Clinical Characteristics and Predictors of Mortality in Hospitalized COVID-19 Patients with Pre-existing Cardiovascular Disease

International Journal of Medicine and Medical Sciences | Vol. 10, No. 8, August 2020 | pp. 58–65

DOI: 10.46882/2020/IJMMS/100058

Original Research Article

Clinical Characteristics and Predictors of Mortality in Hospitalized COVID-19 Patients with Pre-existing Cardiovascular Disease

Chidi O. Okafor¹, Amina J. Hassan², Samuel K. Appiah¹*

¹Department of Medicine, College of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria.

²Department of Cardiology, Korle Bu Teaching Hospital, Accra, Ghana.

Abstract:

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) causes severe multi-organ dysfunction, with high vulnerability seen in patients with pre-existing cardiovascular disease (CVD). This prospective cohort study evaluated the clinical characteristics and distinct predictors of in-hospital mortality among hospitalized COVID-19 patients with underlying CVD. We enrolled 180 laboratory-confirmed COVID-19 adult patients with documented CVD (ischemic heart disease, heart failure, or systemic hypertension) admitted to isolation centers. Demographic, clinical, and laboratory profiles were captured at admission, and outcomes were tracked until discharge or death. The mean age of the cohort was 62.4 ± 8.5 years, and 58.3% were male. The overall in-hospital mortality rate was 22.2% (40/180). Deceased patients presented with significantly higher baseline levels of serum D-dimer (mean = 2.4 ± 0.6 μg/mL vs. 0.8 ± 0.2 μg/mL in survivors, p < 0.01), High-Sensitivity Cardiac Troponin I (hs-cTnI) (mean = 45.8 ± 12.4 ng/L vs. 12.3 ± 3.1 ng/L, p < 0.01), and C-reactive protein (CRP) (mean = 84.2 ± 15.6 mg/L vs. 24.5 ± 5.2 mg/L, p < 0.01). Multivariate logistic regression modeling demonstrated that advanced age ≥ 65 years (OR = 3.2, 95% CI = 1.5–6.8, p < 0.01), hs-cTnI elevation > 28 ng/L (OR = 4.1, 95% CI = 2.0–8.4, p < 0.001), and severe lymphopenia < 0.8 × 10⁹/L (OR = 2.8, 95% CI = 1.2–6.1, p < 0.05) were independent predictors of mortality. Cardiovascular comorbidities worsen the prognosis of COVID-19. Elevated biomarkers of cardiac injury and hypercoagulability at admission serve as crucial tools for risk stratification, necessitating aggressive early therapeutic intervention.

Keywords: COVID-19, SARS-CoV-2, Cardiovascular Disease, Biomarkers, Troponin I, Mortality Predictors

Manuscript Timeline: Received: May 20, 2020; Revised: June 28, 2020; Accepted: July 15, 2020; Published: August 14, 2020.

Citation: Okafor CO, Hassan AJ, Appiah SK. Clinical Characteristics and Predictors of Mortality in Hospitalized COVID-19 Patients with Pre-existing Cardiovascular Disease. International Journal of Medicine and Medical Sciences, 2020, 10(8): 58–65. DOI: 10.46882/2020/IJMMS/100058

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