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Rico-Mesa JS, Haloot J, Anupama BK, Atluri S, Liu J, Khalid U. The Role and Implications of COVID-19 in Incident and Prevalent Heart Failure. Curr Heart Fail Rep 2024:10.1007/s11897-024-00677-7. [PMID: 39042238 DOI: 10.1007/s11897-024-00677-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/11/2024] [Indexed: 07/24/2024]
Abstract
PURPOSE OF REVIEW This review examines the pathophysiological interactions between COVID-19 and heart failure, highlighting the exacerbation of heart failure in COVID-19 patients. It focuses on the complex mechanisms driving worse outcomes in these patients. RECENT FINDINGS Patients with pre-existing heart failure experience more severe symptoms and higher mortality rates due to mechanisms such as cytokine storms, myocardial infarction, myocarditis, microvascular dysfunction, thrombosis, and stress cardiomyopathy. Elevated biomarkers like troponin and natriuretic peptides correlate with severe disease. Long-term cardiovascular risks for COVID-19 survivors include increased incidence of heart failure, non-ischemic cardiomyopathy, cardiac arrest, and cardiogenic shock. COVID-19 significantly impacts patients with pre-existing heart failure, leading to severe symptoms and higher mortality. Elevated cardiac biomarkers are indicators of severe disease. Acute and long-term cardiovascular complications are common, calling for ongoing research into targeted therapies and improved management strategies to better prevent, diagnose, and treat heart failure in the context of COVID-19.
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Affiliation(s)
| | - Justin Haloot
- Department of Cardiology, Baylor College of Medicine, 2002 Holcombe Blvd, Houston, TX, 77030, USA
| | - B K Anupama
- Department of Cardiology, Baylor College of Medicine, 2002 Holcombe Blvd, Houston, TX, 77030, USA
| | - Suman Atluri
- Department of Cardiology, Baylor College of Medicine, 2002 Holcombe Blvd, Houston, TX, 77030, USA
| | - Jing Liu
- Department of Cardiology, Baylor College of Medicine, 2002 Holcombe Blvd, Houston, TX, 77030, USA
| | - Umair Khalid
- Department of Cardiology, Baylor College of Medicine, 2002 Holcombe Blvd, Houston, TX, 77030, USA.
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Hannemann J, Zink A, Mileva Y, Balfanz P, Dahl E, Volland S, Illig T, Schwedhelm E, Kurth F, Stege A, Aepfelbacher M, Hoffmann A, Böger R. A multicenter study of asymmetric and symmetric dimethylarginine as predictors of mortality risk in hospitalized COVID-19 patients. Sci Rep 2024; 14:15739. [PMID: 38977837 PMCID: PMC11231343 DOI: 10.1038/s41598-024-66288-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 07/01/2024] [Indexed: 07/10/2024] Open
Abstract
Mortality of patients hospitalized with COVID-19 has remained high during the consecutive SARS-CoV-2 pandemic waves. Early discrimination of patients at high mortality risk is crucial for optimal patient care. Symmetric (SDMA) and asymmetric dimethylarginine (ADMA) have been proposed as possible biomarkers to improve risk prediction of COVID-19 patients. We measured SDMA, ADMA, and other L-arginine-related metabolites in 180 patients admitted with COVID-19 in four German university hospitals as compared to 127 healthy controls. Patients were treated according to accepted clinical guidelines and followed-up until death or hospital discharge. Classical inflammatory markers (leukocytes, CRP, PCT), renal function (eGFR), and clinical scores (SOFA) were taken from hospital records. In a small subgroup of 23 COVID-19 patients, sequential blood samples were available and analyzed for biomarker trends over time until 14 days after admission. Patients had significantly elevated SDMA, ADMA, and L-ornithine and lower L-citrulline concentrations than controls. Within COVID-19 patients, SDMA and ADMA were significantly higher in non-survivors (n = 41, 22.8%) than in survivors. In ROC analysis, the optimal cut-off to discriminate non-survivors from survivors was 0.579 µmol/L for SDMA and 0.599 µmol/L for ADMA (both p < 0.001). High SDMA and ADMA were associated with odds ratios for death of 11.45 (3.37-38.87) and 5.95 (2.63-13.45), respectively. Analysis of SDMA and ADMA allowed discrimination of a high-risk (mortality, 43.7%), medium-risk (15.1%), and low-risk group (3.6%); risk prediction was significantly improved over classical laboratory markers. We conclude that analysis of ADMA and SDMA after hospital admission significantly improves risk prediction in COVID-19.
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Affiliation(s)
- Juliane Hannemann
- Institute of Clinical Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Zink
- Institute of Clinical Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Yoana Mileva
- Institute of Clinical Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Paul Balfanz
- Department of Cardiology, Angiology and Intensive Care Medicine, Medical Clinic I, University Hospital Aachen, Aachen, Germany
- Institute of Pathology and Central Biobank, University Hospital Aachen, Aachen, Germany
| | - Edgar Dahl
- Hannover Unified Biobank, Medizinische Hochschule Hannover, Hannover, Germany
| | - Sonja Volland
- Department of Physiology, Henri Mondor Hospital, FHU-SENEC, INSERM U955, Université Paris-Est Créteil (UPEC), AP-HP, Créteil, France
| | - Thomas Illig
- Department of Physiology, Henri Mondor Hospital, FHU-SENEC, INSERM U955, Université Paris-Est Créteil (UPEC), AP-HP, Créteil, France
| | - Edzard Schwedhelm
- Institute of Clinical Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Florian Kurth
- Department of Infectious Diseases and Critical Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Alexandra Stege
- Central Biobank Charité, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Aepfelbacher
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Armin Hoffmann
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rainer Böger
- Institute of Clinical Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
- German Centre for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany.
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Gómez-Mesa JE, Escalante M, Muñoz-Ordoñez JA, Azcárate-Rodriguez V, Peláez-Martínez JD, Arteaga-Tobar AA, León-Giraldo H, Valencia-Orozco A, Perna ER, Romero A, Mendoza I, Wyss F, Barisani JL, Speranza M, Alarco W, Herrera C, Lugo-Peña J, Cárdenas-Aldaz LP, Rossel V, Sierra D. Association of Abnormal Cardiac Biomarkers and Cardiovascular Complications, with Mortality in Patients with SARS-CoV-2 Infection in Latin America. J Cardiovasc Dev Dis 2024; 11:205. [PMID: 39057625 PMCID: PMC11277850 DOI: 10.3390/jcdd11070205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 05/29/2024] [Accepted: 06/03/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has highlighted a correlation between cardiac complications and elevated cardiac biomarkers, which are linked to poorer clinical outcomes. OBJECTIVE This study aims to determine the clinical impact of cardiac biomarkers in COVID-19 patients in Latin America. SUBJECTS AND METHODS The CARDIO COVID 19-20 Registry is a multicenter observational study across 44 hospitals in Latin America and the Caribbean. It included hospitalized COVID-19 patients (n = 476) who underwent troponin, natriuretic peptide, and D-dimer tests. Patients were grouped based on the number of positive biomarkers. RESULTS Among the 476 patients tested, 139 had one positive biomarker (Group C), 190 had two (Group B), 118 had three (Group A), and 29 had none (Group D). A directly proportional relationship was observed between the number of positive biomarkers and the incidence of decompensated heart failure. Similarly, there was a proportional relationship between the number of positive biomarkers and increased mortality. In Group B, patients with elevated troponin and natriuretic peptide and those with elevated troponin and D-dimer had 1.4 and 1.5 times higher mortality, respectively, than those with elevated natriuretic peptide and D-dimer. CONCLUSIONS In Latin American COVID-19 patients, a higher number of positive cardiac biomarkers is associated with increased cardiovascular complications and mortality. These findings suggest that cardiac biomarkers should be utilized to guide acute-phase treatment strategies.
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Affiliation(s)
- Juan Esteban Gómez-Mesa
- Departamento de Cardiología, Fundación Valle del Lili, Cali 760032, Colombia;
- Facultad de Ciencias de Salud, Universidad Icesi, Cali 760031, Colombia; (M.E.); (J.A.M.-O.); (V.A.-R.); (J.D.P.-M.)
