Original Article

Pericardial Effusion in COVID-19 Hospitalized Patients in ICU: Prevalence, Related Factors, and Outcomes

Abstract

Purpose: COVID-19 disease is associated with pericardial effusion through both direct invasions of myocardial tissue and activation of inflammatory processes and oxidative stress. However, its exact mechanism and related implications are unclear. We aimed to evaluate the pericardial effusion in hospitalized patients with a definite diagnosis of COVID-19 and finally to determine underlying factors related to this cardiac event. Finally, the hospital outcome of patients with and without pericardial involvement was compared.
Materials and Methods: The hospital records of 1824 patients suffering from COVID-19 were reviewed with respect to pieces evidence of pericardial effusion. Baseline characteristics, cardiovascular risk profiles, laboratory and echocardiography parameters as well as hospital outcomes were reviewed.
Results: Out of 1824 patients hospitalized with COVID-19 in our medical center in Intensive Care Unit (ICU) sections, a total of 300 cases (16.4%) (P value <0.05) had evidence of pericardial effusion. Patients with pericardial effusion had much higher mean age, higher mean heart rate and also a higher prevalence of hypertension, diabetes mellitus, and a history of ischemic heart disease compared to those without this complication. The changes in some echocardiography parameters, including left ventricular end-diastolic diameter, E/A ratio, E/Ep ratio, and tricuspid annular plane systolic excursion were more prominent in those with pericardial effusion. Those with pericardial effusion experienced longer hospitalization and ICU admission and the death rate was significantly higher in such patients.
Conclusion: The occurrence of pericardial effusion is predictable in about 16.4% of patients with COVID-19, which occurs mainly in older people and people with a history of cardiovascular risk profiles. Pericardial effusion in COVID-19 patients leads to poorer in-hospital outcome.

1. Chen C, Haupert SR, Zimmermann L, Shi X, Fritsche LG, Mukherjee B. Global Prevalence of Post COVID-19 Condition or Long COVID: A Meta-Analysis and Systematic Review. J Infect Dis. 2022 Apr 16;jiac136. doi: 10.1093/infdis/jiac136.
2. Aimrane A, Laaradia MA, Sereno D, Perrin P, Draoui A, Bougadir B, Hadach M, Zahir M, Fdil N, El Hiba O, El Hidan MA, Kahime K. Insight into COVID-19's epidemiology, pathology, and treatment. Heliyon. 2022 Jan;8(1):e08799.
3. Sarkar S, Sen R. Insights into Cardiovascular Defects and Cardiac Epigenome in the Context of COVID-19. Epigenomes. 2022 Apr 21;6(2):13.
4. Okor I, Bob-Manuel T, Price J, Sleem A, Amoran O, Kelly J, Ekerete MF, Bamgbose MO, Bolaji OA, Krim SR. COVID-19 Myocarditis: An Emerging Clinical Conundrum. Curr Probl Cardiol. 2022 May 26:101268.
5. Campanello C, Mercuri C, Derchi M, Trocchio G, Consolaro A, Caorsi R, Ravelli A, Rimini A, Marasini M, Gattorno M. Cardiovascular Manifestations in Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with COVID-19 According to Age. Children (Basel). 2022 Apr 20;9(5):583.
6. Tangos M, Budde H, Kolijn D, Sieme M, Zhazykbayeva S, Lódi M, Herwig M, Gömöri K, Hassoun R, Robinson EL, Meister TL, Jaquet K, Kovács Á, Mustroph J, Evert K, Babel N, Miklós F, Lindner D, Püschel K, Westermann D, Mannherz HG, Paneni F, Pfaender S, Toth A, Mügge A, Sossalla S, Hamdani N. SARS-CoV-2 infects human cardiac myocytes promoted by inflammation and oxidative stress. Int J Cardiol. 2022 May 25:S0167-5273(22)00766-5.
7. Gul M, Ozyilmaz S, Bastug Gul Z, Kacmaz C, Satilmisoglu MH. Evaluation of cardiac injury with biomarkers and echocardiography after COVID-19 infection. J Physiol Pharmacol. 2022 Feb;73(1).
8. Osman WAM, Ahmed ASM, Eljack MMF, Abbasher Hussien Mohamed Ahmed K, S Haroun M, Abdelrahim Abdalla Y. Acute pericarditis complicated with pericardial effusion as first presentation of COVID-19 in an adult sudanese patient: A case report. Clin Case Rep. 2022 Mar 22;10(3):e05570.
9. Abdelsayed N, Mckinney B, Carter M. SARS-CoV-2 Complicated by a Large Hemorrhagic Pericardial Effusion. Cureus. 2022 Feb 16;14(2):e22282.
10. Ghantous E, Szekely Y, Lichter Y, Levi E, Taieb P, Banai A, Sapir O, Granot Y, Lupu L, Hochstadt A, Merdler I, Borohovitz A, Sadon S, Ingbir M, Laufer-Perl M, Banai S, Topilsky Y. Pericardial Involvement in Patients Hospitalized With COVID-19: Prevalence, Associates, and Clinical Implications. J Am Heart Assoc. 2022 Apr 5;11(7):e024363.
11. Soewono KY, Raney KC 3rd, Sidhu MS. Pericarditis with pericardial effusion as a delayed complication of COVID-19. Proc (Bayl Univ Med Cent). 2021 May 10;34(5):629-630.
12. Foster B, Liaqat A, Chib A, Bolton SS, Kendig AC. An Unusual Presentation of COVID-19: Hemorrhagic Pericardial Effusion With Tamponade Physiology. Cureus. 2021 Feb 19;13(2):e13438. doi: 10.7759/cureus.13438.
13. Allam HH, Kinsara AJ, Tuaima T, Alfakih S. Pericardial Fluid in a COVID-19 Patient: Is It Exudate or Transudate? Eur J Case Rep Intern Med. 2020 May 12;7(6):001703.
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IssueVol 11 No 3 (2024) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/fbt.v11i3.15887
Keywords
COVID-19 Pericardial Effusion Outcome

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How to Cite
1.
Heydari Soureshjani M, Faghihi Langroudi T, Norouzi H, Tahmasebzadeh A. Pericardial Effusion in COVID-19 Hospitalized Patients in ICU: Prevalence, Related Factors, and Outcomes. Frontiers Biomed Technol. 2024;11(3):443-448.