COVID-19 Research Paper Volume 12, Issue 23 pp 23464—23477

Risk factors for COVID-19 patients with cardiac injury: pulmonary ventilation dysfunction and oxygen inhalation insufficiency are not the direct causes

Sucheng Mu1, *, , Wei Wei1, *, , Chaoyuan Jin1, *, , Ning Pu2, , Kaihuan Yu3, , Guorong Gu1, , Zhe Luo4, , Chaoyang Tong1, , Yi Han1, ,

  • 1 Emergency Department, Zhongshan Hospital, Fudan University, Shanghai 200032, PR China
  • 2 Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, PR China
  • 3 Department of Hepatobiliary Surgery, Remin Hospital of Wuhan University, Wuhan 430060, PR China
  • 4 Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, PR China
* Co-first authors

Received: July 13, 2020       Accepted: August 21, 2020       Published: November 23, 2020
How to Cite

Copyright: © 2020 Mu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Background: Cardiac injury in patients with coronavirus disease 2019 (COVID-19) has been reported in recent studies. However, reports on the risk factors for cardiac injury and their prognostic value are limited.

Results: In total, 15.9% of all cases were defined as cardiac injury in our study. Patients with severe COVID-19 were significantly associated with older age and higher respiratory rates, Sequential Organ Failure Assessment (SOFA) scores, cardiac injury biomarkers and PaO2/FiO2 ratios. Male patients with chest distress and dyspnea were more likely to have severe disease. Patients with cardiac injury were significantly more likely to have a severe condition and have an outcome of death. However, no significant difference was found in respiratory rates, dyspnea or PaO2/FiO2 ratio between patients with or without cardiac injury. In the logistic regression model, pre-existing hypertension and higher SOFA score were independent risk factors for patients with COVID-19 developing cardiac injury.

Conclusions: Our study revealed that cardiac injury was an important predictor for patients having a severe or fatal outcome. Patients with pre-existing hypertension and higher SOFA scores upon admission were more likely to develop cardiac injury. Nevertheless, pulmonary ventilation dysfunction and oxygen inhalation insufficiency were not the main causes of cardiac injury in patients with COVID-19.

Methods: A total of 113 confirmed cases were included in our study. Severe patients were defined according to American Thoracic Society guidelines for community-acquired pneumonia. Cardiac injury was defined as a serum cTnI above the 99th-percentile of the upper reference limit. Patient characteristics, clinical laboratory data and treatment details were collected and analyzed. The risk factors for patients with and without cardiac injury were analyzed.


APACHE II: Acute Physiology and Chronic Health Evaluation II; ARDS: Acute Respiratory Distress Syndrome; AST: aspartate transaminase; BNP: brain natriuretic peptide; CK: creatine kinase; CK-MB: creatine kinase-MB; COVID-19: coronavirus disease 2019; CREA: creatinine; CRP: C-reactive protein; cTnI: cardiac troponin I; IQR: interquartile range; LDH: lactate dehydrogenase; PSI: pneumonia severity index; SOFA: Sequential Organ Failure Assessment; TB: total bilirubin.