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali 760032, Colombia; (H.L.-G.); (A.V.-O.)
| | - Manuela Escalante
- Facultad de Ciencias de Salud, Universidad Icesi, Cali 760031, Colombia; (M.E.); (J.A.M.-O.); (V.A.-R.); (J.D.P.-M.)
| | - Juan Andrés Muñoz-Ordoñez
- Facultad de Ciencias de Salud, Universidad Icesi, Cali 760031, Colombia; (M.E.); (J.A.M.-O.); (V.A.-R.); (J.D.P.-M.)
| | - Valeria Azcárate-Rodriguez
- Facultad de Ciencias de Salud, Universidad Icesi, Cali 760031, Colombia; (M.E.); (J.A.M.-O.); (V.A.-R.); (J.D.P.-M.)
| | - Juan David Peláez-Martínez
- Facultad de Ciencias de Salud, Universidad Icesi, Cali 760031, Colombia; (M.E.); (J.A.M.-O.); (V.A.-R.); (J.D.P.-M.)
| | - Andrea Alejandra Arteaga-Tobar
- Departamento de Cardiología, Fundación Valle del Lili, Cali 760032, Colombia;
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali 760032, Colombia; (H.L.-G.); (A.V.-O.)
| | - Hoover León-Giraldo
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali 760032, Colombia; (H.L.-G.); (A.V.-O.)
| | - Andrea Valencia-Orozco
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali 760032, Colombia; (H.L.-G.); (A.V.-O.)
| | - Eduardo Roque Perna
- Departamento de Cardiología, Instituto de Cardiología JF Cabral, Corrientes 3400, Argentina;
| | - Alexander Romero
- Departamento de Cardiología, Hospital Santo Tomas, Panama City 07093, Panama;
| | - Iván Mendoza
- Departamento de Cardiología, Universidad Central de Venezuela, Caracas 1040A, Venezuela;
| | - Fernando Wyss
- Departamento de Cardiología, Servicios y Tecnología Cardiovascular de Guatemala S.A–Cardiosolutions, Guatemala City 01010, Guatemala;
| | - José Luis Barisani
- Departamento de Cardiología, Clínica Adventista Belgrano, Buenos Aires 1710, Argentina;
| | - Mario Speranza
- Departamento de Cardiología, Hospital Clínica Bíblica, San Jose 10104, Costa Rica;
| | - Walter Alarco
- Departamento de Cardiología, Instituto Nacional Cardiovascular INCOR ESSALUD, Lima 15072, Peru;
| | - Cesar Herrera
- Departamento de Cardiología, Centro de Diagnóstico, Medicina Avanzada y Telemedicina (CEDIMAT), Santo Domingo 10216, Dominican Republic;
| | - Julián Lugo-Peña
- Departamento de Cardiología, Clínica del Occidente, Bogota 110110, Colombia;
| | | | - Victor Rossel
- Departamento de Cardiología, Hospital del Salvador, San Salvador 1101, El Salvador;
| | - Daniel Sierra
- Departamento de Cardiología, Instituto Nacional de Cardiología–Ignacio Chávez, Mexico City 14080, Mexico;
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Sano M, Toyota T, Morimoto T, Noguchi Y, Shigeno R, Murai R, Okada T, Sasaki Y, Taniguchi T, Kim K, Kobori A, Ehara N, Kinoshita M, Doi A, Tomii K, Kihara Y, Furukawa Y. Risk stratification and prognosis prediction using cardiac biomarkers in COVID-19: a single-centre retrospective cohort study. BMJ Open 2024; 14:e082220. [PMID: 38658000 PMCID: PMC11043716 DOI: 10.1136/bmjopen-2023-082220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 02/22/2024] [Indexed: 04/26/2024] Open
Abstract
OBJECTIVE There is a need for a robust tool to stratify the patient's risk with COVID-19. We assessed the prognostic values of cardiac biomarkers for COVID-19 patients. METHODS This is a single-centre retrospective cohort study. Consecutive laboratory-confirmed COVID-19 patients admitted to the Kobe City Medical Center General Hospital from July 2020 to September 2021 were included. We obtained cardiac biomarker values from electronic health records and institutional blood banks. We stratified patients with cardiac biomarkers as high-sensitive troponin I (hsTnI), N-terminal pro-B-type natriuretic peptide (NT-proBNP), creatine kinase (CK) and CK myocardial band (CK-MB), using the clinically relevant thresholds. Prespecified primary outcome measure was all-cause death. RESULTS A total of 917 patients were included. hsTnI, NT-proBNP, CK and CK-MB were associated with the significantly higher cumulative 30-day incidence of all-cause death (hsTnI: <5.0 ng/L group; 4.3%, 5.0 ng/L-99%ile upper reference limit (URL) group; 8.8% and ≥99% ile URL group; 25.2%, p<0.001. NT-proBNP: <125 pg/mL group; 5.3%, 125-900 pg/mL group; 10.5% and ≥900 pg/mL group; 31.9%, p<0.001. CK: CONCLUSIONS Elevation of cardiac biomarkers was associated with poor prognosis of COVID-19 patients.
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Affiliation(s)
- Madoka Sano
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Toshiaki Toyota
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Takeshi Morimoto
- Center for Clinical Research and Innovation, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yu Noguchi
- Department of Cardiovascular Medicine, Tenri Hospital, Tenri, Japan
| | - Ryo Shigeno
- Department of Cardiovascular Medicine, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Ryosuke Murai
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Taiji Okada
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yasuhiro Sasaki
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Tomohiko Taniguchi
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kitae Kim
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Atsushi Kobori
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Natsuhiko Ehara
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Makoto Kinoshita
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Asako Doi
- Department of Infectious disease, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Keisuke Tomii
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yasuki Kihara
- Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
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Rabbani G, Ahmad E, Khan ME, Khan AU, Zamzami MA, Ahmad A, Ali SK, Bashiri AH, Zakri W. Synthesis of carbon nanotubes-chitosan nanocomposite and immunosensor fabrication for myoglobin detection: An acute myocardial infarction biomarker. Int J Biol Macromol 2024; 265:130616. [PMID: 38447842 DOI: 10.1016/j.ijbiomac.2024.130616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 03/02/2024] [Accepted: 03/02/2024] [Indexed: 03/08/2024]
Abstract
The use of single-walled carbon nanotubes (SWCNTs) in biomedical applications is limited due to their inability to disperse in aqueous solutions. In this study, dispersed -COOH functionalized CNTs with N-succinylated chitosan (CS), greatly increasing the water solubility of CNTs and forming a uniformly dispersed nanocomposite solution of CNTs@CS. Coupling reagent EDC/NHS was used as a linker with the -COOH groups present on the N-succinylated chitosan which significantly improved the affinity of the CNTs for biomolecules. Myoglobin (Mb) is a promising biomarker for the precise assessment of cardiovascular risk, type 2 diabetes, metabolic syndrome, hypertension and several types of cancer. A high level of Mb can be used to diagnose the mentioned pathogenic diseases. The CNTs@CS-FET demonstrates superior sensing performance for Mb antigen fortified in buffer, with a wide linear range of 1 to 4000 ng/mL. The detection limit of the developed Mb immunosensor was estimated to be 4.2 ng/mL. The novel CNTs@CS-FET immunosensor demonstrates remarkable capability in detecting Mb without being affected by interferences from nonspecific antigens. Mb spiked serum showed a recovery rate of 100.262 to 118.55 % indicating great promise for Mb detection in clinical samples. The experimental results confirmed that the CNTs@CS-FET immunosensor had excellent selectivity, reproducibility and storage stability.
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Affiliation(s)
- Gulam Rabbani
- IT-medical Fusion Center, 350-27 Gumidae-ro, Gumi-si, Gyeongbuk 39253, Republic of Korea.
| | - Ejaz Ahmad
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI 48109, United States of America
| | - Mohammad Ehtisham Khan
- Department of Chemical Engineering Technology, College of Applied Industrial Technology, Jazan University, Jazan 45142, Saudi Arabia.
| | - Anwar Ulla Khan
- Department of Electrical Engineering Technology, College of Applied Industrial Technology, Jazan University, Jazan 45142, Saudi Arabia
| | - Mazin A Zamzami
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah 21452, Saudi Arabia
| | - Abrar Ahmad
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah 21452, Saudi Arabia
| | - Syed Kashif Ali
- Department of Physical Sciences, Chemistry Division, College of Science, Jazan University, P.O. Box. 114, Jazan 45142, Kingdom of Saudi Arabia; Nanotechnology research unit, College of Science, Jazan University, P.O. Box. 114, Jazan 45142, Kingdom of Saudi Arabia
| | - Abdullateef H Bashiri
- Department of Mechanical Engineering, College of Engineering, Jazan University, P. O. Box 114, Jazan 45142, Saudi Arabia
| | - Waleed Zakri
- Department of Mechanical Engineering, College of Engineering, Jazan University, P. O. Box 114, Jazan 45142, Saudi Arabia
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Zhang J, Luo S, Cai J, Kong X, Zhang L, Qi L, Zhang LJ. Multiparametric Cardiovascular Magnetic Resonance in Nonhospitalized COVID-19 Infection Subjects: An Intraindividual Comparison Study. J Thorac Imaging 2024; 39:86-92. [PMID: 38270475 DOI: 10.1097/rti.0000000000000774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
PURPOSE To investigate intraindividual cardiac structural and functional changes before and after COVID-19 infection in a previously healthy population with a 3T cardiac magnetic resonance (CMR). MATERIALS AND METHODS A total of 39 unhospitalized patients with COVID-19 were recruited. They participated in our previous study as non-COVID-19 healthy volunteers undergoing baseline CMR examination and were recruited to perform a repeated CMR examination after confirmed COVID-19 infection in December 2022. The CMR parameters were measured and compared between before and after COVID-19 infection with paired t tests. The laboratory measures including myocardial enzymes and inflammatory indicators were also collected when performing repeated CMR. RESULTS The median duration was 393 days from the first to second CMR and 26 days from clinical symptoms onset to the second CMR. Four patients (10.3%, 4/39) had the same late gadolinium enhancement pattern at baseline and repeated CMR and 5 female patients (12.8%, 5/39) had myocardial T2 ratio >2 (2.07 to 2.27) but with normal T2 value in post-COVID-19 CMR. All other CMR parameters were in normal ranges before and after COVID-19 infection. Between before and after the COVID-19 infection, there were no significant differences in cardiac structure, function, and tissue characterization, no matter with or without symptoms (fatigue, chest discomfort, palpitations, shortness of breath, and insomnia/sleep disorders) (all P >0.05). The laboratory measures at repeated CMR were in normal ranges in all participants. CONCLUSIONS These intraindividual CMR studies showed unhospitalized patients with COVID-19 with normal myocardial enzymes had no measurable CMR abnormalities, which can help alleviate wide social concerns about COVID-19-related myocarditis.
