Exploring the relationship between severity of lung involvement, cardiovascular health, and mortality in COVID-19 Patients

Pouladzadeh, Mandana; Rajaei Behbahani, Shahram; Hosseinzadeh, Mofid; Gharishvandi, Reza; Moradi Choghakabodi, Parastoo

doi:10.21608/mid.2025.350721.2440

Exploring the relationship between severity of lung involvement, cardiovascular health, and mortality in COVID-19 Patients

Articles in Press

Document Type : Original Article

Authors

¹ Emergency Medicine Department, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

² Department of Pediatrics, School of Medicine, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

³ School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

10.21608/mid.2025.350721.2440

Abstract

Objectives: This analytical observational study aimed to investigate the association between blood pressure, cardiovascular abnormalities, and the degree of lung involvement as assessed by computerized tomography (CT) scans, as well as their impact on adverse outcomes in patients with coronavirus disease 2019 (COVID-19). Methods: Of 1793 COVID-19 patients referred to the Emergency Department (ED), 1711 eligible patients were recruited, and their medical characteristics were prospectively collected and analyzed. Results: The incidence rates of severe infection, myocardial injury, arrhythmia and mortality were significantly more prevalent in older patients and men (p<0.05). In addition to the severity of lung involvement, the mortality rate was strongly associated with hypertension (adjusted HR[95%CI]: 1.95(1.07_3.797), P=0.03), myocardial injury (HR[95%CI]: 1.934(0.83_4.541), P=0.01), arrhythmia (HR[95%CI]: 1.15(1.003_2.630), P=0.04), left ventricular systolic dysfunction (LVSD) (HR[95%CI]: 1.6(0.4_1.876), P=0.009), underlying diseases (HR[95%CI]: 2.163(0.739_6.332), P=0.043], low SpO2 (HR[95%CI]: 0.517(0.432_0.618), P=0.0001), low platelet count (HR[95%CI]: 0.99(0.993_1), P=0.03), high blood urea nitrogen (HR[95%CI]: 1.031(1.018_1.044), P=0.0001), and hyponatremia (HR[95%CI]: 0.969(0.941_0.998), P=0.04). However, the absence of deaths in non-severe COVID-19 patients as well as the strong correlation between the aforementioned variables and lung involvement severity suggest that disease severity is a dominant factor influencing mortality, potentially overshadowing the independent effects of other variables. Conclusion: This study identified key risk factors for adverse outcomes in COVID-19 patients, highlighting the importance of early triage to predict critical outcomes. It also emphasized that disease severity seems to be a dominant factor in mortality risk, and its influence on other variables should be taken into account when assessing patient prognosis.

Keywords