J Med Virol. 2023 Mar 9. doi: 10.1002/jmv.28646. Online ahead of print.
BACKGROUND: Myocarditis as cardiac involvement in COVID-19-infection is well known. Real-world data about incidence in hospitalized COVID-19-patients and risk factors for myocarditis in COVID-19-patients are sparse.
METHODS: We used the German nationwide inpatient sample to analyze all hospitalized patients with confirmed COVID-19-diagnosis in Germany in 2020 and stratified them for myocarditis.
RESULTS: Overall, 176,137 hospitalizations (52.3%males, 53.6%aged≥70years) with confirmed COVID-19-infection were coded in Germany in 2020 and among them, 226 (0.01%) had myocarditis (incidence:1.28 per 1000 hospitalization-cases). Absolute numbers of myocarditis increased, while relative numbers decreased with age. COVID-19-patients with myocarditis were younger (64.0 [IQR 43.0/78.0] vs.71.0 [56.0/82.0], P<0.001). In-hospital case-fatality was 1.3-fold higher in COVID-19-patients with than without myocarditis (24.3% vs. 18.9%, P=0.012). Myocarditis was independently associated with increased case-fatality (OR 1.89 [95%CI 1.33-2.67], P<0.001). Independent risk factors for myocarditis were age<70years (OR 2.36 [95%CI 1.72-3.24], P<0.001), male sex (1.68 [95%CI 1.28-2.23], P<0.001), pneumonia (OR 1.77 [95%CI 1.30-2.42], P<0.001) and multi-systemic inflammatory COVID-19-infection (OR 10.73 [95%CI 5.39-21.39], P<0.001).
CONCLUSION: The incidence of myocarditis in hospitalized COVID-19-patients in Germany was 1.28 cases per 1000 hospitalizations in 2020. Risk factors for myocarditis in COVID-19 were young age, male sex, pneumonia, and multi-systemic inflammatory COVID-19-infection. Myocarditis was independently associated with increased case-fatality. This article is protected by copyright. All rights reserved.