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Affiliation(s)
- Jun Zhang
- Department of Radiology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University
- Department of Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Song Luo
- Department of Radiology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University
| | - Jun Cai
- Department of Radiology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University
| | - Xiang Kong
- Department of Radiology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University
| | - Lingyan Zhang
- Department of Radiology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University
| | - Li Qi
- Department of Radiology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University
- Department of Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Long Jiang Zhang
- Department of Radiology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University
- Department of Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
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Hussain S, Songhua X, Aslam MU, Hussain F. Clinical predictions of COVID-19 patients using deep stacking neural networks. J Investig Med 2024; 72:112-127. [PMID: 37712431 DOI: 10.1177/10815589231201103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic, which emerged in late 2019, has caused millions of infections and fatalities globally, disrupting various aspects of human society, including socioeconomic, political, and educational systems. One of the key challenges during the COVID-19 pandemic is accurately predicting the clinical development and outcome of the infected patients. In response, scientists and medical professionals globally have mobilized to develop prognostic strategies such as risk scores, biomarkers, and machine learning models to predict the clinical course and outcomes of COVID-19 patients. In this contribution, we deployed a mathematical approach called matrix factorization feature selection to select the most relevant features from the anonymized laboratory biomarkers and demographic data of COVID-19 patients. Based on these features, developed a model that leverages the deep stacking neural network (DSNN) to aid in clinical care by predicting patients' mortality risk. To gauge the performance of our suggested model, performed a comparative analysis with principal component analysis plus support vector machine, deep learning, and random forest, achieving outstanding performances. The DSNN model outperformed all the other models in terms of area under the curve (96.0%), F1-score (98.1%), recall (98.5%), accuracy (99.0%), precision (97.7%), specificity (97.0%), and maximum probability of correction decision (93.4%). Our model outperforms the clinical predictive models regarding patient mortality risk and classification in the literature. Therefore, we conclude that our robust model can help healthcare professionals to manage COVID-19 patients more effectively. We expect that early prediction of COVID-19 patients and preventive interventions can reduce the mortality risk of patients.
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Affiliation(s)
- Sajid Hussain
- School of Mathematics and Statistics XJTU, Xian, Shaanxi, China
| | - Xu Songhua
- School of Mathematics and Statistics XJTU, Xian, Shaanxi, China
| | | | - Fida Hussain
- School of Engineering and Sciences, Tecnologico de Monterrey, Monterrey, Nuevo León, Mexico
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Sabbatinelli J, Di Rosa M, Giuliani A, Domenichelli M, Bonfigli AR, Sarzani R, Cherubini A, Antonicelli R, Burattini M, Corsonello A, Galeazzi R, Babini L, Moretti M, Procopio AD, Lattanzio F, Olivieri F. Serum levels of soluble suppression of tumorigenicity 2 (sST2) and heart-type fatty acid binding protein (H-FABP) independently predict in-hospital mortality in geriatric patients with COVID-19. Mech Ageing Dev 2023; 216:111876. [PMID: 37802485 DOI: 10.1016/j.mad.2023.111876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/02/2023] [Accepted: 10/03/2023] [Indexed: 10/10/2023]
Abstract
Elevation of cardiac damage biomarkers is associated with adverse clinical outcomes and increased mortality in COVID-19 patients. This study assessed the association of admission serum levels of sST2 and H-FABP with in-hospital mortality in 191 geriatric patients (median age 86 yrs., IQR 82-91 yrs.) with COVID-19 and available measures of hs-cTnT and NT-proBNP at admission. Cox proportional hazards models were utilized to predict in-hospital mortality, considering clinical/biochemical confounders as covariates. A composite cardiac score was calculated to improve predictive accuracy. Patients deceased during their hospital stay (26%) exhibited higher levels of all biomarkers, which demonstrated good discrimination for in-hospital mortality. Addition of sST2 and H-FABP significantly improved the discriminatory power of hs-cTnT and NT-proBNP. The composite cardiac score (AUC=0.866) further enhanced the predictive accuracy. Crude and adjusted Cox regressions models revealed that both sST2 and H-FABP were independently associated with in-hospital mortality (HR for sST2 ≥129 ng/mL, 4.32 [1.48-12.59]; HR for H-FABP ≥18 ng/mL, 7.70 [2.12-28.01]). The composite cardiac score also independently correlated with in-hospital mortality (HR for 1-unit increase, 1.47 [1.14-1.90]). In older patients with COVID-19, sST2 and H-FABP demonstrated prognostic value, improving the predictive accuracy of the routinely assessed biomarkers hs-cTnT and NT-proBNP.
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Affiliation(s)
- Jacopo Sabbatinelli
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy; Laboratory Medicine Unit, Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy.
| | - Mirko Di Rosa
- Centre for Biostatistics and Applied Geriatric Clinical Epidemiology, IRCCS INRCA, Ancona, Italy
| | - Angelica Giuliani
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Marco Domenichelli
- Laboratory Medicine Unit, Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy
| | | | | | - Antonio Cherubini
- Geriatria, Accettazione geriatrica e Centro di Ricerca Per l'invecchiamento, IRCCS INRCA, Ancona, Italy
| | | | | | - Andrea Corsonello
- Centre for Biostatistics and Applied Geriatric Clinical Epidemiology, IRCCS INRCA, Ancona, Italy; Geriatric Medicine, IRCCS INRCA, Cosenza, Italy
| | - Roberta Galeazzi
- Clinic of Laboratory and Precision Medicine, IRCCS INRCA, Ancona, Italy
| | - Lucia Babini
- Laboratory Medicine Unit, Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy
| | - Marco Moretti
- Laboratory Medicine Unit, Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy
| | - Antonio Domenico Procopio
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy; Clinic of Laboratory and Precision Medicine, IRCCS INRCA, Ancona, Italy
| | | | - Fabiola Olivieri
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy; Clinic of Laboratory and Precision Medicine, IRCCS INRCA, Ancona, Italy
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9
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Zhang M, Jiao Z. Nonlinear Relationship Between Interleukin-6 and NT-proBNP at Admission in Hospitalized COVID-19 Patients. Infect Drug Resist 2023; 16:6259-6267. [PMID: 37753230 PMCID: PMC10519174 DOI: 10.2147/idr.s426470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/14/2023] [Indexed: 09/28/2023] Open
Abstract
Purpose Elevated levels of the inflammatory marker interleukin-6 (IL-6) and cardiac injury marker N-terminal pro-B-type natriuretic peptide (NT-proBNP) have been observed in patients with coronavirus disease 2019 (COVID-19). However, the relationship between IL-6 and NT-proBNP levels remains unclear. Therefore, we investigated the relationship between IL-6 and NT-proBNP levels in patients with COVID-19. Patients and Methods This was a cross-sectional study. Consecutive patients with COVID-19 were included herein. The independent and dependent target variables were the IL-6 and NT-proBNP levels, respectively, measured at baseline. Univariate and multivariate linear regression analyses and curve fitting were also performed. Results The average age of the 121 selected participants was 49.8 ± 15.8 years old, and 48.8% (59/121) were male. The estimated β value between Ln-transformed IL-6 and NT-proBNP was 0.28 (95% confidence interval [CI] 0.12-0.44, P = 0.001) in univariate logistic regression analysis and 0.09 (95% CI -0.04-0.21, P = 0.176) in the fully adjusted model. This relationship was nonlinear, with a point of 2.7, and the β values (and CIs) for the left (<2.7) and right (≥2.7) sides of the inflection point were -0.06 (95% CI -0.23-0.12, P = 0.534) and 0.77 (95% CI 0.18-1.37, P = 0.016) in the fully adjusted model, respectively. Conclusion Our results suggest a nonlinear association between IL-6 and NT-proBNP levels. Higher IL-6 levels are associated with NT-proBNP in patients with COVID-19.
