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Aging and disease    2020, Vol. 11 Issue (4) : 763-769     DOI: 10.14336/AD.2020.0622
Short Communications |
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.
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Abstract  

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.

Keywords COVID-19      cardiovascular disease      clinical features      risk factors      intensive care unit     
Corresponding Authors: Yang Liuping,Cao Jie   
About author: these authors contributed equally to this work.
Just Accepted Date: 26 June 2020   Online First Date: 29 June 2020    Issue Date: 01 August 2020
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He Feng
Quan Yibo
Lei Ming
Liu Riguang
Qin Shuguang
Zeng Jun
Ziwen Zhao
Yu Na
Yang Liuping
Cao Jie
Cite this article:   
He Feng,Quan Yibo,Lei Ming, et al. Clinical features and risk factors for ICU admission in COVID-19 patients with cardiovascular diseases[J]. Aging and disease, 2020, 11(4): 763-769.
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http://www.aginganddisease.org/EN/10.14336/AD.2020.0622     OR
CharacteristicTotal (n=288)non-CVD
(n=203)
CVD
(n=85)
p value
Demographics
Age, median (IOR), years48.5 (34.3, 62.0)43.0 (32.0, 57.0)62.0 (53.3, 67.0)<0.0001
Male, n (%)131 (45.5)85 (41.9)118 (58.1)0.057
Comorbidities
 Hypertension84 (29.2)1 (0.5)83 (97.6)<0.0001
 Diabetes24 (8.3)8 (3.9)16 (18.8)<0.0001
 Chronic kidney disease8 (2.8)3 (1.5)5 (5.9)0.038
 COPD5 (1.7)1 (0.5)4 (4.8)0.012
 Cerebrovascular disease8 (2.8)0 (0.0)8 (9.4)<0.0001
 Chronic liver disease10 (3.5)6 (3.0)4 (4.7)0.459
 Malignancy6 (2.1)4 (2.0)2 (2.4)0.836
Signs and symptoms
 Fever201 (69.8)146 (71.9)55 (64.7)0.224
 Chill55 (19.1)44 (21.7)11 (12.9)0.085
 Cough163 (56.6)110 (54.2)53 (62.4)0.202
 Rhinorrhea18 (6.3)11 (5.4)7 (8.2)0.368
 Sore throat67 (23.3)44 (21.7)23 (27.1)0.324
 Fatigue43 (14.9)34 (16.7)9 (10.6)0.181
 Myalgia or arthralgia35 (12.2)25 (12.3)10 (11.8)0.896
 Headache26 (9.0)21 (10.3)5 (5.9)0.228
 Nausea28 (9.7)22 (10.8)6 (7.1)0.324
 Diarrhea11 (3.8)10 (4.9)1 (1.2)0.13
Respiratory rate
≥24 breaths per min
19 (6.6)8 (3.9)11 (12.9)0.005
Oxygen support
 None88 (30.6)65 (32.0)23 (27.1)0.405
 Normal-flux184 (63.9)131 (64.5)53 (62.4)0.725
 High-fux16 (5.6)7 (3.4)9 (10.6)0.016
Non-invasive mechanical
ventilation
32 (11.1)15 (7.4)17 (20)0.002
Unilateral pneumonia241 (83.7)165 (81.3)76 (89.4)0.089
Bilateral pneumonia31 (10.8)25 (12.4)6 (7.1)0.185
Laboratory variables
White blood cell, × 109/L5.20 (4.14, 6.44)5.01(4.03, 6.22)5.64 (4.42, 7.18)0.271
White blood cell count, × 109/L
(No. (%))
0.109
 ≤462 (21.5)49 (24.1)13 (15.3)
