Background

Myocardial injury in patients with COVID-19 is associated with increased morbidity and mortality during index hospitalization. The purpose of this study is to assess the relationship between CV biomarkers (hsTnT, NT-proBNP) during index hospitalization, and 6-month and 1-year CV, thrombotic, and pulmonary outcomes, readmission rates, functional status, and all-cause mortality.

Methods

Brigham and Women’s Hospital COVID-19 registry is a prospective cohort study of inpatients with documented SARS-CoV-2 infection. Cardiac and immune biomarkers were systematically collected. Clinical outcomes were adjudicated by two clinicians. Multivariable modeling was used to study the association between cardiac injury and longer-term outcomes.

Results

The study cohort includes 500 consecutive patients hospitalized from March to April 2020; 51.4% females, median age 62 (IQR: 50-75), 24.6% Hispanic, 28.6% black non-Hispanic. Median BMI 28.7 (IQR 25-33), 63.6% had HTN, 47.2% HL, 33.4% DM, and 14.8% had CAD. During index hospitalization, 92 (18.4%) died, 66 (13.2%) had thrombotic complications and 127 (25.4%) had CV complications. By 6 months, 104 (20.8%) had died. During index hospitalization, 60.2% of patients had evidence of cardiac injury (hsTnT> 14ng/L); these patients had a 31.2% and 32.2% mortality during index hospitalization and at 6-months, respectively, compared to 3.3% and 4.9% mortality for those who had low level positive and 0% and 0% for those who had undetectable troponin. Of the 408 who were alive after index hospitalization, 84 (20.6%) had at least 1 readmission within 6 months. 8 (9.5%) and 24 (28.6%) of those readmissions involved thrombotic and cardiac complications, respectively. Of the 219 (55.3%) who were alive and had 6-month follow-up, 80 (36.5%) had ongoing COVID-related symptoms, 8 (3.7%) still had an increased supplemental oxygen requirement, 33 (15.1%) had neuro-cognitive decline from baseline, and 41 (18.7%) had worsening functional status requiring additional assistance.

Conclusion

This study provides insights into the relationship between cardiovascular injury during the index hospitalization in COVID-19 patients and longer-term outcomes