Key factors leading to fatal outcomes in COVID-19 patients with cardiac injury

AbstractCardiac injury among patients with COVID-19 has been reported and is associated with a high risk of mortality, but cardiac injury may not be the leading factor related to death. The factors related to poor prognosis among COVID-19 patients with myocardial injury are still unclear. This study aimed to explore the potential key factors leading to in-hospital death among COVID-19 patients with cardiac injury. This retrospective single-center study was conducted at Renmin Hospital of Wuhan University, from January 20, 2020 to April 10, 2020, in Wuhan, China. All inpatients with confirmed COVID-19 (≥ 18 years old) and cardiac injury who had died or were discharged by April 10, 2020 were included. Demographic data and clinical and laboratory findings were collected and compared between survivors and nonsurvivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with mortality in COVID-19 patients with cardiac injury. A total of 173 COVID-19 patients with cardiac injury were included in this study, 86 were discharged and 87 died in the hospital. Multivariable regression showed increased odds of in-hospital death were associated with advanced age (odds ratio 1.12, 95% CI 1.05–1.18, per year increase; p < 0.001), coagulopathy (2.54, 1.26–5.12; p = 0·009), acute respiratory distress syndrome (16.56, 6.66–41.2; p < 0.001), and elevated hypersensitive troponin I (4.54, 1.79–11.48; p = 0.001). A high risk of in-hospital death was observed among COVID-19 patients with cardiac injury in this study. The factors related to death include advanced age, coagulopathy, acute respiratory distress syndrome and elevated levels of hypersensitive troponin I.

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Evaluation of a Ventilation Strategy to Prevent Barotrauma in Patients at High Risk for Acute Respiratory Distress Syndrome

Survey of Anesthesiology ◽

10.1097/00132586-199902000-00009 ◽

1999 ◽

Vol 43 (1) ◽

pp. 8-9

Author(s):

THOMAS E. STEWART ◽

MAUREEN O. MEADE ◽

DEBORAH J. COOK ◽

JOHN T. GRANTON ◽

RICHARD V. HODDER ◽

...

Keyword(s):

Acute Respiratory Distress Syndrome ◽

High Risk ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Ventilation Strategy

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Acute Respiratory Distress Syndrome Prediction Score: Derivation and Validation

American Journal of Critical Care ◽

10.4037/ajcc2021753 ◽

2021 ◽

Vol 30 (1) ◽

pp. 64-71

Author(s):

Lixue Huang ◽

Man Song ◽

Yan Liu ◽

Wenmei Zhang ◽

Zhenye Pei ◽

...

Keyword(s):

Cardiac Surgery ◽

Acute Respiratory Distress Syndrome ◽

High Risk ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Aortic Surgery ◽

Area Under The Curve ◽

Prediction Score ◽

Derivation Cohort

Background Despite advances in treatment strategies, acute respiratory distress syndrome (ARDS) after cardiac surgery remains associated with high morbidity and mortality. A method of screening patients for risk of ARDS after cardiac surgery is needed. Objectives To develop and validate an ARDS prediction score designed to identify patients at high risk of ARDS after cardiac or aortic surgery. Methods An ARDS prediction score was derived from a retrospective derivation cohort and validated in a prospective cohort. Discrimination and calibration of the score were assessed with area under the receiver operating characteristic curve and the Hosmer-Lemeshow goodness-of-fit test, respectively. A sensitivity analysis was conducted to assess model performance at different cutoff points. Results The retrospective derivation cohort consisted of 201 patients with and 602 patients without ARDS who had undergone cardiac or aortic surgery. Nine routinely available clinical variables were included in the ARDS prediction score. In the derivation cohort, the score distinguished patients with versus without ARDS with area under the curve of 0.84 (95% CI, 0.81-0.88; Hosmer-Lemeshow P = .55). In the validation cohort, 46 of 1834 patients (2.5%) had ARDS develop within 7 days after cardiac or aortic surgery. Area under the curve was 0.78 (95% CI, 0.71-0.85), and the score was well calibrated (Hosmer-Lemeshow P = .53). Conclusions The ARDS prediction score can be used to identify high-risk patients from the first day after cardiac or aortic surgery. Patients with a score of 3 or greater should be closely monitored. The score requires external validation before clinical use.

