Mortality Predictors in Patients with Cardiovascular Involvement by COVID-19

Abstract

Introduction: SARS-CoV-2 is a new coronavirus responsible for one of the most evident diseases today, COVID-19, registering approximately 419,000 deaths until 2020. Some risk factors for infection and mortality must be assessed in clinical and research scenarios, such as the presence of cardiovascular diseases, with clinical and laboratory alterations. Objective: Our study aims to analyze the association between clinical and laboratory data and in-hospital mortality in patients with cardiovascular involvement by COVID-19 in Brazil. Method: This is a retrospective, observational, single-center cohort study. The sample consisted of patients admitted to a reference hospital from July 2020 to April 2021. We included patients over 18 years of age, hospitalized with COVID-19 infection, who developed heart involvement identified by clinical or laboratory findings. Patients who were pregnant or had negative serological tests for COVID-19 were excluded. Clinical variables such as gender, age, comorbidities, medications used during hospitalization, chest computed-tomography findings, need for intensive care unit, need for mechanical ventilation, and need for intravenous vasoactive drugs were analyzed. The laboratory variables analyzed were: troponin, NT-proBNP and D-dimer levels. The endpoint of the study was in-hospital death. Statistical analysis of the collected data was performed using Pearson's Chi-square test, Student's T test; p values < 0.05 were considered statistically significant. Results: 139 patients were included, and 30 (21.58%) patients died during hospitalization. The group that evolved to death, compared to the discharge group, was older (71 vs 65 years; p = 0.03), had more pleural effusion on chest computed-tomography (36% vs 17%; p = 0.023), had higher troponin levels (40% vs 20%; p = 0.02), more need for intensive care (83% vs 52%; p = 0.002), orotracheal intubation (83% vs 26%; p = 0.001), use of norepinephrine (76% vs 18%; p = 0.001), use of dobutamine (16% vs 4%; p = 0.023), and use of unfractioned heparin (46% vs 21%; p = 0.005). Conclusion: Advanced age was significantly associated with in-hospital death. In radiological patterns, despite the high incidence of ground-glass opacities, pleural effusion was the only finding associated with mortality. Increased troponin levels, but not NT-proBNP or D-dimer, was associated with in-hospital mortality. The need for norepinephrine and dobutamine, in addition to Intensive Care Unit admission and orotracheal Intubation, were also more frequent in the group that presented death during hospitalization, as wells as the use of unfractionated heparin rather than enoxaparin.