The association between COVID-19 infection and cardiac involvement in hospitalized patients at a tertiary care center (preprint)

ABSTRACT

Objective The effect of COVID-19 infection on the cardiovascular system is 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 the outcomes associated with COVID-19 infection with cardiac involvement.Method In this 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). The patients with evidence of ACI were significantly more likely to have diabetes mellitus (75% vs. 60%; p = 0.003), cardiovascular disease (48% Vs. 37%; p = 0.042), chronic lung disease (22.2% vs. 12.4%; p = 0.02), and chronic kidney disease (32.3% vs. 16.2%; p = < 0.001). Additionally, the patients with ACI were significantly more likely to have cardiomegaly (60.6% vs. 44.8%; p = 0.004) and bilateral lobe infiltrates (77.8% vs. 60%; p < 0.001) on X-ray. The patients with ACI were significantly more likely to suffer from complications such as cardiogenic shock (5.3% vs. 0%; p = 0.001), arrhythmias (42% vs. 30.5%; p = 0.002), pneumonia (80.1% vs. 65.7%; p = 0.003), sepsis (24.2% vs. 9.5%; p < 0.001), and acute respiratory distress syndrome (ARDS) (33.1% vs. 8.6%; p < 0.001). Patients with ACI were also significantly more likely to be admitted to the intensive care unit (ICU) (57% vs. 26.7%; p < 0.001) and significantly more likely to die (38.1% vs. 11.4%; p < 0.001). The results of the multivariate regression analysis indicated that mortality was significantly higher in patients with elevated troponin levels (adjusted odds ratio [OR] 4.73; 95% confidence interval [CI] 2.49–8.98).Conclusion In COVID-19 patients who exhibited evidence of ACI, age, diabetes mellitus, chronic lung disease, and chronic kidney disease were associated with increased risk of ACI. Patients with these risk factors are at risk of severe complications, such as ICU admission, sepsis, and death.