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Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study

BMJ ◽

10.1136/bmj.m1091 ◽

2020 ◽

pp. m1091 ◽

Cited By ~ 1031

Author(s):

Tao Chen ◽

Di Wu ◽

Huilong Chen ◽

Weiming Yan ◽

Danlei Yang ◽

...

Keyword(s):

Heart Failure ◽

Acute Respiratory Distress Syndrome ◽

Respiratory Failure ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Clinical Characteristics ◽

Distress Syndrome ◽

Cardiac Injury ◽

Cardiac Complications ◽

Type I

Abstract Objective To delineate the clinical characteristics of patients with coronavirus disease 2019 (covid-19) who died. Design Retrospective case series. Setting Tongji Hospital in Wuhan, China. Participants Among a cohort of 799 patients, 113 who died and 161 who recovered with a diagnosis of covid-19 were analysed. Data were collected until 28 February 2020. Main outcome measures Clinical characteristics and laboratory findings were obtained from electronic medical records with data collection forms. Results The median age of deceased patients (68 years) was significantly older than recovered patients (51 years). Male sex was more predominant in deceased patients (83; 73%) than in recovered patients (88; 55%). Chronic hypertension and other cardiovascular comorbidities were more frequent among deceased patients (54 (48%) and 16 (14%)) than recovered patients (39 (24%) and 7 (4%)). Dyspnoea, chest tightness, and disorder of consciousness were more common in deceased patients (70 (62%), 55 (49%), and 25 (22%)) than in recovered patients (50 (31%), 48 (30%), and 1 (1%)). The median time from disease onset to death in deceased patients was 16 (interquartile range 12.0-20.0) days. Leukocytosis was present in 56 (50%) patients who died and 6 (4%) who recovered, and lymphopenia was present in 103 (91%) and 76 (47%) respectively. Concentrations of alanine aminotransferase, aspartate aminotransferase, creatinine, creatine kinase, lactate dehydrogenase, cardiac troponin I, N-terminal pro-brain natriuretic peptide, and D-dimer were markedly higher in deceased patients than in recovered patients. Common complications observed more frequently in deceased patients included acute respiratory distress syndrome (113; 100%), type I respiratory failure (18/35; 51%), sepsis (113; 100%), acute cardiac injury (72/94; 77%), heart failure (41/83; 49%), alkalosis (14/35; 40%), hyperkalaemia (42; 37%), acute kidney injury (28; 25%), and hypoxic encephalopathy (23; 20%). Patients with cardiovascular comorbidity were more likely to develop cardiac complications. Regardless of history of cardiovascular disease, acute cardiac injury and heart failure were more common in deceased patients. Conclusion Severe acute respiratory syndrome coronavirus 2 infection can cause both pulmonary and systemic inflammation, leading to multi-organ dysfunction in patients at high risk. Acute respiratory distress syndrome and respiratory failure, sepsis, acute cardiac injury, and heart failure were the most common critical complications during exacerbation of covid-19.

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Comorbidities as Risk Factors for Mortality in COVID-19 Acute Respiratory Distress Syndrome Adult Patients: A Single-Center Retrospective Study

International Journal Of Scientific Advances ◽

10.51542/ijscia.v2i6.10 ◽

2021 ◽

Vol 2 (6) ◽

Author(s):

Putra Kurnia Nugraha ◽

Edward Kusuma ◽

Soni Sunarso Sulistiawan ◽

Teuku Aswin Husain

Keyword(s):

Risk Factors ◽

Acute Respiratory Distress Syndrome ◽

Chronic Disease ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Hospital Death ◽