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Affiliation(s)
- Meijuan Zhang
- Department of Cardiology, Tianjin Institute of Respiratory Diseases, Tianjin Haihe Hospital, Tianjin University, Tianjin, People’s Republic of China
| | - Zhanquan Jiao
- Department of Cardiology, Tianjin Institute of Respiratory Diseases, Tianjin Haihe Hospital, Tianjin University, Tianjin, People’s Republic of China
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10
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Gao Q, Yang Y, Luo Y, Chen X, Gong T, Wu D, Feng Y, Zheng X, Wang H, Zhang G, Lu G, Gong L. African Swine Fever Virus Envelope Glycoprotein CD2v Interacts with Host CSF2RA to Regulate the JAK2-STAT3 Pathway and Inhibit Apoptosis to Facilitate Virus Replication. J Virol 2023; 97:e0188922. [PMID: 37022174 PMCID: PMC10134862 DOI: 10.1128/jvi.01889-22] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/14/2023] [Indexed: 04/07/2023] Open
Abstract
African swine fever (ASF) is a highly infectious disease caused by the African swine fever virus (ASFV) in swine. It is characterized by the death of cells in infected tissues. However, the molecular mechanism of ASFV-induced cell death in porcine alveolar macrophages (PAMs) remains largely unknown. In this study, transcriptome sequencing of ASFV-infected PAMs found that ASFV activated the JAK2-STAT3 pathway in the early stages and apoptosis in the late stages of infection. Meanwhile, the JAK2-STAT3 pathway was confirmed to be essential for ASFV replication. AG490 and andrographolide (AND) inhibited the JAK2-STAT3 pathway, promoted ASFV-induced apoptosis, and exerted antiviral effects. Additionally, CD2v promoted STAT3 transcription and phosphorylation as well as translocation into the nucleus. CD2v is the main envelope glycoprotein of the ASFV, and further investigations showed that CD2v deletion downregulates the JAK2-STAT3 pathway and promotes apoptosis to inhibit ASFV replication. Furthermore, we discovered that CD2v interacts with CSF2RA, which is a hematopoietic receptor superfamily member in myeloid cells and a key receptor protein that activates receptor-associated JAK and STAT proteins. In this study, CSF2RA small interfering RNA (siRNA) downregulated the JAK2-STAT3 pathway and promoted apoptosis to inhibit ASFV replication. Taken together, ASFV replication requires the JAK2-STAT3 pathway, while CD2v interacts with CSF2RA to regulate the JAK2-STAT3 pathway and inhibit apoptosis to facilitate virus replication. These results provide a theoretical basis for the escape mechanism and pathogenesis of ASFV. IMPORTANCE African swine fever is a hemorrhagic disease caused by the African swine fever virus (ASFV), which infects pigs of different breeds and ages, with a fatality rate of up to 100%. It is one of the key diseases affecting the global livestock industry. Currently, no commercial vaccines or antiviral drugs are available. Here, we show that ASFV replicates via the JAK2-STAT3 pathway. More specifically, ASFV CD2v interacts with CSF2RA to activate the JAK2-STAT3 pathway and inhibit apoptosis, thereby maintaining the survival of infected cells and promoting viral replication. This study revealed an important implication of the JAK2-STAT3 pathway in ASFV infection and identified a novel mechanism by which CD2v has evolved to interact with CSF2RA and maintain JAK2-STAT3 pathway activation to inhibit apoptosis, thus elucidating new information regarding the signal reprogramming of host cells by ASFV.
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Affiliation(s)
- Qi Gao
- Guangdong Provincial Key Laboratory of Zoonosis Prevention and Control, College of Veterinary Medicine, South China Agricultural University, Guangzhou, China
- African Swine Fever Regional Laboratory of China (Guangzhou), Guangzhou, China
- Maoming Branch, Guangdong Laboratory for Lingnan Modern Agriculture, Maoming, China
| | - Yunlong Yang
- Guangdong Provincial Key Laboratory of Zoonosis Prevention and Control, College of Veterinary Medicine, South China Agricultural University, Guangzhou, China
- African Swine Fever Regional Laboratory of China (Guangzhou), Guangzhou, China
| | - Yizhuo Luo
- Guangdong Provincial Key Laboratory of Zoonosis Prevention and Control, College of Veterinary Medicine, South China Agricultural University, Guangzhou, China
- African Swine Fever Regional Laboratory of China (Guangzhou), Guangzhou, China
| | - Xiongnan Chen
- Guangdong Provincial Key Laboratory of Zoonosis Prevention and Control, College of Veterinary Medicine, South China Agricultural University, Guangzhou, China
- Key Laboratory of Animal Vaccine Development, Ministry of Agriculture and Rural Affairs, Guangzhou, China
| | - Ting Gong
- Guangdong Provincial Key Laboratory of Zoonosis Prevention and Control, College of Veterinary Medicine, South China Agricultural University, Guangzhou, China
- Key Laboratory of Animal Vaccine Development, Ministry of Agriculture and Rural Affairs, Guangzhou, China
| | - Dongdong Wu
- Guangdong Provincial Key Laboratory of Zoonosis Prevention and Control, College of Veterinary Medicine, South China Agricultural University, Guangzhou, China
- Key Laboratory of Animal Vaccine Development, Ministry of Agriculture and Rural Affairs, Guangzhou, China
| | - Yongzhi Feng
- Guangdong Provincial Key Laboratory of Zoonosis Prevention and Control, College of Veterinary Medicine, South China Agricultural University, Guangzhou, China
- Maoming Branch, Guangdong Laboratory for Lingnan Modern Agriculture, Maoming, China
| | - Xiaoyu Zheng
- Guangdong Provincial Key Laboratory of Zoonosis Prevention and Control, College of Veterinary Medicine, South China Agricultural University, Guangzhou, China
- Maoming Branch, Guangdong Laboratory for Lingnan Modern Agriculture, Maoming, China
| | - Heng Wang
- Guangdong Provincial Key Laboratory of Zoonosis Prevention and Control, College of Veterinary Medicine, South China Agricultural University, Guangzhou, China
- African Swine Fever Regional Laboratory of China (Guangzhou), Guangzhou, China
- Maoming Branch, Guangdong Laboratory for Lingnan Modern Agriculture, Maoming, China
| | - Guihong Zhang
- Guangdong Provincial Key Laboratory of Zoonosis Prevention and Control, College of Veterinary Medicine, South China Agricultural University, Guangzhou, China
- Key Laboratory of Animal Vaccine Development, Ministry of Agriculture and Rural Affairs, Guangzhou, China
| | - Gang Lu
- Guangdong Provincial Key Laboratory of Zoonosis Prevention and Control, College of Veterinary Medicine, South China Agricultural University, Guangzhou, China
- Key Laboratory of Animal Vaccine Development, Ministry of Agriculture and Rural Affairs, Guangzhou, China
| | - Lang Gong
- Guangdong Provincial Key Laboratory of Zoonosis Prevention and Control, College of Veterinary Medicine, South China Agricultural University, Guangzhou, China
- African Swine Fever Regional Laboratory of China (Guangzhou), Guangzhou, China
- Key Laboratory of Animal Vaccine Development, Ministry of Agriculture and Rural Affairs, Guangzhou, China
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Grassi S, Arena V, Zedda M, Cazzato F, Cianci R, Gambassi G, Oliva A. What can autopsy say about COVID-19? A case series of 60 autopsies. Leg Med (Tokyo) 2023; 62:102241. [PMID: 36924619 PMCID: PMC10008096 DOI: 10.1016/j.legalmed.2023.102241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 03/03/2023] [Accepted: 03/08/2023] [Indexed: 03/17/2023]
Abstract
INTRODUCTION Autopsies in SARS-CoV-2 infected cadavers are mainly performed to distinguish patients who died with SARS-CoV-2 infection from those who died of COVID-19. The aim of the current study is to assess the most frequent autopsy findings in patients who died of COVID-19 and to establish an association with clinical records. MATERIALS AND METHODS 60 patients died between April 2020 and March 2021 after SARS-CoV-2 infection underwent a full autopsy performed at Fondazione Policlinico Universitario Agostino Gemelli IRCCS (Rome). Ante-mortem diagnosis of SARS-CoV-2 infection was microbiologically confirmed. RESULTS 55 (92%) of cases had at least a comorbidity. At microscopic examination, 40 (67%) of the patients presented pulmonary intravascular coagulation with an inflammatory pattern. Pulmonary microangiopathy was a rare finding (n = 8; 13%). Myocardiosclerosis was the main heart finding (n = 44; 73%). Liver involvement with congestion and hypotrophy was found in 33 (55%) of cadavers. Renal tubular epithelial exfoliation (n = 12; 20%) and intravascular coagulation (n = 4; 7%) were frequent observations. During hospitalization 31% of patients (n = 19) developed acute kidney injury (AKI). CONCLUSIONS Lungs and kidneys have been shown to play a pivotal role in COVID-19. The gradual worsening of renal function and AKI might be the result of the progressive collapse of cardiopulmonary system.
