To evaluate the prevalence of cardiac injury
and its association with mortality
in hospitalized patients infected with avian influenza A (H7N9) virus.
Retrospective cohort study.
A total of 133 hospitals in 17 provinces, autonomous regions, and municipalities of mainland China that admitted influenza A (H7N9) virus–infected patients between January 22, 2015, and June 16, 2017.
A total of 321 patients with influenza A (H7N9) virus infection were included in the final analysis.
Measurements and Main Results:
Demographics and clinical characteristics were collected from medical records. Cardiac injury
was defined according to cardiac biomarkers, electrocardiography, or echocardiography. Among the 321 patients, 203 (63.2%) showed evidence of cardiac injury
. Compared with the uninjured group, the cardiac injury
group had lower PaO2
(median, 102.0 vs 148.4 mm Hg; p
< 0.001), higher Acute Physiology and Chronic Health Evaluation II score (median, 17.0 vs 11.0; p
< 0.001), longer stay in the ICU (10.0 vs 9.0 d; p
= 0.029), and higher proportion of in-hospital death (64.0% vs 20.3%; p
< 0.001). The proportion of virus clearance until discharge or death was lower in the cardiac injury
group than in the uninjured group (58.6% vs 86.4%; p
< 0.001). Multivariable-adjusted Cox proportional hazards regression analysis showed that cardiac injury
was associated with higher mortality
(hazards ratio, 2.06; 95% CI, 1.31–3.24) during hospitalization.
Conclusions: Cardiac injury
is a frequent condition among hospitalized patients infected with influenza A (H7N9) virus, and it is associated with higher risk of mortality