Abstract
COVID-19 is a respiratory infectious disease caused by SARS-CoV-2, and cardiovascular damage is commonly observed in affected patients. We sought to investigate the effect of SARS-CoV-2 infection on cardiac injury and hypertension during the current coronavirus pandemic. The clinical data of 366 hospitalized COVID-19-confirmed patients were analyzed. The clinical signs and laboratory findings were extracted from electronic medical records. Two independent, experienced clinicians reviewed and analyzed the data. Cardiac injury was found in 11.19% (30/268) of enrolled patients. 93.33% (28/30) of cardiac injury cases were in the severe group. The laboratory findings indicated that white blood cells, neutrophils, procalcitonin, C-reactive protein, lactate, and lactic dehydrogenase were positively associated with cardiac injury marker. Compared with healthy controls, the 190 patients without prior hypertension have higher AngⅡ level, of which 16 (8.42%) patients had a rise in blood pressure to the diagnostic criteria of hypertension during hospitalization, with a significantly increased level of the cTnI, procalcitonin, angiotensin-II (AngⅡ) than those normal blood pressure ones. Multivariate analysis indicated that elevated age, cTnI, the history of hypertension, and diabetes were independent predictors for illness severity. The predictive model, based on the four parameters and gender, has a good ability to identify the clinical severity of COVID-19 in hospitalized patients (area under the curve: 0.932, sensitivity: 98.67%, specificity: 75.68%). Hypertension, sometimes accompanied by elevated cTnI, may occur in COVID-19 patients and become a sequela. Enhancing Ang II signaling, driven by SARS-CoV-2 infection, might play an important role in the renin-angiotensin system, and consequently lead to the development of hypertension in COVID-19.
Highlights
In December 2019, an acute respiratory infectious disease known as "coronavirus disease 2019 (COVID-19)" caused by a novel coronavirus occurred in Wuhan, China [1, 2]
The laboratory findings indicated that white blood cells, neutrophils, procalcitonin, C-reactive protein, lactate, and lactic dehydrogenase were positively associated with cardiac injury marker
The results showed that the median age of patients with or without cardiac injury was 74 y/o and 49 y/o with statistical significance
Summary
In December 2019, an acute respiratory infectious disease known as "coronavirus disease 2019 (COVID-19)" caused by a novel coronavirus occurred in Wuhan, China [1, 2]. Coronavirus is a distinct clade from beta coronavirus associated with human severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) [3], and was officially named "SARS-CoV-2" by World Health Organization. Both SARS-CoV and SARS-CoV-2 have been identified to use the angiotensin converting enzyme II (ACE2) receptor as the portal of entry into the affected cell [4, 5]. Understanding the damage to the cardiovascular system caused by SARS-CoV-2 and the underlying mechanisms is of great importance so that these patients can be treated timely, and the mortality can be reduced. We sought to investigate the effect of SARS-CoV-2 infection on cardiac injury and hypertension during the current coronavirus pandemic
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