ABSTRACT
Introduction: Coronavirus Disease 2019 (COVID-19) is an infectious disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2) which can lead to respiratory failure, acute respiratory distress syndrome (ARDS), pneumonia, and sepsis1. The symptoms of severe COVID-19 usually occur after a few days when viral replication is decreasing and excessive inflammation in the lung alveoli are present. Subsequently, excessive inflammation led to abnormalities in gas exchange, abnormalities in ventilation, and abnormalities in blood perfusion in the lungs2. Severe disease also has the characteristics present in Cytokine Release Syndrome (CRS) such as high fever, and elevated levels of ferritin and C-reactive protein2. Hemoperfusion has been offered to patients with severe COVID-19 who continue to have disease progression and increased inflammatory markers despite maximizing medical therapy. Our main objective is to determine the association of hemoperfusion with the development of disease progression among patients with at least severe COVID-19 in Asian Hospital and Medical Center from March 2020 to March 2021. Method(s): This is a retrospective cohort of patients aged-19 and older with a diagnosis of at least severe COVID-19 who were grouped according to whether they received hemoperfusion or not. These patients were monitored throughout their hospital course for the development of disease progression (i.e., mortality or need for mechanical ventilation). Multivariate analysis was used to determine the association of hemoperfusion with disease progression. Result(s): A total of 267 patients were included in the study, 128 (47.9%) underwent hemoperfusion, and 139 (52.1%) did not. Those who underwent hemoperfusion were older, had more co-morbidities (hypertension, diabetes, and chronic kidney disease), and had more severe disease. Disease progression occurred in 127 patients (47.5%), which was higher in those who underwent hemoperfusion (94 patients). On multivariate analysis, hemoperfusion was significantly associated with the need for intubation (RR 11.94, CI 5.3-26.8;p<0.0001), in-hospital mortality (RR 4.56, CI 2.2-9.4, p<0.0001), and the composite of disease progression (RR 7.44, CI 3.9-14.2, p<0.0001). Thrombocytopenia and hypocalcemia were also significantly more common among those who received hemoperfusion (p<0.0001). [Formula presented] [Formula presented] Conclusion(s): Our cohort showed that hemoperfusion was associated with the development of disease progression and more adverse events. However, those who received hemoperfusion had more co-morbidities and had more severe disease at the onset, which may explain our findings. Based on this study, hemoperfusion could not be recommended in the routine management of patients with at least severe COVID-19;however, a randomized controlled trial is highly recommended to verify our findings. No conflict of interestCopyright © 2023
ABSTRACT
Background: COVID-19 has been reported to cause cardiac injury. It can be detected by an electrocardiogram (ECG), which may show markers that may predict clinical outcome. Robust data on the ECG abnormalities among COVID-19 patients affected by the alpha, beta, and gamma variants have been reported, but there is paucity of data among patients affected by the delta and omicron variants. Purpose(s): This study aims to describe the cardiovascular profile, ECG findings, and clinical course of adult patients with COVID-19, and to determine the association between certain ECG findings and clinical outcomes among these patients. Method(s): We evaluated 547 COVID-19 patients admitted from June 2021 to June 2022. Clinical profiles were extracted from electronic records. Admission ECGs were independently read and adjudicated by three cardiologists. Logistic regression analysis was done to determine the association between ECG abnormalities and adverse outcomes, including in-hospital mortality, ICU admission, need for mechanical ventilation, acute respiratory distress syndrome (ARDS), shock, acute kidney injury (AKI), myocardial infarction (MI), myocarditis, venous thromboembolism (VTE), and stroke. Result(s): A Total of 547 COVID-19 patients (mean age 54;men 51.2%) were included. The most common comorbidities were hypertension, diabetes, and dyslipidemia. Majority of patients had severe COVID-19 infection (36%). On admission, 6.4% needed intubation and 14.6% died. The most common ECG abnormalities were non-specific ST-T wave changes (41.1%) and sinus tachycardia (25.6%). Other findings were ST segment depression (3.3%), T wave inversion (1.6%), and ST segment elevation (1.3%). On logistic regression analysis, intraventricular conduction delay (IVCD), T wave inversion, and poor R wave progression were significantly associated with mortality;sinus tachycardia, atrioventricular (AV) block, ST segment elevation, and T wave inversion were significantly associated with the development of VTE;left axis deviation, ST segment elevation, and T wave inversion were significantly associated with the development of ARDS;sinus tachycardia, ST segment depression, and T wave inversion were significantly associated with the development of shock;and sinus tachycardia, ST segment elevation, and early repolarization changes were significantly associated with ICU admission. No associations were established for AKI, MI, myocarditis, and need for mechanical ventilation due to the low prevalence of these outcomes. Conclusion(s): A baseline ECG in patients with COVID-19 may help predict patients who may warrant hospitalization or even intensive care monitoring. In our cohort, certain ECG abnormalities, especially sinus tachycardia, left axis deviation, ST segment elevation, ST segment depression, T wave inversion, AV block, IVCD, poor R wave progression, and early repolarization changes, were associated with adverse clinical outcomes, including in-hospital mortality.