Prognostic value of GRACE risk score in patients hospitalized for coronavirus disease 2019.

OBJECTIVE: COVID-19 pandemic continues to threaten human health as novel mutant variants emerge and disease severity ranges from asymptomatic to fatal. Thus, studies are needed to identify the patients with ICU need as well as those who have subsequent mortality. Global Registry of Acute Coronary Events (GRACE) risk score is a validated score in acute coronary syndrome. We aimed to evaluate if GRACE score can indicate adverse outcomes and major ischemic events in hospitalized COVID-19 patients. METHODS: All hospitalized patients due to COVID-19 at our institution between March 2020 and September 2020 were included in this retrospective study. Patients were grouped according to GRACE risk scores: low risk 0-108 points, intermediate risk 109-140 and high risk ≥141. RESULTS: A total of 787 patients were enrolled; 434 patients formed group 1. One-hundred forty-one patients in group 2 and 212 patients formed group 3. We found that inhospital mortality, length of hospital stay, ICU and advanced ventilatory support need were associated with increasing GRACE risk score. In addition, major ischemic events were more frequently observed in higher risk groups and strong positive correlations between GRACE risk score and pro-BNP, procalcitonin and moderate positive correlation with D-dimer, CRP, NLR was found. Regression analysis showed that only GRACE risk score was an independent risk factor associated with inhospital mortality, major ischemic events, advanced ventilatory support and ICU need. CONCLUSION: The GRACE risk score is easy to apply on hospital admission and useful for classifying those in medium-high-intensity care units and to raise the assignments of sources.

Long-Term Clinical Consequences of Patients Hospitalized for COVID-19 Infection.

BACKGROUND: Coronavirus disease 2019, putatively caused by infection with severe acute respiratory coronavirus 2, often involves injury to multiple organs and there are limited data regarding the mid- to long-term consequences of coronavirus disease 2019 after discharge from the hospital. The study aimed to describe the mid- to long-term consequences of coronavirus disease 2019 in hospitalized patients after discharge. METHODS: This single-center, prospective study enrolled coronavirus disease 2019 patients who were discharged uneventfully from our center. All participants underwent face-toface interviews by trained physicians and were asked to complete a series of questionnaires on third and sixth months' follow-up visits. RESULTS: A total of 406 consecutive discharged coronavirus disease 2019 patients were enrolled in this study. Patients were divided into 3 groups according to World Health Organization classification as follows: World Health Organization-3 (n=83); World Health Organization-4 (n=291); and World Health Organization-5,6 (n=32). Length of hospital stay was highly, significantly increased in the higher World Health Organization groups (World Health Organization-3 vs. World Health Organization-4, P < .0001; World Health Organization-3 vs. World Health Organization-5,6, P < .0001; World Health Organization-4 vs. World Health Organization-5,6, P < .0001), whereas the length of intensive care unit stay was highly, significantly increased only in World Health Organization-5,6 group compared to other groups (World Health Organization-3 vs. World Health Organization-5,6, P < .0001; World Health Organization-4 vs. World Health Organization-5,6, P < .0001). The most frequent complaints were chest pain (39%), and the frequency of complaints decreased during the 3-6 months follow-up period. Multiple logistic regression analysis indicated that age, coronary artery disease, fibrinogen, C-reactive protein, troponin I, D-dimer, use of steroid and/or low molecular weight heparin, and World Health Organization class were found to be independent predictors of ongoing cardiovascular symptoms. CONCLUSIONS: The current data demonstrated that persistent symptoms were common after coronavirus disease 2019 among hospitalized patients. This should raise awareness among healthcare professionals regarding coronavirus disease 2019 aftercare.

Prognostic value of right ventricular strain pattern on ECG in COVID-19 patients.

OBJECTIVE: COVID-19 spread worldwide, causing severe morbidity and mortality and this process still continues. The aim of this study to investigate the prognostic value of right ventricular (RV) strain in patients with COVID-19. METHODS: Consecutive adult patients admitted to the emergency room for COVID-19 between 1 and 30 April were included in this study. ECG was performed on hospital admission and was evaluated as blind. RV strain was defined as in the presence of one or more of the following ECG findings: complete or incomplete right ventricular branch block (RBBB), negative T wave in V1-V4 and presence of S1Q3T3. The main outcome measure was death during hospitalization. The relationship of variables to the main outcome was evaluated by multivariable Cox regression analysis. RESULTS: A total of 324 patients with COVID-19 were included in the study; majority of patients were male (187, 58%) and mean age was 64.2 ± 14.1. Ninety-five patients (29%) had right ventricular strain according to ECG and 66 patients (20%) had died. After a multivariable survival analysis, presence of RV strain on ECG (OR: 4.385, 95%CI: 2.226-8.638, p < 0.001), high-sensitivity troponin I (hs-TnI), d-dimer and age were independent predictors of mortality. CONCLUSION: Presence of right ventricular strain pattern on ECG is associated with in hospital mortality in patients with COVID-19.

Elevated D-dimer levels on admission are associated with severity and increased risk of mortality in COVID-19: A systematic review and meta-analysis.

