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Journal of Peking University (Health Sciences) ›› 2020, Vol. 52 ›› Issue (3): 420-424. doi: 10.19723/j.issn.1671-167X.2020.03.004

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Risks factors for death among COVID-19 patients combined with hypertension, coronary heart disease or diabetes

Hang YANG1,Lin-cheng YANG2,Rui-tao ZHANG2,Yun-peng LING1,△(),Qing-gang GE3,△()   

  1. 1. Department of Cardiac Surgery
    2. Department of Cardiology
    3. Department of Intensive Care Unit, Peking University Third Hospital, Beijing 100191, China
  • Received:2020-04-13 Online:2020-06-18 Published:2020-06-30
  • Contact: Yun-peng LING,Qing-gang GE E-mail:micsling@163.com;qingganggelin@126.com

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Abstract:

Objective: The pathogenesis of myocardial injury upon corona virus disease 2019 (COVID-19) infection remain unknown,evidence of impact on outcome is insufficient, therefore, we aim to investigate the risk factors for death among COVID-19 patients combined with hypertension, coronary heart disease or diabetes in this study.Methods: This was a single-centered, retrospective, observational study. Patients of Sino-French Eco-City section of Tongji Hospital, Wuhan, China attended by Peking University Supporting Medical Team and admitted from Jan. 29, 2020 to Mar. 20, 2020 were included. The positive nucleic acid of COVID-19 virus and combination with hypertension, coronary heart disease or diabetes were in the standard. We collected the clinical data and laboratory examination results of the eligible patients to evaluate the related factors of death.Results: In the study, 94 COVID-19 patients enrolled were divided into the group of death (13 cases) and the group of survivors (81 cases), the average age was 66.7 years. Compared with the survival group, the death group had faster basal heart rate(103.2 beats/min vs. 88.4 beats /min, P=0.004), shortness of breath(29.0 beats /min vs. 20.0 beats /min, P<0.001), higher neutrophil count(9.2×109/L vs. 3.8×109/L, P<0.001), lower lymphocyte count(0.5×109/L vs. 1.1×109/L, P<0.001), creatine kinase MB(CK-MB, 3.2 μg/L vs. 0.8 μg/L, P<0.001), high sensitivity cardiac troponin Ⅰ(hs-cTnⅠ, 217.2 ng/L vs. 4.9 ng/L, P<0.001), N-terminal pro brain natriuretic peptide(NT-proBNP; 945.0 μg/L vs. 154.0 μg/L, P<0.001), inflammatory factor ferritin(770.2 μg/L vs. 622.8 μg/L , P=0.050), interleukin-2 recepter(IL-2R, 1 586.0 U/mL vs. 694.0 U/mL, P<0.001), interleukin-6(IL-6, 82.3 ng/L vs. 13.0 ng/L, P<0.001), interleukin-10(IL-10, 9.8 ng/L vs. 5.0 ng/L, P<0.001)were higher than those in the survival group. Univariate logistic regression analysis showed that the risk factors for death were old age, low non oxygen saturation, low lymphocyte count, myocardial injury, abnormal increase of IL 2R, IL-6, and IL-10. Multivariate regression showed that old age (OR=1.11, 95%CI=1.03-1.19, P=0.026), low non oxygen saturation(OR=0.85, 95%CI=0.72-0.99, P=0.041), and abnormal increase of IL-10(>9.1 ng/L, OR=101.93, 95%CI=4.74-2190.71, P=0.003)were independent risk factors for COVID-19 patients combined with hypertension, coronary heart disease or diabetes.Conclusion: In COVID-19 patients combined with hypertension, coronary heart disease or diabetes, the risk factors for death were old age, low non oxygen saturation, low lymphocyte count, myocardial injury, and abnormal increase of IL-2R, IL-6, and IL-10. Old age, low non oxygen saturation and abnormal increase of IL-10 were independent risk factors.

Key words: COVID-19, Hypertension, Coronary heart disease, Diabetes, Risk factors

CLC Number: 

  • R563.1

Table 1

Distribution of COVID-19 patients combined with hypertension, coronary heart disease or diabetes"

Items Death group
(n=13)		 Survival group
(n=81)
Hypertension 7 47
Diabetes 2 3
CHD 0 6
Hypertension & diabetes 1 13
Hypertension & CHD 1 4
Diabetes & CHD 1 1
Hypertension & diabetes & CHD 1 7

Table 2

Demographic and baseline informations"