P Value ◽

Chronic Hypertension ◽

Single Center

Background: Geriatric, obesity, and chronic disease are classified as risk factors for adverse outcomes of coronavirus disease 2019 (COVID-19). Studies regarding the importance of these comorbidities in COVID-19 with severe complications such as acute respiratory distress syndrome (ARDS) are scarce. This study aims to analyze age, obesity, and chronic disease comorbidities as risk factors for 28-days mortality in COVID-19 patients with ARDS. Methods: A retrospective, single-center study was conducted in Dr. Soetomo General Hospital, Surabaya, Indonesia between July-October 2020. We included all adult inpatients (≥18 years old) of confirmed COVID-19 with ARDS. Demographic, comorbidities, initial PaO2/FiO2 ratio, time of discharge or death were obtained from medical records and compared the ARDS severity between survivors and non-survivors. The univariate and multivariate logistic regression methods were used to identify risk factors associated with in-hospital death. Result: Among 102 patients of COVID-19 with ARDS, the median age is 52 years. Most of them are within 50 – 59 age categories. The median hospital length of stay (LOS) for survivor is 22 (15.7 – 26) days and 9 (4.25 – 14.4) days for non-survivor. The 28-days mortality rate is 48 (47.1%) patients. Age > 65 years old (HR= 2.7, 95% CI 1.39 – 5.44, p value= 0.004), obesity (HR= 2.2, 95% CI 1.16 – 4.51, p value= 0.016), and chronic hypertension (HR= 1.98, 95% CI 1.11 – 3.52, p value= 0.02) are the independent risk factors for 28-days mortality in COVID-19 with ARDS. Conclusion: Geriatric, obesity, and chronic hypertension comorbidities are the risk factors for mortality of COVID-19 with ARDS complications.

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Abstract 15010: Myocardial Injury in Sepsis With Acute Respiratory Distress Syndrome

Circulation ◽

10.1161/circ.142.suppl_3.15010 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Eunice S Dugan ◽

Robert S Stephens ◽

Steven P Schulman ◽

Thomas S Metkus

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Sofa Score ◽

Myocardial Injury ◽

Distress Syndrome ◽

Troponin I ◽

High Morbidity ◽

Multicenter Cohort Study ◽

Significant Difference

Introduction: Sepsis is common and associated with high morbidity and mortality; novel prognostic biomarkers are needed. The association of myocardial injury with mortality in sepsis has not been fully characterized. Hypothesis: We hypothesized that elevated plasma high-sensitivity troponin I (hs-TnI) would be associated with 60-day mortality in patients with sepsis and acute respiratory distress syndrome (ARDS). Methods: We conducted a retrospective multicenter cohort study of subjects from the MI-ARDS study with ARDS and sepsis. The exposure variable was plasma hs-TnI on intubation (Day 0) and Day 3. Hs-TnI was measured using Abbott Laboratories’ ARCHITECT STAT assay. Patients were divided into four hs-TnI (ng/L) groups (Grp): GrpA: <2 (undetectable), GrpB: ≥2-<26 (<99 th percentile of population), GrpC: ≥26-<130 (<5 times upper limit of normal [ULN]), GrpD: ≥130 (>5 times ULN). The primary outcome was 60-day mortality. We determined the association between hs-TnI and mortality using Cox proportional hazards models. Results: Of 320 subjects, there were 15 (4%) in GrpA, 97 (30%) in GrpB, 88 (28%) in GrpC, and 120 (38%) in GrpD. Mean age was 50 years and 172 subjects (54%) required vasopressors. Higher plasma levels of hs-TnI were associated with higher SOFA score and creatinine, and more vasopressor use. Overall mortality was 33%. There was no significant difference in 60-day survival between clinical categories of Day 0 hs-TnI (Fig 1-A). Rising troponin between Day 0 and Day 3 was associated with a higher risk of mortality after adjusting for age, sex, trial assignment, and SOFA score (HR: 1.75, CI: 1.11-2.77, p=0.02) (Fig 1-B), and additionally adjusting for Day 0 hs-TnI (HR: 1.72, CI: 1.03-2.85, p=0.04). Conclusions: Initial hs-TnI in patients with sepsis and ARDS was not associated with mortality. Increase in hs-TnI of at least 20% by Day 3 was associated with 60-day mortality. Future studies should assess mechanism and treatment of myocardial injury in sepsis.

