Patients Hospitalized With COVID-19 May be at Risk for Acute Pericarditis

Acute pericarditis (AP) is a rare, but severe, in-hospital complication among patients with COVID-19 infection. These findings were published in the Journal of the American Heart Association.

Several cardiovascular complications have been associated with COVID-19, including myocarditis, myocardial infarction, cardiac arrest, and atrial fibrillation. The number of case reports describing AP in COVID-19 has been increasing.

To evaluate the incidence rates and outcomes of AP in COVID-19, investigators from Virginia Commonwealth University in the United States and First Affiliated Hospital of Shantou University Medical College in China performed this retrospective cohort study using data from the National Inpatient Sample (NIS) 2020 database. Patients (N=211,619) with a primary diagnosis of COVID-19 were assessed for in-hospital mortality and severe complications on the basis of AP status (n=983). To balance for cohort differences, a 1:3 propensity matching approach was used for final sample sizes of 980 patients with AP and 2936 patients without AP.

Among the propensity-matched cohorts, the patients with and without AP had mean ages of 60.03 (SD, 19.18) and 60.46 (SD, 19.08) years, 52.4% and 52.8% were men, and 40.3% and 40.1% were White, respectively.

Between March and December of 2020, the incidence rates of AP ranged between 0.39% in October to 0.57% in May and August.

The patients with AP had significantly higher rates of death (21.3% vs 11.1%; P <.001), acute kidney injury (38.3% vs 28.9%; P <.001), acute congestive heart failure (14.3% vs 4.8%; P <.001), cardiac arrest (5.0% vs 2.6%; P <.001), ventricular arrhythmia (4.7% vs 1.9%; P <.001), and cardiogenic shock (4.2% vs 0.5%: P <.001) compared with the patients without AP.

Compared with control patients, AP was associated with increased risk for cardiogenic shock (odds ratio [OR], 9.11; 95% CI, 5-17), acute congestive heart failure (OR, 3.3; 95% CI, 3-4), ventricular arrhythmia (OR, 2.49; 95% CI, 2-4), and death (OR, 2.18; 95% CI, 2-3).

Patients with AP also had longer hospital length of stay (median, 7.00 vs 5.00 d; P <.001) and total health care charges (median, $75,067 vs $44,824; P <.001) compared with patients without AP.

The investigators also performed an analysis comparing AP outcomes among patients with and without COVID-19. Among 46,913 patients with AP, 3.96% had COVID-19.

Rates of in-hospital mortality (23.7% vs 7.5%; P <.001) were higher among the COVID-19 group compared with the group without COVID-19 after matching, respectively. In addition, the patients with COVID-19 had higher rates of cardiac arrest, acute kidney injury, and acute respiratory failure but lower rates of acute congestive heart failure and cardiac tamponade.

This study may have been limited by not having access to data about severity of conditions.

The study authors concluded, “Our findings suggest that optimizing a diagnosis algorithm, especially focused on the early detection, prevention, and treatment of AP, should be considered during admission and monitoring of patients with COVID-19.”

This article originally appeared on The Cardiology Advisor