Mortality Predictors in COVID-19 Patients with Cardiogenic Shock

PURPOSE: Novel Coronavirus SARS-CoV2 disease (COVID-19) primarily affects the respiratory system; however, severe cases have been reported that have resulted in cardiogenic shock (CS). While it is known that COVID-19 is more severe in those cardiovascular disease, the predictors of mortality of CS with COVID-19 has yet to be explored in depth. Utilizing a large hospital research database, we explored the predictors of death in these patients. METHODS: Subjects with diagnosis codes “COVID-19” and “cardiogenic shock” or “acute dilated cardiomyopathy” were identified in an institutional registry of patients. 72 patients met the diagnostic criteria. Clinical variables studied included disease history, biomarkers, and imaging were included. Descriptive statistics and logistic regression modeling were performed using STATA/ SE 15.1. RESULTS: Of the 72 patients diagnosed with CS with COVID-19, 29 died. History of heart failure (HF) was associated with a higher risk of death (OR 4.06, p=0.012) as was diuretic use (likely a proxy for HF (OR 2.71, p=0.05)). Age, sex, and other clinical variables (see table) were not associated with death. In a multivariable model including age and sex, prior HF diagnosis remained significantly associated with death (OR 4.27 p=0.015). CONCLUSION: In CS with COVID-19, a history of cardiac disease and/or HF strongly predicted mortality. Other markers presumed to be associated with mortality such as age, sex and biomarkers were not significantly associated with death in this population. Given these findings, HF patients should be strongly encouraged to reduce their risk of exposure to infection.