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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

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Front. Med.    2021, Vol. 15 Issue (4) : 629-637    https://doi.org/10.1007/s11684-020-0825-2
RESEARCH ARTICLE
Comparison of the clinical features and therapeutics of COVID-19 in cardio-cerebrovascular disease (CCVD) and non-CCVD patients
Yu Wang1, Lan Li1, Yuanjiang Pan2, Yu He3, Zuhua Chen5, Yunhao Xun5, Yuhan Xu1, Yilei Guo1, Jiehong Yang4(), Jianchun Guo5(), Haitong Wan1()
1. Institute of Cardio-cerebrovascular Disease, Zhejiang Chinese Medical University, Hangzhou 310053, China
2. Department of Chemistry, Zhejiang University, Hangzhou 310027, China
3. College of Pharmaceutical Science, Zhejiang Chinese Medical University, Hangzhou 310053, China
4. School of Basic Medical Sciences and Public Health, Zhejiang Chinese Medical University, Hangzhou 310053, China
5. Integrated TCM & Western Medicine Department, Xixi Hospital of Hangzhou, Hangzhou 310023, China
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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     
Corresponding Author(s): Jiehong Yang,Jianchun Guo,Haitong Wan   
Just Accepted Date: 13 January 2021   Online First Date: 27 April 2021    Issue Date: 23 September 2021
 Cite this article:   
Yu Wang,Lan Li,Yuanjiang Pan, et al. Comparison of the clinical features and therapeutics of COVID-19 in cardio-cerebrovascular disease (CCVD) and non-CCVD patients[J]. Front. Med., 2021, 15(4): 629-637.
 URL:  
https://academic.hep.com.cn/fmd/EN/10.1007/s11684-020-0825-2
https://academic.hep.com.cn/fmd/EN/Y2021/V15/I4/629
Classification Diagnostic criteria
Mild Mild clinical symptoms and no evident abnormality in chest computed tomography (CT)
General With fever, respiratory symptoms, and imaging characteristics of pneumonia
Severe Compliance with any of the following:
1. Dyspnea and respiratory rate ≥ 30 per min;
2. SPO2≤ 93% on room air;
3. PaO2/FiO2≤ 300 mmHg (1 mmHg= 0.133 kPa)
Pulmonary imaging showed that the lesions progressed more than 50% within 24–48 h
Critical Compliance with any of the following:
1. Respiratory failure occurrence and mechanical ventilation requirement;
2. Shock;
3. Combination with other organ failure; intensive care unit monitoring and treatment requirement
Tab.1  Diagnostic criteria for clinical classification of COVID-19
Variable Total (n = 102) CCVD (n = 20) Non-CCVD (n = 82) P value
Age and gender
Age, year (median (IQR)) 40 (33–56) 56 (42–62) 38 (31–51) <0.001
Male (N (%)) 46 (45.0%) 8 (40%) 38 (46.3%) 0.795
Vital signs
Respiratory rate, per minute 18 (18–19) 18 (18–20) 18 (18–19)
Heart rate, per minute 87 (78–100) 86 (80–101) 88 (76–101)
Systolic blood pressure (mmHg) 128 (115–137) 136 (126–144) 125 (112–136)
Body temperature (°C) 36.9 (36.7–37.5) 36.9 (36.7–37.2) 36.9 (36.7–37.7)
Signs and symptoms at admission (N (%))
Fever 72 (70.5%) 14 (70%) 58 (70.7%) 1.000
Cough 63 (61.7%) 15 (75%) 48 (58.5%) 0.271
Expectoration 22 (21.5%) 6 (30%) 16 (19.5%) 0.472
Rhinorrhea 5 (4.9%) 1 (5%) 4 (4.8%) 1.000
Sore throat 12 (11.7%) 2 (3%) 10 (12.1%) 1.000
Diarrhea 9 (8.8%) 3 (15%) 6 (7.3%) 0.518
Inappetence 7 (6.8%) 3 (15%) 4 (4.8%) 0.266
Fatigue 25 (24.5%) 3 (15%) 22 (26.8%) 0.481
Dizziness and headache 15 (14.7%) 3 (15%) 12 (14.6%) 1.000
Asymptomatic 6 (5.8%) 1 (5%) 5 (6.09%) 1.000
Exposure history (N (%)) 0.333
Yes 76 (74.5%) 15 (75%) 61 (74.3%)
No 13 (12.7%) 4 (20%) 9 (10.9)
Not clear 13 (12.7%) 1 (5%) 12 (14.6%)
Comorbidity (N (%))
CCVD 20 (19.6%) / /
Digestive system disease 39 (38.2%) 10 (50%) 29 (35.3%) 0.342
Urinary system disease 12 (11.7%) 5 (25%) 7 (8.5%) 0.097
Respiratory system disease 7 (6.8%) 0 (0%) 7 (8.5%) 0.389
Endocrine system disease 9 (8.8%) 4 (20%) 5 (6.0%) 0.127
Chronic hepatitis B virus infection 10 (9.8%) 2 (10%) 8 (9.7%) 1.000
