Comparison of the clinical features and therapeutics of COVID-19 in cardio-cerebrovascular disease (CCVD) and non-CCVD patients

Abstract

Cardio-cerebrovascular disease (CCVD) is a major comorbidity of coronavirus disease 2019 (COVID-19). However, the clinical characteristics and outcomes remain unclear. In this study, 102 cases of COVID-19 from January 22, 2020 to March 26, 2020 in Xixi Hospital of Hangzhou were included. Twenty cases had pre-existing CCVD. Results showed that compared with non-CCVD patients, those with CCVD are more likely to develop severe disease (15% versus 1%), and the proportion of pneumonia severity index grade IV was significantly higher (25% versus 3.6%). Computed tomography images demonstrated that the proportion of multiple lobe lesion involvement was significantly higher in the CCVD group than in the non-CCVD group (90% versus 63.4%). Compared with non-CCVD group, the levels of C-reactive protein, fibrinogen, D-dimer, and serum amyloid-A were higher, whereas the total protein and arterial partial PaO₂ were lower in the CCVD group. Although no statistical difference was observed in the outcomes between groups, CCVD patients received more intensive comprehensive treatment to improve COVID-19 symptoms compared with non-CCVD patients. Integrated Chinese and Western medicine treatments have certain advantages in controlling the severe conversion rate and mortality of COVID-19. In addition, given that COVID-19 patients are usually related to coagulation disorders and thrombosis risk, the application of Chinese medicine in promoting blood circulation and removing stasis should be strengthened.

Keywords

COVID-19 / cardio-cerebrovascular disease / traditional Chinese medicine / clinical features / clinical therapeutics

References

[1] Wei X, Li X, Cui J. Evolutionary perspectives on novel coronaviruses identified in pneumonia cases in China. Natl Sci Rev 2020; 7(2): 239–242

[2] Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA 2020; 323(13): 1239

[3] Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, Zhao X, Huang B, Shi W, Lu R, Niu P, Zhan F, Ma X, Wang D, Xu W, Wu G, Gao GF, Tan W; China Novel Coronavirus Investigating and Research Team. A novel coronavirus from patients with pneumonia in china, 2019. N Engl J Med 2020; 382(8): 727–733

[4] WHO Director-General/Speeches. WHO Director-General’s remarks at the media briefing on 2019-nCoV on 11 February 2020. 2020.

[5] Eurosurveillance Editorial Team. Note from the editors: World Health Organization declares novel coronavirus (2019-nCoV) sixth public health emergency of international concern. Euro Surveill 2020; 25(5): pii=200131e

[6] World Health Organization. Coronavirus disease (COVID-19) situation report-161. 2020.

[7] Wang F, Zheng S, Zheng C, Sun X. Attaching clinical significance to COVID-19-associated diarrhea.  Life Sci 2020; 260: 118312

[8] Li JY, You Z, Wang Q, Zhou ZJ, Qiu Y, Luo R, Ge XY. The epidemic of 2019-novel-coronavirus (2019-nCoV) pneumonia and insights for emerging infectious diseases in the future. Microbes Infect 2020; 22(2): 80–85

[9] Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, Xiang J, Wang Y, Song B, Gu X, Guan L, Wei Y, Li H, Wu X, Xu J, Tu S, Zhang Y, Chen H, Cao B. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020; 395(10229): 1054–1062

[10] Chen J, Qi T, Liu L, Ling Y, Qian Z, Li T, Li F, Xu Q, Zhang Y, Xu S, Song Z, Zeng Y, Shen Y, Shi Y, Zhu T, Lu H. Clinical progression of patients with COVID-19 in Shanghai, China. J Infect 2020; 80(5): e1–e6

[11] National Health Commission of the People’s Republic of China. Diagnosis and Treatment Protocol for COVID-19 (Trial Version 7). 2020.

[12] World Health Organization. Clinical management of severe acute respiratory infection when novel coronavirus (2019-nCoV) infection is suspected: interim guidance, 28 January 2020. 2020.

[13] Liu K, Chen Y, Lin R, Han K. Clinical features of COVID-19 in elderly patients: a comparison with young and middle-aged patients. J Infect 2020; 80(6): e14–e18

[14] World Health Organization. Laboratory testing for coronavirus disease 2019 in suspected human cases: interim guidance, 2 March 2020. 2020.

[15] World Health Organization. Coronavirus disease 2019 (COVID-19): situation report, 63. 2020.

[16] Ahn DG, Shin HJ, Kim MH, Lee S, Kim HS, Myoung J, Kim BT, Kim SJ. Current status of epidemiology, diagnosis, therapeutics, and vaccines for novel coronavirus disease 2019 (COVID-19). J Microbiol Biotechnol 2020; 30(3): 313–324

[17] Li Y, Hu Y, Yu J, Ma T. Retrospective analysis of laboratory testing in 54 patients with severe- or critical-type 2019 novel coronavirus pneumonia. Lab Invest 2020; 100(6): 794–800