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Affiliation(s)
- Simone Grassi
- Forensic Medical Sciences, Department of Health Science, University of Florence, Largo Brambilla 3, Florence 50134, Italy; Legal Medicine, Department of Health Surveillance and Bioethics, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Vincenzo Arena
- Area of Pathology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00147, Italy
| | - Massimo Zedda
- Legal Medicine, Department of Health Surveillance and Bioethics, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
| | - Francesca Cazzato
- Legal Medicine, Department of Health Surveillance and Bioethics, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Rossella Cianci
- Department of Translational Medicine and Surgery, Catholic University of Rome, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome 00168, Italy
| | - Giovanni Gambassi
- Department of Translational Medicine and Surgery, Catholic University of Rome, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome 00168, Italy
| | - Antonio Oliva
- Legal Medicine, Department of Health Surveillance and Bioethics, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Abstract
PURPOSE OF REVIEW Cardiac consequences occur in both acute COVID-19 and post-acute sequelae of COVID-19 (PASC). Here, we highlight the current understanding about COVID-19 cardiac effects, based upon clinical, imaging, autopsy, and molecular studies. RECENT FINDINGS COVID-19 cardiac effects are heterogeneous. Multiple, concurrent cardiac histopathologic findings have been detected on autopsies of COVID-19 non-survivors. Microthrombi and cardiomyocyte necrosis are commonly detected. Macrophages often infiltrate the heart at high density but without fulfilling histologic criteria for myocarditis. The high prevalences of microthrombi and inflammatory infiltrates in fatal COVID-19 raise the concern that recovered COVID-19 patients may have similar but subclinical cardiac pathology. Molecular studies suggest that SARS-CoV-2 infection of cardiac pericytes, dysregulated immunothrombosis, and pro-inflammatory and anti-fibrinolytic responses underlie COVID-19 cardiac pathology. The extent and nature by which mild COVID-19 affects the heart is unknown. Imaging and epidemiologic studies of recovered COVID-19 patients suggest that even mild illness confers increased risks of cardiac inflammation, cardiovascular disorders, and cardiovascular death. The mechanistic details of COVID-19 cardiac pathophysiology remain under active investigation. The ongoing evolution of SARS-CoV-2 variants and vast numbers of recovered COVID-19 patients portend a burgeoning global cardiovascular disease burden. Our ability to prevent and treat cardiovascular disease in the future will likely depend on comprehensive understanding of COVID-19 cardiac pathophysiologic phenotypes.
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Affiliation(s)
- Lorenzo R. Sewanan
- Department of Medicine, Columbia University Irving Medical Center, New York, NY USA
| | - Kevin J. Clerkin
- Center for Advanced Cardiac Care, Division of Cardiology, Columbia University Irving Medical Center, New York, NY USA
| | | | - Emily J. Tsai
- Center for Advanced Cardiac Care, Division of Cardiology, Columbia University Irving Medical Center, New York, NY USA
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13
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Cireli E, Mertoğlu A. A Cross-Sectional Study for Determining the Role of High-Sensitivity Cardiac Troponin T in Predicting 4-Month Mortality during the First Wave of the COVID-19 Pandemic. TANAFFOS 2023; 22:200-208. [PMID: 38628878 PMCID: PMC11016924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 01/12/2022] [Indexed: 04/19/2024]
Abstract
Background Positivity of cardiac troponins is common in hospitalized COVID-19 patients and may serve as an additional risk stratification tool in everyday clinical settings. Since patients with elevated troponins have a higher risk of in-hospital mortality, troponins have prognostic importance. As well as in-hospital mortality, high-sensitive troponin T may reflect 4-month mortality. We analyzed the relationship between cardiac troponin T levels and 4-month mortality of COVID-19. Materials and Methods It was conducted as a retrospective cross-sectional study in Health Sciences University Dr. Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital Izmir, Turkey, with COVID-19 pneumonia patients during the first wave of the pandemic. We analyzed their comorbidities, C-reactive protein, ferritin, aspartate transaminase, alanine transaminase, cardiac troponin T, N-terminal-prohormone B-type-natriuretic peptide, international normalized ratio; duration of hospital stay, and survival status. Results Factors associated with mortality were cardiac troponin T > 0.53 pg/dl (p = 0.009) and aspartate transaminase > 26.5 U/l (p = 0.012). The threshold for cardiac troponin T to predict 4-month mortality was 5.83pg/ml. Its sensitivity was 82.8% and its specificity was 66.4%. Conclusion Cardiac troponin T and AST are indicators that can be used to predict 4-month mortality in addition to showing in-hospital mortality. The threshold for cardiac troponin T to predict 4-month all-cause mortality is 5.83pg/ml. The mortality difference persists at the beginning, middle, and end of the 4 months. Reference thresholds likely underestimate the true prognostic extent of cardiac injury and lower cutoff values may show mortality.
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Affiliation(s)
- Emel Cireli
- Health Sciences University Dr Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital, Izmir, Turkey
| | - Aydan Mertoğlu
- Health Sciences University Dr Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital, Izmir, Turkey
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14
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Effect of troponin I and coagulation parameters on mortality in COVID-19 patients. MARMARA MEDICAL JOURNAL 2023. [DOI: 10.5472/marumj.1235703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Objective: Our aim is to determine the levels of troponin-I and some coagulation markers (D-dimer, fibrinogen and International Normalized Ratio (INR)) in coronavirus disease 2019 (COVID-19) patients and to investigate the effects of these markers on mortality.
Patients and Methods: It is planned as a descriptive, cross-sectional and analytical study. The study was conducted by retrospectively scanning the files of COVID-19 patients who applied to Inonu University Turgut Ozal Medical Center between 01.03.2020 and 31.12.2020. Levels of cardiac troponin I markers and coagulation parameters (D-dimer, fibrinogen and INR) were detected.
Results: The results of a total of 1858 patients were obtained. One thousand, three hundred and twenty-six patients with only troponin I and D-dimer results (Group 1), 606 patients with only troponin I and fibrinogen results (Group 2), and 1308 patients with only troponin I and INR results (Group 3) were included. Troponin I levels were significantly higher in all patients who died. 96.6% of the patients with high D-dimer levels died in Group 1, 85.5% of the patients with high fibrinogen levels died in Group 2 and 77.3 % of the patients with high INR levels died in Group 3.
Conclusion: Measurements of troponin-I and coagulation markers such as D-dimer, fibrinogen and INR can help predict clinical severity and mortality in COVID-19 patients.
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15
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Kanaeva TV, Karoli NA. Prognostic biomarkers for cardiovascular injury in patients with COVID-19: a review. SECHENOV MEDICAL JOURNAL 2023. [DOI: 10.47093/2218-7332.2022.13.3.14-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Investigations into the causes of adverse outcomes of the novel coronavirus infection (COVID-19) have been ongoing since the beginning of the pandemic. There is evidence that coronavirus-induced cardiovascular injury is as important to a risk of adverse outcome as respiratory injury. Many studies have shown that concomitant cardiovascular disease aggravates the course of COVID-19. However, in some patients who did not have cardiovascular diseases before COVID-19, they are detected during hospitalization or after discharge from the hospital. The review examines data on the effect of serum biomarkers of cardiovascular disease determined during COVID-19 on the risk of adverse outcomes in the near and long-term follow-up periods. Among such biomarkers are considered: troponins, N-terminal pro B-type natriuretic peptide, creatine phosphokinase-MB, lactate dehydrogenase, myoglobin, growth stimulation expressed gene 2, pentraxin 3, angiotensin II, as well as D-dimer and homocysteine. Threshold values have been set for some of these biomarkers, which allow predicting the risk of an unfavorable outcome. At the same time, in most prognostic models, these markers are considered in association with cytokine storm indicators and other risk factors.
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Affiliation(s)
- T. V. Kanaeva
- Saratov State Medical University named after V.I. Razumovsky
| | - N. A. Karoli
- Saratov State Medical University named after V.I. Razumovsky
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16
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COVID-19: A Comprehensive Review on Cardiovascular Alterations, Immunity, and Therapeutics in Older Adults. J Clin Med 2023; 12:jcm12020488. [PMID: 36675416 PMCID: PMC9865642 DOI: 10.3390/jcm12020488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 01/11/2023] Open
Abstract
Here, we present a review focusing on three relevant issues related to COVID-19 and its impact in older adults (60 years and older). SARS-CoV-2 infection starts in the respiratory system, but the development of systemic diseases accompanied by severe clinical manifestations has also been reported, with cardiovascular and immune system dysfunction being the major ones. Additionally, the presence of comorbidities and aging represent major risk factors for the severity and poor prognosis of the disease. Since aging-associated decline has been largely related to immune and cardiovascular alterations, we sought to investigate the consequences and the underlying mechanisms of these pathologies to understand the severity of the illness in this population. Understanding the effects of COVID-19 on both systems should translate into comprehensive and improved medical care for elderly COVID-19 patients, preventing cardiovascular as well as immunological alterations in this population. Approved therapies that contribute to the improvement of symptoms and a reduction in mortality, as well as new therapies in development, constitute an approach to managing these disorders. Among them, we describe antivirals, cytokine antagonists, cytokine signaling pathway inhibitors, and vaccines.
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Smer A, Squires RW, Bonikowske AR, Allison TG, Mainville RN, Williams MA. Cardiac Complications of COVID-19 Infection and the Role of Physical Activity. J Cardiopulm Rehabil Prev 2023; 43:8-14. [PMID: 35839441 PMCID: PMC9828583 DOI: 10.1097/hcr.0000000000000701] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Since December 2019, the newly emerging coronavirus has become a global pandemic with >250 million people infected and >5 million deaths worldwide. Infection with coronavirus disease-2019 (COVID-19) causes a severe immune response and hypercoagulable state leading to tissue injury, organ damage, and thrombotic events. It is well known that COVID-19 infection predominately affects the lungs; however, the cardiovascular complications of the disease have been a major cause of morbidity and mortality. In addition, patients with cardiovascular disease are vulnerable to contract a severe form of the illness and increased mortality. A significant number of patients who survived the disease may experience post-COVID-19 syndrome with a variety of symptoms and physical limitations. Here, we review the cardiac complications of COVID-19 infection and the results of cardiopulmonary exercise testing and guidelines for exercise training after infection.
