Key result
Intracardiac thrombosis in COVID-19 inpatients is linked to ~232% higher in-hospital mortality.
Why the study?
Intracardiac thrombosis is a potentially serious complication of COVID-19-associated hypercoagulability, but its incidence, predictors, and outcomes have seldom been evaluated in this population.
Does intracardiac thrombosis increase the risk of in-hospital mortality and morbidities in COVID-19 inpatients?
Observational (n=1,683,785)
Yes
Does intracardiac thrombosis increase the risk of in-hospital mortality and morbidities in COVID-19 inpatients?
Odds Ratio: 3.32 (95% CI 2.42–4.54)
p-value: p=<0.001
Although rare, intracardiac thrombosis in COVID-19 inpatients is independently associated with significantly increased risks of in-hospital mortality and major cardiovascular morbidities.
May inform risk stratification in COVID-19 inpatients; extends observational data but remains hypothesis-generating.
Background: COronaVIrus Disease 2019 (COVID-19) has been observed to be associated with a hypercoagulable state. Intracardiac thrombosis are potentially serious complications but have seldomly been evaluated in COVID-19 patients. We assessed the incidence, associated factors, and outcomes of COVID-19 patients with intracardiac thrombosis. Methods: COVID-19 inpatients during 2020 were retrospectively identified from the national inpatient sample (NIS) database, and data retrieved regarding clinical characteristics, intracardiac thrombosis, and adverse outcomes. Multivariable logistic regression was performed to identify the clinical factors associated with intracardiac thrombosis and in-hospital mortality and morbidities. Results: A total of 1,683,785 COVID-19 inpatients were identified in 2020 from NIS, with mean age of 63.8±1.6 years and 32.2% were females. Overall in-hospital outcomes include all-cause mortality 13.2% (222,695/1,683,785), cardiovascular mortality 3.5%, cardiac arrest 2.6%, acute coronary syndrome (ACS) 4.4%, heart failure 16.1%, stroke 1.3% and acute kidney injury (AKI) 28.3%. Intracardiac thrombosis was present in 0.001% (1,830) patients. The main factors associated with intracardiac thrombosis were history of congestive heart failure, stroke, coagulopathy and male sex. Intracardiac thrombosis was independently associated with a higher risk of in-hospital all-cause mortality (OR: 3.32, 95%CI: 2.42-4.54, p<0.001), cardiovascular mortality (OR: 2.95, 95%CI: 1.96-4.44, p<0.001), cardiac arrest (OR: 2.04, 95%CI: 1.22-3.43, p=0.006), ACS (OR: 1.62, 95%CI: 1.17-2.22, p=0.003), stroke (OR: 3.10, 95%CI: 2.11-4.56, p<0.001), and AKI (OR: 2.13 95%CI: 1.68-2.69, p<0.001), but not incident heart failure (p=0.27). Conclusion: Although intracardiac thrombosis is rare in COVID-19 inpatients, its presence was independently associated with higher risks of in-hospital mortality and most morbidities. Prompt investigations and treatments for intracardiac thrombosis are warranted when there are high index of suspicion and a confirmed diagnosis respectively.
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Wang et al. (2023) conducted an observational in COVID-19 (n=1,683,785). Intracardiac thrombosis vs. No intracardiac thrombosis was evaluated on In-hospital all-cause mortality (OR 3.32, 95% CI 2.42-4.54, p=<0.001). Intracardiac thrombosis in COVID-19 inpatients was independently associated with a higher risk of in-hospital all-cause mortality (OR 3.32; 95% CI 2.42-4.54; p<0.001).
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