[18] Zhu L, She ZG, Cheng X, Qin JJ, Zhang XJ, Cai J, Lei F, Wang H, Xie J, Wang W, Li H, Zhang P, Song X, Chen X, Xiang M, Zhang C, Bai L, Xiang D, Chen MM, Liu Y, Yan Y, Liu M, Mao W, Zou J, Liu L, Chen G, Luo P, Xiao B, Zhang C, Zhang Z, Lu Z, Wang J, Lu H, Xia X, Wang D, Liao X, Peng G, Ye P, Yang J, Yuan Y, Huang X, Guo J, Zhang BH, Li H. Association of blood glucose control and outcomes in patients with COVID-19 and pre-existing type 2 diabetes. Cell Metab 2020; 31(6): 1068–1077.e3

[19] Lake MA. What we know so far: COVID-19 current clinical knowledge and research. Clin Med (Lond) 2020; 20(2): 124–127

[20] Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, Liu L, Shan H, Lei CL, Hui DSC, Du B, Li LJ, Zeng G, Yuen KY, Chen RC, Tang CL, Wang T, Chen PY, Xiang J, Li SY, Wang JL, Liang ZJ, Peng YX, Wei L, Liu Y, Hu YH, Peng P, Wang JM, Liu JY, Chen Z, Li G, Zheng ZJ, Qiu SQ, Luo J, Ye CJ, Zhu SY, Zhong NS; China Medical Treatment Expert Group for Covid-19. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020; 382(18): 1708–1720

[21] Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, Wang B, Xiang H, Cheng Z, Xiong Y, Zhao Y, Li Y, Wang X, Peng Z. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020; 323(11): 1061–1069

[22] Dolhnikoff M, Duarte-Neto AN, de Almeida Monteiro RA, da Silva LFF, de Oliveira EP, Saldiva PHN, Mauad T, Negri EM. Pathological evidence of pulmonary thrombotic phenomena in severe COVID-19. J Thromb Haemost 2020; 18(6): 1517–1519

[23] Thomas W, Varley J, Johnston A, Symington E, Robinson M, Sheares K, Lavinio A, Besser M. Thrombotic complications of patients admitted to intensive care with COVID-19 at a teaching hospital in the United Kingdom. Thromb Res 2020; 191: 76–77

[24] Klok FA, Kruip MJHA, van der Meer NJM, Arbous MS, Gommers D, Kant KM, Kaptein FHJ, van Paassen J, Stals MAM, Huisman MV, Endeman H. Confirmation of the high cumulative incidence of thrombotic complications in critically ill ICU patients with COVID-19: an updated analysis. Thromb Res 2020; 191: 148–150

[25] Helms J, Tacquard C, Severac F, Leonard-Lorant I, Ohana M, Delabranche X, Merdji H, Clere-Jehl R, Schenck M, Fagot Gandet F, Fafi-Kremer S, Castelain V, Schneider F, Grunebaum L, Anglés-Cano E, Sattler L, Mertes PM, Meziani F; CRICS TRIGGERSEP Group (Clinical Research in Intensive Care and Sepsis Trial Group for Global Evaluation and Research in Sepsis). High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study. Intensive Care Med 2020; 46(6): 1089–1098

[26] Wang K, Zhang D, Wu J, Liu S, Zhang X, Zhang B. A comparative study of Danhong injection and Salvia miltiorrhiza injection in the treatment of cerebral infarction: a systematic review and meta-analysis. Medicine (Baltimore) 2017; 96(22): e7079

[27] Feng X, Li Y, Wang Y, Li L, Little PJ, Xu SW, Liu S. Danhong injection in cardiovascular and cerebrovascular diseases: pharmacological actions, molecular mechanisms, and therapeutic potential. Pharmacol Res 2019; 139: 62–75

[28] Lyu M, Yan CL, Liu HX, Wang TY, Shi XH, Liu JP, Orgah J, Fan GW, Han JH, Wang XY, Zhu Y. Network pharmacology exploration reveals endothelial inflammation as a common mechanism for stroke and coronary artery disease treatment of Danhong injection. Sci Rep 2017; 7(1): 15427

[29] Zhao S, Tang Y, Cai H, Liu W, Zhang L, Chen D, Chen B. Treatment of Danhong Injection combined with Naoxintong Capsule in acute coronary syndrome patients undergoing PCI operation: study for a randomized controlled and double-blind trial. Evid Based Complement Alternat Med 2018; 2018: 8485472

[30] Zou JB, Zhang XF, Wang J, Wang F, Cheng JX, Yang FY, Song X, Wang Y, Liang YL, Shi YJ. The therapeutic efficacy of Danhong injection combined with percutaneous coronary intervention in acute coronary syndrome: a systematic review and meta-analysis. Front Pharmacol 2018; 9: 550

Acknowledgements

This work was supported by the National Natural Science Foundation of China (No. 81930111) and Zhejiang Province High-level Talents Project (No. 2019R51002).

Compliance with ethics guidelines

Yu Wang, Lan Li, Yuanjiang Pan, Yu He, Zuhua Chen, Yunhao Xun, Yuhan Xu, Yilei Guo, Jiehong Yang, Jianchun Guo, and Haitong Wan declare no conflict of interest. Given the retrospective nature of this study, informed consent was waived. The study was approved by the Ethics Committee of Xixi Hospital of Hangzhou (Approval No.: 2020-14).

RIGHTS & PERMISSIONS

2021 Higher Education Press