Impact of heart failure on all-cause mortality in COVID-19: findings from the Eurasian International Registry

Comorbidities and mortality risk in COVID-19 patients with congestive heart failure: A comprehensive analysis

The COVID-19 pandemic has posed unprecedented challenges to global healthcare systems, resulting in alarming incidence and mortality rates among patients with comorbidities, including heart failure. Understanding the characteristics of heart failure and other comorbidities during the COVID-19 pandemic is crucial for effective prevention and treatment. However, the current understanding of these characteristics among different racial groups remains incomplete. In this study, we investigated a cohort of 4711 patients, classifying them into congestive heart failure (CHF) and non-CHF groups. Biomarker analysis revealed noteworthy variations in blood urea nitrogen, aspartate aminotransferase, and white blood cell levels based on the presence or absence of CHF. Stratified by three racial groups, univariate logistic regression analysis identified significant differences in multiple variables, including CHF. Subsequent univariate Cox regression and Kaplan-Meier analysis demonstrated variations in mortality factors among distinct populations, with age and comorbidity playing prominent roles. This study utilized a large-scale database to investigate the characteristics of heart failure and related variables during the COVID-19 pandemic. The findings revealed distinctive mortality risk factors among various racial groups, emphasizing the significance of customized risk assessment and management approaches for diverse populations. These findings also provide a valuable resource for the development of targeted interventions and the promotion of equitable healthcare outcomes in the context of the COVID-19 pandemic.

Coronary artery calcification score as a prognostic indicator for COVID-19 mortality: evidence from a retrospective cohort study in Iran

Background

Coronary artery calcification (CAC) has been established as an independent risk factor for major adverse cardiovascular events. Nevertheless, the effect of CAC on in-hospital mortality and adverse clinical outcomes in patients with COVID-19 has yet to be determined.

Objective

To investigate the association between CAC score and in-hospital mortality of COVID-19 patients.

Method

This retrospective cohort study was conducted across tertiary hospitals of University of Medical Sciences in Babol, a northern city in Iran, and enroled 551 confirmed COVID-19 patients with definitive clinical outcomes of death or discharge between March and October 2021. Demographic and clinical data, along with chest computed tomography (CT) findings and CAC score on admission, were systematically collected. The study utilized logistic regression analysis and Kaplan-Meier plots to explore the association between CAC score and in-hospital death and adverse clinical outcomes.

Results

The mean age was 60.05±12.8. A significant difference regarding CAC score, age, history of hypertension, hyperlipidemia, cardiovascular diseases, and respiratory diseases among survivors and non-survivors was observed; however, gender was not found to be different. Furthermore, in multivariate analysis, CAC score greater than or equal to 400 [odds ratio (OR): 4.2, 95% CI: 1.70-10.33, P value: 0.002], hospitalization time (OR: 1.31, 95% CI: 1.13-1.53, P value < 0.001), length of ICU stay (OR: 2.02, 95% CI: 1.47-2.77, P value < 0.001), severe or critical COVID-19 severity in time of admission (95% CI: 1.79-18.29, P value: 0.003), and history of respiratory diseases (95% CI: 2.18-40, P value: 0.003) were found to be associated with higher odds of in-hospital mortality. Log-rank test also revealed a significant difference regarding the time of admission to death between patients with CAC score greater than or equal to 400 and those with CAC score less than 400 (P value < 0.001).

Conclusion

Elevated CAC score is a crucial risk factor linked to in-hospital mortality and unfavourable clinical results in confirmed COVID-19 patients. This finding emphasizes the need for careful monitoring of individuals with high CAC scores.

New score to predict COVID-19 progression in vaccine and early treatment era: the COVID-19 Sardinian Progression Score (CSPS)

BACKGROUND

Several scores aimed at predicting COVID-19 progression have been proposed. As the variables vaccination and early SARS-CoV-2 treatment were systematically excluded from the prognostic scores, the present study's objective was to develop a new model adapted to the current epidemiological scenario.

