Hospital Outcomes Among Covid-19 Hospitalizations With Myocarditis: Results From California State Inpatient Database
Journal of Cardiac Failure
Patients with COVID-19 can develop myocarditis due to respiratory hypoxemia, hyperinflammation, as well as direct injury due to binding of the virus to the angiotensin-converting enzyme 2 receptors in myocyte. In this study we examined the association between myocarditis among COVID-19 hospitalizations and adverse hospital outcomes.
We hypothesized that adverse hospital outcomes such as in-hospital mortality, cardiac arrest, cardiogenic shock, mechanical ventilation, and acute respiratory distress syndrome would be higher among COVID-19 hospitalizations with myocarditis.
The current study was a retrospective analysis of data collected in California State Inpatient Database (SID) during 2020. All hospitalizations for COVID-19 were included for the analysis. ICD-10-CM diagnosis was used to identify COVID-19 (U07.1) and myocarditis hospitalizations and other procedures and conditions. Propensity score match analysis, survival analysis, and conditional logistic regression were done to compare adverse clinical outcomes between COVID-19 patients with and without myocarditis.
A total of 164,368 COVID-19 hospitalizations were included for the analysis. Among them, 575 (0.4%) hospitalizations had myocarditis. Prior to propensity score matching, the rate of in-hospital mortality was significantly higher among COVID-19 hospitalizations with myocarditis (29.8% versus 14.0%, P<0.001). Even after propensity score matching, the rate of in-hospital mortality was significantly higher among the myocarditis group (30.0% versus 17.5%, P<0.001). Supporting this finding, survival analysis with log-rank test also showed that 30-day survival rates were significantly lower among those with myocarditis (39.5% versus 46.3%, P<0.001). Conditional logistic regression analysis showed that the odds of cardiac arrest (OR,1.90; 95% CI, 1.16-3.14), cardiogenic shock (OR,4.13; 95% CI, 2.14-7.99), mechanical ventilation (OR,3.30 (2.47-4.41), and acute respiratory distress syndrome (OR, 2.49; 95% CI, 1.70-3.66) were significantly higher among those with myocarditis.
Our study using a large administrative database found that myocarditis was associated with greater rates of in-hospital mortality and adverse hospital outcomes among COVID-19 patients. Early suspicion is important for prompt diagnosis and timely management.
Jimenez Carcamo FJ, Rubens M, Saxena A, Zevallos J, Pelaez JR, Chi L, Delic T, Chaparro S. Hospital Outcomes Among Covid-19 Hospitalizations With Myocarditis: Results From California State Inpatient Database. Journal of Cardiac Failure. 2023; 29(4). doi: 10.1016/j.cardfail.2022.10.318.