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Affiliation(s)
- Aiman Smer
- Department of Cardiovascular Medicine, CHI Health Creighton University School of Medicine, Omaha, Nebraska (Drs Smer and Williams); and Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota (Drs Squires, Bonikowske, and Allison and Ms Mainville)
| | - Ray W. Squires
- Department of Cardiovascular Medicine, CHI Health Creighton University School of Medicine, Omaha, Nebraska (Drs Smer and Williams); and Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota (Drs Squires, Bonikowske, and Allison and Ms Mainville)
| | - Amanda R. Bonikowske
- Department of Cardiovascular Medicine, CHI Health Creighton University School of Medicine, Omaha, Nebraska (Drs Smer and Williams); and Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota (Drs Squires, Bonikowske, and Allison and Ms Mainville)
| | - Thomas G. Allison
- Department of Cardiovascular Medicine, CHI Health Creighton University School of Medicine, Omaha, Nebraska (Drs Smer and Williams); and Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota (Drs Squires, Bonikowske, and Allison and Ms Mainville)
| | - Rylie N. Mainville
- Department of Cardiovascular Medicine, CHI Health Creighton University School of Medicine, Omaha, Nebraska (Drs Smer and Williams); and Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota (Drs Squires, Bonikowske, and Allison and Ms Mainville)
| | - Mark A. Williams
- Department of Cardiovascular Medicine, CHI Health Creighton University School of Medicine, Omaha, Nebraska (Drs Smer and Williams); and Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota (Drs Squires, Bonikowske, and Allison and Ms Mainville)
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Sebbar EH, Choukri M. Cardiovascular markers and COVID-19. MATERIALS TODAY. PROCEEDINGS 2023; 72:3356-3359. [PMID: 35937953 PMCID: PMC9343768 DOI: 10.1016/j.matpr.2022.07.388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
COVID-19 is an emerging viral disease with incompletely elucidated pathogenesis, a heterogeneous clinical profile, and significant interindividual variability. The major cardiovascular complications of COVID-19 include acute cardiac injury, acute myocardial infarction (AMI), myocarditis, arrhythmia, heart failure, and venous thromboembolism (VTE)/pulmonary embolism (PE). Elevated BNP /NT-proBNP, troponin and d-dimer levels has been found in a significant proportion of patients since the first data analysis, suggesting that myocardial damage is a likely pathogenic mechanism contributing to severe disease and mortality. The level of these markers is now associated with a risk of adverse outcome, namely mortality. The aim of our study is to highlight the importance of these biomarkers for the prediction of cardiovascular complications and their potential role in the evolution of COVID-19.
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19
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Consequences of COVID-19 on the cardiovascular and renal systems. Sleep Med 2022; 100:31-38. [PMID: 35994936 PMCID: PMC9345655 DOI: 10.1016/j.sleep.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 07/15/2022] [Accepted: 07/16/2022] [Indexed: 01/11/2023]
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Pickering JW, Scrase R, Troughton R, Jamieson HA. Evaluation of the added value of Brain Natriuretic Peptide to a validated mortality risk-prediction model in older people using a standardised international clinical assessment tool. PLoS One 2022; 17:e0277850. [PMID: 36399481 PMCID: PMC9674136 DOI: 10.1371/journal.pone.0277850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 11/03/2022] [Indexed: 11/19/2022] Open
Abstract
The ability to accurately predict the one-year survival of older adults is challenging for clinicians as they endeavour to provide the most appropriate care. Standardised clinical needs assessments are routine in many countries and some enable application of mortality prediction models. The added value of blood biomarkers to these models is largely unknown. We undertook a proof of concept study to assess if adding biomarkers to needs assessments is of value. Assessment of the incremental value of a blood biomarker, Brain Naturetic Peptide (BNP), to a one year mortality risk prediction model, RiskOP, previously developed from data from the international interRAI-HomeCare (interRAI-HC) needs assessment. Participants were aged ≥65 years and had completed an interRAI-HC assessment between 1 January 2013 and 21 August 2021 in Canterbury, New Zealand. Inclusion criteria was a BNP test within 90 days of the date of interRAI-HC assessment. The primary outcome was one-year mortality. Incremental value was assessed by change in Area Under the Receiver Operating Characteristic Curve (AUC) and Brier Skill, and the calibration of the final model. Of 14,713 individuals with an interRAI-HC assessment 1,537 had a BNP within 90 days preceding the assessment and all data necessary for RiskOP. 553 (36.0%) died within 1-year. The mean age was 82.6 years. Adding BNP improved the overall AUC by 0.015 (95% CI:0.004 to 0.028) and improved predictability by 1.9% (0.26% to 3.4%). In those with no Congestive Heart Failure the improvements were 0.029 (0.004 to 0.057) and 4.0% (0.68% to 7.6%). Adding a biomarker to a risk model based on standardised needs assessment of older people improved prediction of 1-year mortality. BNP added value to a risk prediction model based on the interRAI-HC assessment in those patients without a diagnosis of congestive heart failure.
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Affiliation(s)
- John W. Pickering
- Better Ageing with Big Data Research Group, Department of Medicine, University of Otago, Christchurch, New Zealand
- Department of Medicine, University of Otago, Christchurch Heart Institute, Christchurch, New Zealand
| | - Richard Scrase
- Te Whatu Ora–Health New Zealand, University of Otago, Christchurch, New Zealand
| | - Richard Troughton
- Department of Medicine, University of Otago, Christchurch Heart Institute, Christchurch, New Zealand
| | - Hamish A. Jamieson
- Better Ageing with Big Data Research Group, Department of Medicine, University of Otago, Christchurch, New Zealand
- * E-mail:
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21
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Turégano-Yedro M, Ruiz-García A, Castillo-Moraga M, Jiménez-Baena E, Barrios V, Serrano-Cumplido A, Pallarés-Carratalá V. Los péptidos natriuréticos en el diagnóstico de la insuficiencia cardíaca en atención primaria. Semergen 2022; 48:101812. [DOI: 10.1016/j.semerg.2022.101812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/29/2022] [Accepted: 06/06/2022] [Indexed: 10/14/2022]
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22
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Umeh CA, Ranchithan S, Watanabe K, Tuscher L, Gupta R. Elevated Troponin and Mortality in Patients with COVID-19: A Multicenter Retrospective Cohort Study. Open Cardiovasc Med J 2022. [DOI: 10.2174/18741924-v16-e2207210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction:
Myocardial injury, causing elevated troponin levels, have been associated with worse outcomes in coronavirus disease 2019 (COVID-19) disease patients. However, our anecdotal experience did not consistently reflect this pattern. Therefore, we evaluated the outcomes of COVID-19 patients with elevated troponin.
Methods:
This is a retrospective study of 1,024 COVID-19 patients admitted to two hospitals in Southern California in the United States. We categorized the troponin levels as normal (≤1× upper reference limit (URL)), mildly elevated (>1 to ≤3× URL), and severely elevated (>3× URL). We compared the characteristics of the three troponin groups using chi-square for categorical variables and one-way Anova for the continuous variables. Finally, backward selection Cox regression analysis was carried out using mortality as a dependent variable.
Results:
Of the COVID-19 1,024 patients included in the study, 944 (92%) had normal troponin, 45 (4.4%) had mild elevation, and 35 (3.4%) had a severe elevation in troponin levels. In the multivariate Cox regression analysis, troponin elevation in patients without ST-elevation on ECG was not independently associated with mortality (hazard ratio 0.92, 95% CI 0.64-1.3). Increased risk of death was independently associated with age as well as serum C-reactive protein and serum creatinine levels.
Conclusion:
Elevated troponins without ST-elevation on ECG on hospital admission were not independently associated with increased mortality in hospitalized COVID-19 patients. However, further research is needed to fully understand the absence of a relationship between troponin elevation and mortality in our study population.
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23
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Muthyala A, Sasidharan S, John KJ, Lal A, Mishra AK. Utility of cardiac bioenzymes in predicting cardiovascular outcomes in SARS-CoV-2. World J Virol 2022; 11:375-390. [PMID: 36188743 PMCID: PMC9523328 DOI: 10.5501/wjv.v11.i5.375] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/12/2022] [Accepted: 08/11/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Cardiovascular complications have been increasingly recognized in the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) associated coronavirus disease 2019 (COVID-19). Cardiac biomarkers are released because of this ongoing cardiovascular injury and can act as surrogate markers to assess the disease severity.
AIM To review the variation and utility of these biomarkers in COVID-19 to ascertain their role in diagnosis, prognosis and clinical outcomes of the disease.
METHODS We performed a literature search in PubMed, Medline and the Reference Citation Analysis (RCA), using the search terms “COVID-19” and “cardiac bioenzymes” or “cardiac biomarkers”. Additionally, we also used the latest reference citation analysis tool to identify more articles.
RESULTS Cardiac troponin has been consistently elevated in patients with COVID-19 associated myocarditis, and strongly correlated with adverse prognosis. Natri-uretic peptides including brain natriuretic peptide (BNP) and pro-BNP is elevated in patients with COVID-19 associated cardiac injury, irrespective of their prior heart failure status, and independently correlated with worst outcomes. Alongside these traditional biomarkers, novel cardiac bioenzymes including presepsin, soluble ST2 and copeptin, are also increasingly recognized as markers of cardiovascular injury in COVID-19 and can be associated with poor outcomes.