Electrolyte disorder 39 (38.2%) 10 (50%) 29 (35.3%) 0.342
Clinical classification (N (%)) 0.012
Mild 19 (18.6%) 2 (10%) 17 (20.7%)
General 79 (77.5%) 15 (75%) 64 (78.0%)
Severe 4 (3.9%) 3 (15%) 1 (1.2%)
PSI grades <0.001
I 36 (35.2%) 0 (0%) 36 (43.9%)
II 43 (42.1%) 8 (40%) 35 (42.6%)
III 15 (14.7%) 7 (35%) 8 (9.7%)
IV 8 (7.8%) 5 (25%) 3 (3.6%) <0.01
Tab.2  Clinical and epidemiologic features of COVID-19 on admission
Fig.1  CT scans of two patients. (A–D) Case 1: (A) Chest CT scans upon admission of a 43-year-old female with CCVD on day 2 after fever, manifested by bilateral multiple GGO. (B) CT scan showing worsening on day 7. The area of subpleural lesions in the lower lobes of both lungs was remarkably enlarged; mixed GGO and consolidation were the main features. (C) Improvements of original lesions on day 12. Lesions in the lower lobes of both lungs reduced in scope and density, presenting as light GGO with patchy consolidations. (D) CT re-examination 14 days after patient’s discharge showing that lesions in the lower lobes of both lungs were basically absorbed, presenting as a small light GGO. (E–H) Case 2: (E) Chest CT scans on admission of a 40-year-old female, manifesting multiple GGO in the inferior lobe of the left lung, on day 3 after onset of symptoms. (F) The scope of lesion in the inferior lobe of the left lung was significantly enlarged, with mixed GGO and consolidation on day 7. (G) Improvement of original lesions on day 11; the scope of lesion in the inferior lobe of the left lung was reduced, presenting as light GGO with patchy consolidations. (H) CT re-examination showing further absorption of original lesions 7 days after patient’s discharge.
Variable Total (n = 102) CCVD (n = 20) Non-CCVD (n = 82) P value
CT results 0.042
No remarkable abnormality and single lobe lesion 32 (31.4%) 2 (10%) 30 (36.6%)
Multiple lobe lesions 70 (68.6%) 18 (90%) 52 (63.4%)
Laboratory indicators at admission
White blood cells (×109/L) 5.24 (4.31–7.29) 5.6 (4.12–7.37) 5.17(4.48–6.74) 0.696
Lymphocytes (×109/L) 1.24 (0.88–1.82) 1.29 (0.86–1.87) 1.12 (0.85–1.46) 0.067
C-reactive protein (mg/L) 0.023
0–10 70 (68.6%) 9 (45%) 61 (74.4%)
>10 32 (31.4%) 11 (55%) 21 (25.6%)
Fibrinogen (g/L) 0.014
≥1.8 to≤3.5 58 (56.9%) 6 (30%) 52 (63.4%)
>3.5 44 (43.1%) 14 (70%) 30 (36.6%)
D-dimer (mg/L) 0.017
≤0.5 75 (73.5%) 10 (50%) 65 (79.3%)
>0.5 to≤1 8 (7.8%) 2 (10%) 6 (7.3%)
>1 19(18.6%) 8 (40%) 11(13.4%)
Total protein (g/L) 0.034
<65.0 17 (16.7%) 7 (35%) 10 (12.2%)
≥65.0 to≤85 85 (83.3%) 13 (65%) 72 (87.8%)
AST/ALT 0.942
<1 29 (28.4%) 5 (25%) 24 (29.3%)
≥1 74 (72.5%) 15 (75%) 58 (70.7%)
Globulin (g/L) 28.6 (25.6–32) 30.4 (25.3–32.6) 29.3 (26.4–32.8) 0.019
Albumin (g/L) 40.8 (34–43.8) 35 (32.3–43.2) 42.6 (39.4–45.5) 0.477
Arterial partial PaO2 (mmHg) 93.9 (62.4–113) 79.6 (49.4–93.9) 112 (92.2–182) 0.028
Oxygen saturation (%) 97.8 (94.2–98.6) 96.1 (83.9–98.0) 99.5 (98.5–98.9) 0.386
Serum amyloid A (mg/L) 55 (11–147) 113 (28–150) 37 (10–122) 0.044
Tab.3  Chest CT and laboratory results of COVID-19 patients on admission
Variable Total (n = 102) CCVD (n = 20) Non-CCVD (n = 82) P value
Treatment
Lopinavir and arbidol tablets 97 (95.1%) 20 (100%) 77 (93.9%) 0.579
Interferon 85 (83.3%) 17 (85%) 68 (82.9%) 1.000
TCM 102 (100%) 20 (100%) 82 (100%) –
Antibiotic 9 (8.8%) 3 (15%) 6 (7.3%) 0.518
Immunoglobulin 14 (13.7%) 4 (20%) 10 (12.1%) 0.584
Corticosteroid 7 (6.8%) 1 (5%) 6 (7.3%) 1.000
Outcomes
Healed and discharged 102 (100%) 20 (100%) 82 (100%) –
Hospital length of stay, day 16 (11–21.3) 15 (11.3–22.8) 16 (11–21) 0.918
Duration of viral shedding after COVID-19 onset, day 14 (10–20) 13.5 (9–21.5) 14 (10–19) 0.743
Time course of symptom disappearance, day 17 (12–22) 18.5 (12.5–26.3) 16 (12–21) 0.412
Time course of cough disappearance, day 20 (14–25.3) 20.5 (14–30.5) 19 (14–24) 0.156
Tab.4  Treatment and outcomes
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