i> &lt; .001); had more comorbidities (eg, hypertension in 49 of 82 [59.8%] vs 78 of 334 [23.4%];<i>P</i> &lt; .001); had higher leukocyte counts (median [interquartile range (IQR)], 9400 [6900-13 800] vs 5500 [4200-7400] cells/μL) and levels of C-reactive protein (median [IQR], 10.2 [6.4-17.0] vs 3.7 [1.0-7.3] mg/dL), procalcitonin (median [IQR], 0.27 [0.10-1.22] vs 0.06 [0.03-0.10] ng/mL), creatinine kinase–myocardial band (median [IQR], 3.2 [1.8-6.2] vs 0.9 [0.6-1.3] ng/mL), myohemoglobin (median [IQR], 128 [68-305] vs 39 [27-65] μg/L), high-sensitivity troponin I (median [IQR], 0.19 [0.08-1.12] vs &lt;0.006 [&lt;0.006-0.009] μg/L), N-terminal pro-B-type natriuretic peptide (median [IQR], 1689 [698-3327] vs 139 [51-335] pg/mL), aspartate aminotransferase (median [IQR], 40 [27-60] vs 29 [21-40] U/L), and creatinine (median [IQR], 1.15 [0.72-1.92] vs 0.64 [0.54-0.78] mg/dL); and had a higher proportion of multiple mottling and ground-glass opacity in radiographic findings (53 of 82 patients [64.6%] vs 15 of 334 patients [4.5%]). Greater proportions of patients with cardiac injury required noninvasive mechanical ventilation (38 of 82 [46.3%] vs 13 of 334 [3.9%];<i>P</i> &lt; .001) or invasive mechanical ventilation (18 of 82 [22.0%] vs 14 of 334 [4.2%];<i>P</i> &lt; .001) than those without cardiac injury. Complications were more common in patients with cardiac injury than those without cardiac injury and included acute respiratory distress syndrome (48 of 82 [58.5%] vs 49 of 334 [14.7%];<i>P</i> &lt; .001), acute kidney injury (7 of 82 [8.5%] vs 1 of 334 [0.3%];<i>P</i> &lt; .001), electrolyte disturbances (13 of 82 [15.9%] vs 17 of 334 [5.1%];<i>P</i> = .003), hypoproteinemia (11 of 82 [13.4%] vs 16 of 334 [4.8%];<i>P</i> = .01), and coagulation disorders (6 of 82 [7.3%] vs 6 of 334 [1.8%];<i>P</i> = .02). Patients with cardiac injury had higher mortality than those without cardiac injury (42 of 82 [51.2%] vs 15 of 334 [4.5%];<i>P</i> &lt; .001). In a Cox regression model, patients with vs those without cardiac injury were at a higher risk of death, both during the time from symptom onset (hazard ratio, 4.26 [95% CI, 1.92-9.49]) and from admission to end point (hazard ratio, 3.41 [95% CI, 1.62-7.16]). <h3>Conclusions and Relevance</h3> Cardiac injury is a common condition among hospitalized patients with COVID-19 in Wuhan, China, and it is associated with higher risk of in-hospital mortality.