 4-10216 (75.0)149 (73.4)67 (78.8)
 >1010 (3.5)5 (2.5)5 (5.9)
Lymphocyte count, × 109/L1.42 (1.04, 1.96)1.45 (1.06, 2)1.31 (0.9, 1.84)0.373
Lymphocyte count, × 109/L
(No. (%))
0.751
<1.191 (31.6)63 (31.0)28 (32.9)
Platelet count, × 109/L194.5 (158, 247)196 (160, 248)190 (153, 240.5)0.762
Hemoglobin, g/L135.5 (123, 147)135 (123, 146)136 (121.5, 147.5)0.782
Procalcitonin, ng/mL0.13 (0.04, 32.6)0.09 (0.03, 32.6)0.30 (0.05, 34.9)0.314
C-reactive protein, mg/L9 (8, 22.7)9 (8, 18.04)13.18 (8, 37.5)0.004
C-reactive protein, mg/L
(No. (%))
0.001
 ≤10175 (60.8)136 (67)39 (45.9)
>10113 (39.2)67 (33)46 (54.1)
Troponin I, μg/L (No. (%))0.002
 ≤0.03168 (88.4)116 (93.5)52 (78.8)
 >0.0322 (11.6)8 (6.5)14 (21.2)
BNP, μg/L35 (13, 117.5)18.5 (9, 74.5)45 (22, 179)0.177
Creatine kinase, U/L52 (36, 80)54 (38, 80)48.5 (28.75, 82.5)0.385
Creatinine, μmol/L61.8 (50.2, 76.58)58.8 (48.1, 74.9)66.9 (52.1, 78)0.001
ATL, U/L22.45 (14.3, 34.5)22.4 (14, 34.4)22.5 (15.9, 34.9)0.317
AST, U/L18.35 (14.9, 25.63)17.7 (13.7, 24.5)19.4 (16.4, 27.4)0.105
Complications
Acute cardiac injury22 (11.6)8 (6.5)14 (21.2)0.020
ARDS3 (1.0)1 (0.5)2 (2.4)0.156
Acute kidney injury5 (1.7)2 (1.0)3 (3.5)0.132
Clinical Types a
(Severe/Critically severe)
30 (10.4)15 (7.4)15 (17.6)0.009
ICU Admission27 (9.4)12 (5.9)15 (17.6)0.002
Table 1  Clinical features of COVID-19 patients with CVD.
Univariable
OR (95% CI)
p valueMultivariable
OR (95% CI)
p value
Age, years1.09 (1.02-1.15)0.0101.08 (1.02-1.17)0.018
Female sex (vs. male)0.24 (0.06-0.91)0.0360.18 (0.29-1.06)0.058
Diabetes1.76 (0.48-6.46)0.396....
Chronic kidney disease3.44 (0.52-22.64)0.199....
COPD1.72 (0.17-17.83)0.650....
Cerebrovascular disease1.64 (0.30-9.05)0.57....
Fever1.63 (0.47-5.63)0.444....
Cough2.83 (0.73-10.93)0.132....
Respiratory rate ≥24 breaths per min37.77 (5.52-258.28)<0.000125.52 (5.48-118.87)<0.0001
White blood cell count, ×109/L
≤400.999....
4-101(ref)......
>102.77 (0.42-18.31)0.291....
Lymphocyte count, ×109/L
<1.15.78 (1.74-19.18)0.0040.47 (0.15-1.52)0.210
≥1.11(ref)..1(ref)..
Procalcitonin, ng/mL
<0.051(ref)..1(ref)..
0.05-104.07 (0.78-21.27)0.0964.13 (0.42-40.77)0.225
>101.31 (0.22-7.87)0.7680.48 (0.03-7.44)0.602
C-reactive protein, mg/L
<101(ref)..1(ref)..
≥1024.57 (5.69-106.13)<0.00018.12 (1.63-40.49)0.011
Troponin I, ug/L
≤0.031(ref)..1(ref)..
>0.0314.72 (5.03-43.13)<0.00019.14 (2.66-31.43)<0.0001
BNP, 100 μg/L
≤1001(ref)......
>10060 (5.47-658.76)0.001....
Creatinine, μmol/L
≤1061(ref)..1(ref)..
>1065.31 (1.25-22.60)0.0242.00 (0.18-22.08)0.572
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.
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