Clinical features and risk factors for ICU admission in COVID-19 patients with cardiovascular diseases
Feng He1, Yibo Quan1, Ming Lei2, Riguang Liu1, Shuguang Qin1, Jun Zeng1, Ziwen Zhao1, Na Yu1, Liuping Yang2,*, Jie Cao1,*
1Guangzhou First People's Hospital, The Second Affiliated Hospital of South China University of Technology, Guangzhou, China. 2Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China.
Previous studies on coronavirus disease 2019 (COVID-19) have focused on the general population. However, cardiovascular disease (CVD) is a common comorbidity that has rarely been investigated in detail. This study aims to describe clinical characteristics and determine risk factors for intensive care unit (ICU) admission of COVID-19 patients with CVD. In this retrospective cohort study, we included 288 adult patients with COVID-19 in Guangzhou Eighth People's Hospital from January 15, 2020 to March 10, 2020. Demographic characteristics, laboratory results, radiographic findings, complications, and treatments were recorded and compared between CVD and non-CVD groups. A binary logistic regression model was used to identify risk factors associated with ICU admission for infected patients with underlying CVD. COVID-19 patients in the CVD group were older and had higher levels of troponin I (TnI), C-reactive protein (CRP), and creatinine. They were also more prone to develop into severe or critically severe cases, receive ICU admission, and require respiratory support treatment. Multivariate regression analysis showed that the following were risk factors for ICU admission in COVID-19 patients with CVD: each 1-year increase in age (odds ratio (OR), 1.08; 95% confidence interval (CI), 1.02-1.17; p = 0.018); respiratory rate over 24 times per min (OR, 25.52; 95% CI, 5.48-118.87; p < 0.0001); CRP higher than 10 mg/L (OR, 8.12; 95% CI, 1.63-40.49; p = 0.011); and TnI higher than 0.03 μg/L (OR, 9.14; 95% CI, 2.66-31.43; p < 0.0001). Older age, CRP greater than 10 mg/L, TnI higher than 0.03 μg/L, and respiratory rate over 24 times per minute were associated with increasing odds of ICU admission in COVID-19 patients with CVD. Investigating and monitoring these factors could assist in the risk stratification of COVID-19 patients with CVD at an early stage.
Table 1 Clinical features of COVID-19 patients with CVD.
Univariable OR (95% CI)
Multivariable OR (95% CI)
Female sex (vs. male)
Chronic kidney disease
Respiratory rate ≥24 breaths per min
White blood cell count, ×109/L
Lymphocyte count, ×109/L
C-reactive protein, mg/L
Troponin I, ug/L
BNP, 100 μg/L
Table 2 Risk factors of ICU admission for COVID-19 patients with CVD.
Figure 1. Representative chest computed tomography (CT) images of COVID-19 pneumonia in a non-cardiovascular disease (CVD) case and a CVD case. Top panel: A 60-year-old man with COVID-19, but not CVD: chest CT images showed ground-glass opacity (GGO) and patchy consolidation with peripheral and subpleural distribution, which had been absorbed at 21 days after hospitalization with treatment. Bottom panel: A 65-year-old man with both COVID19 and CVD: chest CT images showed diffusely subpleural consolidation with a crazy-paving pattern. Diffuse shadowing and consolidation were seen on chest radiography after intensive care unit (ICU) admission with extracorporeal membrane oxygenation (ECMO) support at day 16.
Lan J, Ge J, Yu J, Shan S, Zhou H, Fan S, et al. (2020). Structure of the SARS-CoV-2 spike receptor-binding domain bound to the ACE2 receptor. Nature, 581:215-220.
Clerkin KJ, Fried JA, Raikhelkar J, Sayer G, Masoumi A, et al. (2020). COVID-19 and Cardiovascular Disease. Circulation, 141:1648-1655.
Sankha SC, Upinder K, Anindita B, Upasana G, Tuhina B, Sarama S, et al. (2020). COVID-19 in India: Are Biological and Environmental Factors Helping to Stem the Incidence and Severity? Aging Dis, 11:480-488.
Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. (2020). Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA.
Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. (2020). Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet, 395:1054-1062.
Wu Z, McGoogan JM (2020). Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72314 Cases from the Chinese Center for Disease Control and Prevention. JAMA, in press.
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. (2020). Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet, 395:497-506.
Stewart J, Manmathan G, Wilkinson P (2017). Primary prevention of cardiovascular disease: A review of contemporary guidance and literature. JRSM Cardiovasc Dis, 6:2048004016687211.
Yang J, Zheng Y, Gou X, Pu K, Chen Z, Guo Q, et al. (2020). Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis. Int J Infect Dis, 94:91-95.
Driggin E, Madhavan MV, Bikdeli B, Chuich T, Laracy J, Biondi-Zoccai G, et al. (2020). Cardiovascular Considerations for Patients, Health Care Workers, and Health Systems During the COVID-19 Pandemic. J Am Coll Cardiol, 75:2352-2371.
Opal SM, Girard TD, Ely EW (2005). The immunopathogenesis of sepsis in elderly patients. Clin Infect Dis, 41 Suppl 7:S504-512.
Qin C, Zhou L, Hu Z, Zhang S, Yang S, Tao Y, et al. (2020). Dysregulation of immune response in patients with COVID-19 in Wuhan, China. Clin Infect Dis, in press.
Guo T, Fan Y, Chen M, Wu X, Zhang L, He T, et al. (2020). Cardiovascular Implications of Fatal Outcomes of Patients with Coronavirus Disease 2019 (COVID-19). JAMA Cardiol, in press.
Zheng YY, Ma YT, Zhang JY, Xie X (2020). COVID-19 and the cardiovascular system. Nat Rev Cardiol, 17:259-260.
Ferrario CM, Jessup J, Chappell MC, Averill DB, Brosnihan KB, Tallant EA, et al. (2005). Effect of angiotensin-converting enzyme inhibition and angiotensin II receptor blockers on cardiac angiotensin-converting enzyme 2. Circulation, 111:2605-2610.
Zhang P, Zhu L, Cai J, Lei F, Qin JJ, Xie J, et al. (2020). Association of Inpatient Use of Angiotensin Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers with Mortality Among Patients with Hypertension Hospitalized With COVID-19. Circ Res, in press.
Nir Barzilai, James C Appleby, Steven N Austad, Ana Maria Cuervo, Matt Kaeberlein, Christian Gonzalez-Billault, Stephanie Lederman, Ilia Stambler, Felipe Sierra. Geroscience in the Age of COVID-19[J]. Aging and disease, 2020, 11(4): 725-729.