• Daoyuan Si, Beibei Du, Lujia Ni, Bo Yang, Huan Sun, Nan Jiang, Guohui Liu, Stéphane Massé, Lina Jin, Jared Nanthakumar, Abhishek Bhaskaran, Ping Yang, and Kumaraswamy Nanthakumar.
• Department of Cardiology (Si, Du, Sun, Liu, Yang), The Third Hospital of Jilin University, Jilin Provincial Molecular Biology Research Center for Precision Medicine of Major Cardiovascular Disease, Changchun, China; Department of Ultrasound (Ni), The Third Hospital of Jilin University, Changchun, China; Institute of Organ Transplantation (Yang), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Intensive Care Unit (Jiang), The Third Hospital of Jilin University, Changchun, China; The Hull Family Laboratory (Massé, J. Nanthakumar, Bhaskaran, K. Nanthakumar), Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ont.; Department of Epidemiology and Biostatistics (Jin), School of Public Health, Jilin University, Changchun, Jilin, China sidaoyuan@jlu.edu.cn kumar.nanthakumar@uhn.ca.
• CMAJ. 2020 Jul 13; 192 (28): E791-E798.

BackgroundCardiac injury is common in severe coronavirus disease 2019 (COVID-19) and is associated with poor outcomes. We aimed to study predictors of in-hospital death, characteristics of arrhythmias and the effects of QT-prolonging therapy in patients with cardiac injury.MethodsWe conducted a retrospective cohort study involving patients with severe COVID-19 who were admitted to Tongji Hospital in Wuhan, China, between Jan. 29 and Mar. 8, 2020. Among patients who had cardiac injury, which we defined as an elevated level of cardiac troponin I (cTnI), we identified demographic and clinical characteristics associated with mortality and need for invasive ventilation.ResultsAmong 1284 patients with severe COVID-19, 1159 had a cTnI level measured on admission to hospital, of whom 170 (14.7%) had results that showed cardiac injury. We found that mortality was markedly higher in patients with cardiac injury (71.2% v. 6.6%, p < 0.001). We determined that initial cTnI (per 10-fold increase, hazard ratio [HR] 1.32, 95% confidence interval [CI] 1.06-1.66) and peak cTnI level during illness (per 10-fold increase, HR 1.70, 95% CI 1.38-2.10) were associated with poor survival. Peak cTnI was also associated with the need for invasive ventilation (odds ratio 3.02, 95% CI 1.92-4.98). We found arrhythmias in 44 of the 170 patients with cardiac injury (25.9%), including 6 patients with ventricular tachycardia or fibrillation, all of whom died. We determined that patients who received QT-prolonging drugs had longer QTc intervals than those who did not receive them (difference in medians, 45 ms, p = 0.01), but such treatment was not independently associated with mortality (HR 1.04, 95% CI 0.69-1.57).InterpretationWe found that in patients with COVID-19 and cardiac injury, initial and peak cTnI levels were associated with poor survival, and peak cTnI was a predictor of need for invasive ventilation. Patients with COVID-19 warrant assessment for cardiac injury and monitoring, especially if therapy that can prolong repolarization is started.Trial RegistrationChinese Clinical Trial Registry, No. ChiCTR2000031301.© 2020 Joule Inc. or its licensors.

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