Pericardial Effusion in COVID-19 Hospitalized Patients in ICU: Prevalence, Related Factors, and Outcomes

Abstract

Purpose: COVID-19 disease is associated with pericardial effusion through both direct invasions of myocardial tissue and activation of inflammatory processes and oxidative stress. However, its exact mechanism and related implications are unclear. We aimed to evaluate the pericardial effusion in hospitalized patients with a definite diagnosis of COVID-19 and finally to determine underlying factors related to this cardiac event. Finally, the hospital outcome of patients with and without pericardial involvement was compared. Materials and Methods: The hospital records of 1824 patients suffering from COVID-19 were reviewed with respect to pieces evidence of pericardial effusion. Baseline characteristics, cardiovascular risk profiles, laboratory and echocardiography parameters as well as hospital outcomes were reviewed. Results: Out of 1824 patients hospitalized with COVID-19 in our medical center in Intensive Care Unit (ICU) sections, a total of 300 cases (16.4%) (P value <0.05) had evidence of pericardial effusion. Patients with pericardial effusion had much higher mean age, higher mean heart rate and also a higher prevalence of hypertension, diabetes mellitus, and a history of ischemic heart disease compared to those without this complication. The changes in some echocardiography parameters, including left ventricular end-diastolic diameter, E/A ratio, E/Ep ratio, and tricuspid annular plane systolic excursion were more prominent in those with pericardial effusion. Those with pericardial effusion experienced longer hospitalization and ICU admission and the death rate was significantly higher in such patients. Conclusion: The occurrence of pericardial effusion is predictable in about 16.4% of patients with COVID-19, which occurs mainly in older people and people with a history of cardiovascular risk profiles. Pericardial effusion in COVID-19 patients leads to poorer in-hospital outcome.