Items Death group(n=13) Survival group(n=81) t/Z/χ2 P
General information
Age/years, M(IQR) 77.0 (67.5, 83.0) 66.0 (59.0, 72.5) -2.894 0.731
Male, n(%) 8 (61.5) 37 (45.7) 1.129 0.288
Vital signs on admission
Heart rate/(beats/min), x?±s 103.2±15.8 88.4±16.7 2.997 0.004
Systolic pressure/mmHg, M(IQR) 135.0 (109.0, 161.5) 140.0 (125.0, 149.5) -0.526 0.599
Diastolic pressure (mmHg), x?±s 84.6±15.7 84.0±13.1 0.156 0.876
Respiratory rate/(beats/min), M(IQR) 29.0 (24.0, 30.0) 20.0 (20.0, 24.0) -3.689 <0.001
SpO2/%, M(IQR) 89.0 (78.5, 94.5) 96.0 (94.0, 98.0) -3.232 1.000
Complete blood count
WBC (×109/L), M(IQR) 10.2 (6.3, 14.7) 5.6 (4.5, 7.8) -3.242 1.000
Neutrophil (×109/L), M(IQR) 9.2 (5.5, 13.9) 3.8 (2.7, 5.9) -3.510 <0.001
Lymphocyte (×109/L), M(IQR) 0.5 (0.3, 0.7) 1.1 (0.7, 1.5) -3.719 <0.001
Creatinine/(μmol/L), M(IQR) 86.0 (73.5, 112.5) 74.0 (57.0, 92.0) -1.807 0.073
Biomarkers of myocardial injury
CK-MB/(μg/L), M(IQR) 3.2 (2.3, 6.9) 0.8 (0.5, 1.0) -4.196 <0.001
hs-cTNⅠ/(ng/L), M(IQR) 217.2 (34.4, 4037.4) 4.9 (2.5, 13.9) -4.513 <0.001
NT-proBNP/(μg/L), M(IQR) 945.0 (518.5, 3 464.0) 154.0 (75.0, 415.3) -4.111 <0.001
Myocardial injury, n(%) 10 (76.9) 13 (16.0) 22.461 <0.001
Cytokines
Ferritin/(μg/L), M(IQR) 770.2 (598.0, 2 172.0) 622.8 (385.3, 1 162.7) -2.180 0.050
IL-2R/(U/mL), M(IQR) 1 586.0 (1 253.0, 2 364.0) 694.0 (425.0, 1 054.5) -3.740 <0.001
IL-6/(ng/L), M(IQR) 82.3 (37.8, 164.8) 13.0 (4.0, 39.4) -3.960 <0.001
IL-8/(ng/L), M(IQR) 29.1 (16.2, 52.4) 12.4 (7.0, 21.3) -2.551 0.160
IL-10/(ng/L), M(IQR) 9.8 (6.8, 17.9) 5.0 (5.0, 5.5) -4.376 <0.001
TNF-α/(ng/L), M(IQR) 13.3 (7.2, 17.4) 8.8 (5.7, 12.3) -2.202 0.051

Table 3

Logistic regression analysis of factors of death"

Items Univariate analysis Multivariate analysis
OR(95%CI) P OR(95%CI) P
Age/years 1.11 (1.03, 1.19) 0.004 1.18 (1.02, 1.36) 0.026
Male 1.90 (0.57, 6.32) 0.293 0.16 (0.02, 1.55) 0.113
Hypertension (No vs. Yes) 0.47 (0.11, 2.00) 0.307
Diabetes (No vs. Yes) 1.48 (0.44, 5.00) 0.524
CHD (No vs. Yes) 1.05 (0.26, 4.23) 0.945
SpO2/% 0.89 (0.83, 0.96) 0.001 0.85 (0.72, 0.99) 0.041
Neutrophil (×109/L) 1.05 (0.98, 1.11) 0.155
Lymphocyte (×109/L) 0.03 (0.00, 0.30) 0.003
Creatinine/(μmol/L) 1.00 (0.99, 1.01) 0.897
Myocardial injury 17.44 (4.21, 72.1) <0.001 11.77 (0.93, 148.87) 0.057
Ferritin>400 μg/L 5.36 (0.66, 43.48) 0.116
IL-2R>710 U/mL 5.64 (1.18, 27.05) 0.031
IL-6>35 ng/L 8.40 (2.12, 33.33) 0.002
IL-8>62 ng/L 4.73 (0.71, 31.52) 0.109
IL-10>9.1 ng/L 14.60 (3.84, 55.46) <0.001 101.93 (4.74, 2 190.71) 0.003
TNF-α>8.1 ng/L 1.71 (0.49, 6.02) 0.402
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