CONCLUSION Assessment of cardiac bioenzymes at admission and their serial monitoring can help assess the severity of disease and predict mortality in patients with SARS-CoV-2 infection. Future studies are needed to elude the critical importance of novel biomarkers.
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Affiliation(s)
- Anjani Muthyala
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Sandeep Sasidharan
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Kevin John John
- Department of Critical Care, Belivers Church Medical College Hospital, Thiruvalla 689103, Kerela, India
| | - Amos Lal
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN 55905, United States
| | - Ajay K Mishra
- Department of Cardiology, Saint Vincent Hospital, Worcester, MA 01608, United States
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24
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Terlecki M, Wojciechowska W, Klocek M, Olszanecka A, Bednarski A, Drożdż T, Pavlinec C, Lis P, Zając M, Rusinek J, Siudak Z, Bartuś S, Rajzer M. Impact of concomitant COVID-19 on the outcome of patients with acute myocardial infarction undergoing coronary artery angiography. Front Cardiovasc Med 2022; 9:917250. [PMID: 36211554 PMCID: PMC9536466 DOI: 10.3389/fcvm.2022.917250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background The impact of COVID-19 on the outcome of patients with MI has not been studied widely. We aimed to evaluate the relationship between concomitant COVID-19 and the clinical course of patients admitted due to acute myocardial infarction (MI). Methods There was a comparison of retrospective data between patients with MI who were qualified for coronary angiography with concomitant COVID-19 and control group of patients treated for MI in the preceding year before the onset of the pandemic. In-hospital clinical data and the incidence of death from any cause on 30 days were obtained. Results Data of 39 MI patients with concomitant COVID-19 (COVID-19 MI) and 196 MI patients without COVID-19 in pre-pandemic era (non-COVID-19 MI) were assessed. Compared with non-COVID-19 MI, COVID-19 MI was in a more severe clinical state on admission (lower systolic blood pressure: 128.51 ± 19.76 vs. 141.11 ± 32.47 mmHg, p = 0.024), higher: respiratory rate [median (interquartile range), 16 (14–18) vs. 12 (12–14)/min, p < 0.001], GRACE score (178.50 ± 46.46 vs. 161.23 ± 49.74, p = 0.041), percentage of prolonged (>24 h) time since MI symptoms onset to coronary intervention (35.9 vs. 15.3%; p = 0.004), and cardiovascular drugs were prescribed less frequently (beta-blockers: 64.1 vs. 92.8%, p = 0.009), angiotensin-converting enzyme inhibitors/angiotensin receptor blockers: 61.5 vs. 81.1%, p < 0.001, statins: 71.8 vs. 94.4%, p < 0.001). Concomitant COVID-19 was associated with seven-fold increased risk of 30-day mortality (HR 7.117; 95% CI: 2.79–18.14; p < 0.001). Conclusion Patients admitted due to MI with COVID-19 have an increased 30-day mortality. Efforts should be focused on infection prevention and implementation of optimal management to improve the outcomes in those patients.
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Affiliation(s)
- Michał Terlecki
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Wiktoria Wojciechowska
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Marek Klocek
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Agnieszka Olszanecka
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Adam Bednarski
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Tomasz Drożdż
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Christopher Pavlinec
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Paweł Lis
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Maciej Zając
- Student's Scientific Group in the First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Jakub Rusinek
- Student's Scientific Group in the First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Zbigniew Siudak
- Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland
| | - Stanisław Bartuś
- Second Department of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Marek Rajzer
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
- *Correspondence: Marek Rajzer
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25
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Biter Hİ, Kalyoncuoğlu M, Tosu AR, Çakal S, Apaydın Z, Gümüşdağ A, Çınar T, Eyüpkoca F, Belen E, Can MM. Prognostic value of the TyG index for in-hospital mortality in nondiabetic COVID-19 patients with myocardial injury. Rev Assoc Med Bras (1992) 2022; 68:1297-1302. [PMID: 36228261 PMCID: PMC9575008 DOI: 10.1590/1806-9282.20220410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/02/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE The purpose of this study was to explore the efficacy of the triglyceride glucose (TyG) index on in-hospital mortality in nondiabetic coronavirus disease 2019 (COVID-19) patients with myocardial injury. METHODS This was a retrospective study, which included 218 nondiabetic COVID-19 patients who had myocardial injury. The TyG index was derived using the following equation: log [serum triglycerides (mg/dL) ×fasting blood glucose (mg/dL)/2]. RESULTS Overall, 49 (22.4%) patients died during hospitalization. Patients who did not survive had a higher TyG index than survivors. In multivariate Cox regression analysis, it was found that the TyG index was independently associated with in-hospital death. A TyG index cutoff value greater than 4.97 was predicted in-hospital death in nondiabetic COVID-19 patients with myocardial damage, with 82% sensitivity and 66% specificity. A pairwise evaluation of receiver operating characteristic (ROC) curves demonstrated that the TyG index (AUC: 0.786) had higher discriminatory performance than both triglyceride (AUC: 0.738) and fasting blood glucose (AUC: 0.660) in predicting in-hospital mortality among these patients. CONCLUSIONS The TyG index might be used to identify high-risk nondiabetic COVID-19 patients with myocardial damage.
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Affiliation(s)
- Halil İbrahim Biter
- Health Sciences University, Sultangazi Haseki Training and Research Hospital, Department of Cardiology – Istanbul, Turkey
| | - Muhsin Kalyoncuoğlu
- Health Sciences University, Sultangazi Haseki Training and Research Hospital, Department of Cardiology – Istanbul, Turkey
| | - Aydın Rodi Tosu
- Health Sciences University, Sultangazi Haseki Training and Research Hospital, Department of Cardiology – Istanbul, Turkey
| | - Sinem Çakal
- Health Sciences University, Sultangazi Haseki Training and Research Hospital, Department of Cardiology – Istanbul, Turkey
| | - Ziya Apaydın
- Health Sciences University, Sultangazi Haseki Training and Research Hospital, Department of Cardiology – Istanbul, Turkey
| | - Ayça Gümüşdağ
- Health Sciences University, Sultangazi Haseki Training and Research Hospital, Department of Cardiology – Istanbul, Turkey
| | - Tufan Çınar
- Health Sciences University, Sultan Abdülhamid Han Training and Research Hospital, Department of Cardiology – Istanbul, Turkey.,Corresponding author:
| | | | - Erdal Belen
- Health Sciences University, Sultangazi Haseki Training and Research Hospital, Department of Cardiology – Istanbul, Turkey
| | - Mehmet Mustafa Can
- Health Sciences University, Sultangazi Haseki Training and Research Hospital, Department of Cardiology – Istanbul, Turkey
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26
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Lalani K, Seshadri S, Samanth J, Thomas JJ, Rao MS, Kotian N, Satheesh J, Nayak K. Cardiovascular complications and predictors of mortality in hospitalized patients with COVID-19: a cross-sectional study from the Indian subcontinent. Trop Med Health 2022; 50:55. [PMID: 35982484 PMCID: PMC9385411 DOI: 10.1186/s41182-022-00449-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/07/2022] [Indexed: 01/08/2023] Open
Abstract
Background COVID-19 has spread rapidly across the world, producing significant morbidity and mortality. We investigated the cardiovascular complications and association of laboratory parameters with severity and mortality predictors in COVID-19 hospitalized patients. Methods Between May 2020 and June 2021, 730 COVID-19 patients were included in this retrospective observational study in the Coastal Karnataka region of South India. Acute coronary syndrome (ACS), myocarditis, arrhythmias, and all-cause mortality were reported as cardiovascular consequences. Neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), serum creatinine, D-dimer, troponin T, N-terminal pro-brain natriuretic peptide (NT-ProBNP), serum ferritin, and serum lactate dehydrogenase (LDH) were among the laboratory parameters measured.
Results Most common electrocardiogram (ECG) changes were prolonged QTc interval (45.6%) followed by ST-T changes (40.7%) and sinus tachycardia (24.2%). 9.2% patients presented with ACS, with 38.8% having ST-elevation myocardial infarction (STEMI) and 61.2% having non-ST elevation myocardial infarction (NSTEMI). In non-survivors, NLR (p < 0.001) and PLR (p = 0.001) were significantly higher. Multivariable regression analysis showed that age (OR:1.019, 95% CI 1.003–1.034; p = 0.017), acute kidney injury (OR:3.562, 95% CI 1.737–7.301; p = 0.001), white blood cell count (WBC) (OR = 1.100, 95% CI 1.035–1.169; p = 0.002), platelet count (OR = 0.994, 95% CI 0.990–0.997; p = 0.001), PLR (OR = 1.002, 95% CI 1.000–1.004; p = 0.023) and severe COVID-19 (OR = 9.012, 95% CI 3.844–21.129; p = 0.001) were independent predictors of mortality in COVID-19 patients. Conclusions Age, WBC count, neutrophil%, NLR, PLR, creatinine, D-dimer, ferritin, LDH, tachycardia, and lymphocytes% strongly correlated with the severity of the disease. Age, acute kidney injury, elevated WBC count, a greater PLR, low platelet count, and COVID-19 severity were independent predictors of mortality. Supplementary Information The online version contains supplementary material available at 10.1186/s41182-022-00449-w.
