Clinical features of COVID-19 patients with comorbid coronary heart disease (preprint)

Background: In addition to the lungs, the coronavirus disease 2019 (COVID-19) also affects multiple organs throughout the body. The relationship between COVID-19 infection and cardiovascular disease, and the mechanisms by which this disease causes damage to the cardiovascular system are unclear. Coronary heart disease (CHD) is one of the common comorbidities of COVID-19, but there is insufficient evidence for its clinical features and impact on clinical outcomes. The aim of this study was to analyze the clinical characteristics of COVID-19 patients with comorbid CHD and the possible risk factors for the occurrence of critical illness. Methods: A single-center, retrospective study was conducted to analyze COVID-19 patients admitted to the Sino-French New City Campus of Tongji Hospital in Wuhan, Hubei Province and treated by the Peking University National Medical Assistance Team between January 29 and March 10, 2020. Patients testing positive for SARS-CoV-2 viral nucleic acid in nasopharyngeal swab specimens and who had comorbid CHD, were included in the study. Clinical data and laboratory test results of eligible patients were collected, and the factors associated with the occurrence of critical illness among these patients were evaluated. Results: A total of 205 patients were enrolled in this study, including 20 CHD patients and 185 non-CHD patients. The mean age was 66.7 years. Compared to non-CHD patients, more CHD patients had comorbid hypertension and diabetes (P < 0.05). In terms of laboratory tests, the CHD group did not differ significantly from the non-CHD group in blood routine, blood chemistry, and various inflammatory cytokines. More CHD patients experienced myocardial injury (25% vs 8.1% P < 0.031) and CHD patients were more likely to progress to critical illness (40% vs 16.8%P = 0.012). Univariate logistic regression analysis indicated that a history of CHD, occurrence of myocardial injury, high white blood cell (WBC) count, low lymphocyte count, and elevated levels of Cr, ferritin, IL-2R, IL-8 at admission were factors associated with the occurrence of critical illness. Multivariate regression analysis found that a history of CHD（OR=3.529, 95% CI =1.032-12.075, P =0.044），high WBC count（OR=1.289, 95% CI =1.136-1.463, P＜0.001） and low lymphocyte count（OR=0.215, 95% CI =0.075-0.616, P =0.004）were independent factors for the occurrence of critical illness among COVID-19 patients. Conclusion: COVID-19 patients with comorbid CHD commonly exhibited myocardial injury and were prone to developing critical illness. Among COVID-19 patients, a history of CHD，high WBC count and low lymphocyte count were independent risk factors for the occurrence of critical illness. Greater attention and vigilance are needed in this regard during clinical practice.

Clinical characteristics and prognostic factors in elderly patients with COVID-19 (preprint)

Background: The COVID-19 pandemic posed tremendous threats to the world. Elderly patients were among the high-risk population, and apt to experience worse outcomes.Methods: Elderly patients (age ≥60 years old) were enrolled from January 28 to February 29, 2020, in Tongji Hospital, one of designated COVID-19 medical centers in Wuhan, China. A retrospective study was performed to describe clinical characteristics and outcomes of elderly COVID-19 patients. COX regression was used to analyze predictors for 28-day mortality. Linear regression models were constructed to analyze factors associated with length of hospital stay (LOS).Result: A total of 186 elderly patients (aged 70.4 ± 7.1 years, 95 males (51.6%)) were enrolled, 120 patients (64.5%) were severe or critical type, and mortality rate was 16.1%. Patients in non-survival group had a higher smoking rate, more symptoms of dyspnea, lab results indicative of poorer health. Age (HR 1.128, 95% CI 1.066-1.194), lymphocyte count (HR 0.261, 95% CI 0.073-0.930), LDH (HR 1.003, 95% CI 1.002-1.005), procalcitonin (HR 1.061, 95% CI 1.002-1.125), and qSOFA (HR 3.162, 95% CI 1.646-6.072) were independently associated with 28-day mortality. CURB-65 plus LDH on admission were predictors of mortality by ROC analysis (AUROC=0.891). Among surviving patients, consolidation on CTs, elevated ferritin level and neutrophil count were associated with increased LOS.Conclusion: High incidence of comorbidities and mortality were observed in elderly patients. Decreased lymphocyte, older age, higher qSOFA score, procalcitonin and LDH levels were independent factors associated with mortality, CURB-65 plus LDH could be a predictive model of fatal outcome. Consolidation on CTs, elevated ferritin and neutrophil level correlated with increased LOS. Further prospective studies should be performed to test our findings and explore potential treatments.