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The effect of preemptive airway pressure release ventilation on patients with high risk for acute respiratory distress syndrome: a randomized controlled trial

Brazilian Journal of Anesthesiology (English Edition) ◽

10.1016/j.bjane.2021.03.022 ◽

2021 ◽

Author(s):

Mehtap Pehlivanlar Küçük ◽

Çağatay Erman Öztürk ◽

Nazan Köylü İlkaya ◽

Ahmet Oğuzhan Küçük ◽

Dursun Fırat Ergül ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Acute Respiratory Distress Syndrome ◽

High Risk ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Airway Pressure ◽

Distress Syndrome ◽

Controlled Trial ◽

Randomized Controlled ◽

Pressure Release Ventilation

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Biomarkers of cardiac injury in acute respiratory distress syndrome: Getting to the heart of the matter*

Critical Care Medicine ◽

10.1097/01.ccm.0000288097.81989.d3 ◽

2007 ◽

Vol 35 (11) ◽

pp. 2638-2639 ◽

Cited By ~ 1

Author(s):

Timothy D. Girard ◽

Lorraine B. Ware

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Cardiac Injury

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Rationale and design of a prospective, multicentre, randomised, conventional treatment-controlled, parallel-group trial to evaluate the efficacy and safety of ulinastatin in preventing acute respiratory distress syndrome in high-risk patients

BMJ Open ◽

10.1136/bmjopen-2018-025523 ◽

2019 ◽

Vol 9 (3) ◽

pp. e025523 ◽

Cited By ~ 1

Author(s):

Zongyu Wang ◽

Liyuan Tao ◽

Yingying Yan ◽

Xi Zhu

Keyword(s):

Acute Respiratory Distress Syndrome ◽

High Risk ◽

Lung Injury ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Conventional Treatment ◽

Distress Syndrome ◽

High Risk Patients ◽

Parallel Group ◽

Risk Patients

IntroductionAcute respiratory distress syndrome (ARDS) is challenging in the intensive care unit (ICU). Although pharmacotherapy for ARDS has gained increasing attention, most trials have yielded negative results. Patients with ARDS have usually been recruited as subjects; the inflammatory reaction has already expanded into a cascade at this point, and its severity is sufficient to damage the lung parenchyma. This raises the question of whether early treatment can prevent ARDS and the associated lung injury. We hypothesise that ARDS is preventable in high-risk patients by administration of ulinastatin as an anti-inflammatory drug before ARDS onset, and we are performing a study to test ulinastatin, a protease inhibitor, versus treatment-as-usual in a group of patients at increased risk for ARDS.Methods and analysisThis report presents the protocol for a multicentre, randomised, conventional treatment-controlled, parallel group study to prevent the development of ARDS using ulinastatin in high-risk patients. The study population will comprise patients at risk of ARDS in the ICU (≥18 years of age and Lung Injury Prediction Score of >4); patients with confirmed ARDS and some other conditions (immunodeficiency, use of some drugs, etc.) will be excluded. The enrolled patients will be randomly allocated to an ulinastatin group (ulinastatin will be intravenously administered every 8 hours for a total of 600 000 U/day for five consecutive days) or control group. The efficacy of ulinastatin in preventing ARDS development will be evaluated by the incidence rate of ARDS as the primary outcome; the secondary outcomes include the severity of ARDS, clinical outcome, extrapulmonary organ function and adverse events incurred by ulinastatin. Based on the results of preliminary studies and presuming the incidence of ARDS will decrease by 9% in high-risk patients, 880 patients are needed to obtain statistical power of 80%.Ethics and disseminationThis study has been approved by the Peking University Third Hospital Medical Science Research Ethics Committee. The findings will be published in peer-reviewed journals and presented at national and international conferences.Trial registration numberNCT03089957; Pre-results.

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