Association between right ventricular dysfunction and in-hospital mortality in surges of SARS-CoV-2 infection attributed to the Alpha, Delta, and Omicron variants.

Abstract

Right ventricular (RV) dysfunction in acute COVID-19 was reported to be associated with poor prognosis. We studied the association between parameters of RV dysfunction and in-hospital mortality during the surges caused by different SARS-CoV-2 variants. In a retrospective single-center study, we enrolled 648 consecutive patients hospitalized with COVID-19 [66 (10%) hospitalized during the alpha variant surge, 433 (67%) during the delta variant surge, and 149 (23%), during the omicron variant surge]. Patients were reported from a hospital with an underreported population of mostly African American and Hispanic patients. Patients were followed for a median of 11days during which in-hospital death occurred in 155 (24%) patients [Alpha wave: 25 (38%), Delta Wave: 112 (26%), Omicron wave: 18 (12%), p<0.001]. RV dysfunction occurred in 210 patients (alpha: 32%, 26%, delta: 29%, and omicron: 49%, p<0.001) and was associated with higher mortality across waves, however, independently predicted in-hospital mortality in the Alpha (HR=5.1, 95% CI: 2.06-12.5) and Delta surges (HR=1.6, 95% CI: 1.11-2.44), but not in the Omicron surge. When only patients with RV dysfunction were compared, the mortality risk was found to decrease significantly from the Alpha (HR=13.6, 95% CI: 3.31-56.3) to the delta (HR=1.93, 95% CI: 1.25-2.96) and to the Omicron waves (HR=11, 95% CI: 0.6-20.8). RV dysfunction continues to occur in all strains of the SARS-CoV-2 virus, however, the mortality risk decreased from wave to wave likely due to evolution of better therapeutics, increase rate of vaccination, or viral mutations resulting in decrease virulence.Registration number of clinical studies: BronxCare Hospital center institutional review board under the number 05 13 21 04.