BACKGROUND: In this systematic review and meta-analysis, we aimed to investigate the correlation of D-dimer levels measured on admission with disease severity and the risk of death in patients with coronavirus disease 2019 (COVID-19) pneumonia. MATERIALS AND METHODS: We performed a comprehensive literature search from several databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed in abstracting data and assessing validity. Quality assessment was performed using the Newcastle-Ottawa quality assessment scale (NOS). D-dimer levels were pooled and compared between severe/non-severe and surviving/non-surviving patient groups. Weighted mean difference (WMD), risk ratios (RRs) and 95% confidence intervals (CIs) were analyzed. RESULTS: Thirty-nine studies reported on D-dimer levels in 5750 non-severe and 2063 severe patients and 16 studies reported on D-dimer levels in 2783 surviving and 697 non-surviving cases. D-dimer levels were significantly higher in patients with severe clinical status (WMD: 0.45 mg/L, 95% CI: 0.34-0.56; p < 0.0001). Non-surviving patients had significantly higher D-dimer levels compared to surviving patients (WMD: 5.32 mg/L, 95% CI: 3.90-6.73; p < 0.0001). D-dimer levels above the upper limit of normal (ULN) was associated with higher risk of severity (RR: 1.58, 95% CI: 1.25-2.00; p < 0.0001) and mortality (RR: 1.82, 95% CI: 1.40-2.37; p < 0.0001). CONCLUSION: Increased levels of D-dimer levels measured on admission are significantly correlated with the severity of COVID-19 pneumonia and may predict mortality in hospitalized patients.

The effect of the severity COVID-19 infection on electrocardiography.

OBJECTIVE: Acute myocardial damage is detected in a significant portion of patients with coronavirus 2019 disease (COVID-19) infection, with a reported prevalence of 7-28%. The aim of this study was to investigate the relationship between electrocardiographic findings and the indicators of the severity of COVID-19 detected on electrocardiography (ECG). METHODS: A total of 219 patients that were hospitalized due to COVID-19 between April 15 and May 5, 2020 were enrolled in this study. Patients were divided into two groups according to the severity of COVID-19 infection: severe (n = 95) and non-severe (n = 124). ECG findings at the time of admission were recorded for each patient. Clinical characteristics and laboratory findings were retrieved from electronic medical records. RESULTS: Mean age was 65.2 ± 13.8 years in the severe group and was 57.9 ± 16.0 years in the non-severe group. ST depression (28% vs. 14%), T-wave inversion (29% vs. 16%), ST-T changes (36% vs. 21%), and the presence of fragmented QRS (fQRS) (17% vs. 7%) were more frequent in the severe group compared to the non-severe group. Multivariate analysis revealed that hypertension (odds ratio [OR]: 2.42, 95% confidence interval [CI]:1.03-5.67; p = 0.041), the severity of COVID-19 infection (OR: 1.87, 95% CI: 1.09-2.65; p = 0.026), presence of cardiac injury (OR: 3.32, 95% CI: 1.45-7.60; p = 0.004), and d-dimer (OR: 3.60, 95% CI: 1.29-10.06; p = 0.014) were independent predictors of ST-T changes on ECG. CONCLUSION: ST depression, T-wave inversion, ST-T changes, and the presence of fQRS on admission ECG are closely associated with the severity of COVID-19 infection.

Prognostic significance of cardiac injury in COVID-19 patients with and without coronary artery disease.

OBJECTIVE: COVID-19 is a disease with high mortality, and risk factors for worse clinical outcome have not been well-defined yet. The aim of this study is to delineate the prognostic importance of presence of concomitant cardiac injury on admission in patients with COVID-19. METHODS: For this multi-center retrospective study, data of consecutive patients who were treated for COVID-19 between 20 March and 20 April 2020 were collected. Clinical characteristics, laboratory findings and outcomes data were obtained from electronic medical records. In-hospital clinical outcome was compared between patients with and without cardiac injury. RESULTS: A total of 607 hospitalized patients with COVID-19 were included in the study; the median age was 62.5 ± 14.3 years, and 334 (55%) were male. Cardiac injury was detected in 150 (24.7%) of patients included in the study. Mortality rate was higher in patients with cardiac injury (42% vs. 8%; P < 0.01). The frequency of patients who required ICU (72% vs. 19%), who developed acute kidney injury (14% vs. 1%) and acute respiratory distress syndrome (71%vs. 18%) were also higher in patients with cardiac injury. In multivariate analysis, age, coronary artery disease (CAD), elevated CRP levels, and presence of cardiac injury [odds ratio (OR) 10.58, 95% confidence interval (CI) 2.42-46.27; P < 0.001) were found to be independent predictors of mortality. In subgroup analysis, including patients free of history of CAD, presence of cardiac injury on admission also predicted mortality (OR 2.52, 95% CI 1.17-5.45; P = 0.018). CONCLUSION: Cardiac injury on admission is associated with worse clinical outcome and higher mortality risk in COVID-19 patients including patients free of previous CAD diagnosis.