METHODS

We included all patients evaluated by the Infectious Disease Unit in Sassari, with SARS-CoV-2 infection and without signs of respiratory failure at the first evaluation (P/F > 300). Disease progression was defined by the prescription of supplemental oxygen. In addition, variables related to demographics, vaccines, comorbidities, symptoms, CT scans, blood tests, and therapies were collected. Multivariate logistic regression modelling was performed to determine factors associated with progression; any variable with significant univariate test or clinical relevance was selected as a candidate for multivariate analysis. Hosmer-Lemeshow (HL) goodness of fit statistic was calculated. Odds ratio values were used to derive an integer score for developing an easy-to-use progression risk score. The discrimination performance of the risk index was determined using the AUC, and the best cut-off point, according to the Youden index, sensitivity, specificity, predictive value, and likelihood ratio, was chosen.

RESULTS

1145 patients [median (IQR) age 74 (62-83) years; 53.5% males] were enrolled; 336 (29.3%) had disease progression. Patients with a clinical progression were older and showed more comorbidities; furthermore, they were less vaccinated and exposed to preventive therapy. In the multivariate logistic regression analysis, age ≥ 60 years, COPD, dementia, haematological tumours, heart failure, exposure to no or one vaccine dose, fever, dyspnoea, GGO, consolidation, ferritin, De Ritis ≥ 1.2, LDH, and no exposure to early anti-SARS-CoV-2 treatment were associated with disease progression. The final risk score ranged from 0 to 45. The ROC curve analysis showed an AUC of 0.92 (95% CI 0.90-0.93) with a 93.7% specificity and 72.9% sensitivity. Low risk was defined when the cut-off value was less than 23. Three risk levels were identified: low (0-23 points), medium (24-35), and high (≥ 36).

CONCLUSIONS

The proportion of patients with progression increases with high scores: the assessment of the risk could be helpful for clinicians to plan appropriate therapeutic strategies.

Correlation between coronary artery calcification and COVID-19

Background

Coronary heart disease (CHD) is an underlying cardiac condition contributing to increased COVID-19 mortality and morbidity which can be assessed by several diagnosis methods including coronary artery calcification (CAC). The goal of this study was to find out if there were potential links between CAC, clinical findings, severity of COVID-19, and in-hospital outcomes.

Methods

This retrospective study evaluated 551 suspected patients admitted to teaching hospitals of the Babol University of Medical Sciences, Babol, Iran, from March to October 2021. Data included previous diseases, comorbidities, clinical examinations, routine laboratory tests, demographic characteristics, duration of hospitalization, and number of days under ventilation were recorded in a checklist.

Results

Findings of current study provide evidence of a significant relationship between coronary artery calcification (CAC) and in-hospital mortality. Additionally, we observed significant correlations between CAC and several clinical parameters including age, duration of hospitalization, pulse rate, maximum blood pressure, erythrocyte sedimentation rate (ESR), blood urea nitrogen (BUN), neutrophil count, white blood cell (WBC) count, and oxygen saturation. However, we did not observe a significant association between CAC and the severity index of COVID-19. In addition, logistic regression tests did not find a significant value of CAC to predict in-hospital mortality.

Conclusion

Our findings showed a significant relationship between CAC and in-hospital mortality.

The Influence of SARS-CoV-2 Infection on Acute Myocardial Infarction Outcomes

BACKGROUND

This multicenter retrospective study with a control group was designed to assess the influence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on the outcomes of patients with myocardial infarction (MI).

METHODS

A total of 129 patients with COVID-19 who were treated for MI were included in this study. The control group comprised 129 comparable patients without SARS-CoV-2 infection. The in-hospital, out-of-hospital, and overall mortality were analyzed.

RESULTS

A total of thirty-one (24%) patients died in the study group, and two (1.6%) patients died in the control group (OR = 20.09; CI: 4.69-85.97; p < 0.001). Similar results were observed in all analyzed patient subgroups. Multivariable Cox regression analysis confirmed the significant influence of SARS-CoV-2 infection on in-hospital outcomes (HR: 8.48459; CI: 1.982-36.320; p = 0.004). Subanalysis of the groups with COVID-19 plus ST-elevation MI (STEMI) or non-ST-elevation MI (NSTEMI) revealed comparable mortality rates: 14 (21.12%) patients in the NSTEMI group and 17 (26.98%) patients in the STEMI subgroup died (OR: 1.3; CI: 0.56-3.37; p = 0.45). During out-of-hospital observation, no differences in mortality were observed (OR: 0.77; CI: 0.11-4.07; p = 0.73).

CONCLUSIONS

SARS-CoV-2 infection affects the in-hospital outcomes of patients with both MI and COVID-19, regardless of MI type (STEMI vs. NSTEMI).