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Affiliation(s)
- Kanhai Lalani
- Department of Cardiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India
| | - Sneha Seshadri
- Department of General Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India
| | - Jyothi Samanth
- Department of Cardiovascular Technology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India
| | - Jaimin Jose Thomas
- Department of Cardiovascular Technology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India
| | - M Sudhakar Rao
- Department of Cardiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India.
| | - Nisha Kotian
- Department of Cardiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India
| | - Jijin Satheesh
- Department of Cardiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India
| | - Krishnananda Nayak
- Department of Cardiovascular Technology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India
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27
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Sharma M, Jagirdhar GSK, Guntupalli KK, Kashyap R, Surani S. Heart failure in general and cardiac transplant patients with COVID-19. World J Cardiol 2022; 14:392-402. [PMID: 36161057 PMCID: PMC9350602 DOI: 10.4330/wjc.v14.i7.392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/19/2022] [Accepted: 06/27/2022] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is primarily an infection of the respiratory tract, but it can have multisystem manifestations. Cardiac complications of COVID-19 can range from acute myocardial injury, cardiac arrhythmias, or heart failure, amongst others. Heart failure (HF) in COVID-19 can be a de novo process or due to worsening of pre-existing cardiovascular ailment. HF in a patient with COVID-19 not only poses challenges in clinical presentation and management of COVID-19 but also affect prognosis of the patient. This article aims to succinctly revisit the implications of this pandemic regarding pre-existing HF or new-onset HF based on prevailing data. It also focuses on the management and special recommendations from prior studies and guidelines.
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Affiliation(s)
- Munish Sharma
- Department of Medicine, Baylor College of Medicine, Houston, TX 77030, United States
| | | | - Kalpalatha K Guntupalli
- Department of Pulmonary, Critical Care and Sleep, Baylor College of Medicine, Houston, TX 77030, United States
| | - Rahul Kashyap
- Department of Anesthesiology, Mayo Clinic, Rochester, MN 55905, United States
| | - Salim Surani
- Department of Anesthesiology, Mayo Clinic, Rochester, MN 55905, United States
- Department of Medicine, Texas A&M University, Bryan, TX 77807, United States
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28
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Mohammad KO, Rodriguez JBC, Urey MA. Coronavirus disease 2019 and the cardiologist. Curr Opin Cardiol 2022; 37:335-342. [PMID: 35731679 DOI: 10.1097/hco.0000000000000958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE OF REVIEW There continues to be extensive clinical and epidemiological data to suggest that coronavirus disease 2019 (COVID-19) infection is associated with numerous different types of cardiac involvement. RECENT FINDINGS Myocardial injury has been reported in over 25% of patients hospitalized due to COVID-19 infection and is not only associated with a worse prognosis but with higher mortality, approaching 40%. Currently proposed mechanisms of myocardial injury include direct viral infection, cytokine storm, endothelial inflammation, demand ischemia, interferon-mediated response and stress cardiomyopathy. COVID-19 infection is associated with new-onset arrhythmias and heart failure regardless of history of previous cardiovascular disease. Echocardiographic findings can be useful to predict mortality in COVID-19 patients and cardiac MRI is an effective tool to both assess COVID-19 induced myocarditis and to follow-up on cardiac complications of COVID-19 long-term. Although there is an association between COVID-19 vaccination and myocarditis, pericarditis or arrhythmias, the risk appears lower when compared to risk attributable to the natural infection. SUMMARY Patients with cardiovascular disease are not only more likely to suffer from severe COVID-19 infection but are at increased risk for further complications and higher mortality. Further data compilation on current and emerging treatments of COVID-19 will have additional impact on cardiovascular morbidity and mortality of COVID-19 infection.
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Affiliation(s)
- Khan O Mohammad
- Department of Internal Medicine, Dell Medical School at the University of Texas, Austin, Texas
| | - Jose B Cruz Rodriguez
- Division of Cardiovascular Medicine, Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Marcus A Urey
- Division of Cardiovascular Medicine, Department of Medicine, University of California San Diego, San Diego, California, USA
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29
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Whiteson JH, Azola A, Barry JT, Bartels MN, Blitshteyn S, Fleming TK, McCauley MD, Neal JD, Pillarisetti J, Sampsel S, Silver JK, Terzic CM, Tosto J, Verduzco‐Gutierrez M, Putrino D. Multi-disciplinary collaborative consensus guidance statement on the assessment and treatment of cardiovascular complications in patients with post-acute sequelae of SARS-CoV-2 infection (PASC). PM R 2022; 14:855-878. [PMID: 35657351 PMCID: PMC9347705 DOI: 10.1002/pmrj.12859] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/27/2022] [Accepted: 06/01/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Jonathan H. Whiteson
- Department of Rehabilitation Medicine and Department of MedicineRusk Rehabilitation, NYU Langone HealthNew YorkNew YorkUSA
| | - Alba Azola
- Department of Physical Medicine and RehabilitationJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - John T. Barry
- Good Shepherd Penn Partners, Penn Therapy & Fitness—University CityPhiladelphiaPennsylvaniaUSA
| | - Matthew N. Bartels
- Department of Rehabilitation Medicine, Montefiore Health SystemAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Svetlana Blitshteyn
- Department of NeurologyUniversity at Buffalo Jacobs School of Medicine and Biomedical SciencesBuffaloNew YorkUSA
| | - Talya K. Fleming
- Department of Physcial Medicine and RehabilitationJFK Johnson Rehabilitation Institute at Hackensack Meridian HealthEdisonNew JerseyUSA
| | - Mark D. McCauley
- Department of Medicine, Section of CardiologyUniversity of Illinois at Chicago and Jesse Brown VA Medical CenterChicagoIllinoisUSA
| | - Jacqueline D. Neal
- Physical Medicine and RehabilitationNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA,Physical Medicine and RehabilitationPhysical Medicine and Rehabilitation, Jesse Brown VA Medical CenterChicagoIllinoisUSA
| | - Jayasree Pillarisetti
- Division of Cardiology, Department of MedicineUniversity of Texas Health San AntonioSan AntonioTexasUSA
| | | | - Julie K. Silver
- Department of Physical Medicine and RehabilitationHarvard Medical School, Spaulding Rehabilitation HospitalBostonMassachusettsUSA
| | - Carmen M. Terzic
- Department of Physical Medicine and Rehabilitation and Department of Cardiovascular MedicineMayo ClinicRochesterMinnesotaUSA
| | - Jenna Tosto
- Department of Rehabilitation and Human Performance, Abilities Research CenterIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | | | - David Putrino
- Department of Rehabilitation and Human PerformanceIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
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30
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Schneider M. The Role of Biomarkers in Hospitalized COVID-19 Patients With Systemic Manifestations. Biomark Insights 2022; 17:11772719221108909. [PMID: 35783222 PMCID: PMC9243490 DOI: 10.1177/11772719221108909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/06/2022] [Indexed: 01/08/2023] Open
Abstract
The following article aims to review COVID-19 biomarkers used in hospital
practice. It is apparent that COVID-19 is not simply a pulmonary disease but has
systemic manifestations. For this reason, biomarkers must be used in the
management of diagnosed patients to provide holistic care. Patients with
COVID-19 have been shown to have pulmonary, hepatobiliary, cardiovascular,
neurologic, and renal injury, along with coagulopathy and a distinct cytokine
storm. Biomarkers can effectively inform clinicians of systemic organ injury due
to COVID-19. Furthermore, biomarkers can be used in predictive models for severe
COVID-19 in admitted patients. The utility of doing so is to allow for risk
stratification and utilization of proper treatment protocols. In addition,
COVID-19 biomarkers in the pediatric population are discussed, specifically in
predicting Multisystem Inflammatory Syndrome. Ultimately, biomarkers can be used
as predictive tools to allow clinicians to identify and adequately manage
patients at increased risk for worse outcomes from COVID-19. Both literature
review and anecdotal evidence has shown that severe COVID-19 is a systemic
disease, and understanding associated biomarkers are crucial for hospitalized
patients’ proper clinical decision-making. For example, the cytokine storm
releases inflammatory markers in different organ systems such as the pulmonary,
hepatobiliary, hematological, cardiac, neurological, and renal systems. This
review summarizes the latest research of COVID-19 that can help inform
healthcare professionals how to better mitigate morbidity and mortality
associated with this disease and provides information about certain systemic
biomarkers that can be incorporated into hospital practice to provide more
comprehensive care for hospitalized COIVD-19 patients.
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Affiliation(s)
- Michael Schneider
- University of Queensland Ochsner Clinical School, New Orleans, LA, USA
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31
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Srinivasan A, Wong F, Couch LS, Wang BX. Cardiac Complications of COVID-19 in Low-Risk Patients. Viruses 2022; 14:v14061322. [PMID: 35746793 PMCID: PMC9228093 DOI: 10.3390/v14061322] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 06/13/2022] [Accepted: 06/15/2022] [Indexed: 02/06/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has resulted in over 6 million deaths and significant morbidity across the globe. Alongside common respiratory symptoms, COVID-19 is associated with a variety of cardiovascular complications in the acute and post-acute phases of infection. The suggested pathophysiological mechanisms that underlie these complications include direct viral infection of the myocardium via the angiotensin-converting enzyme 2 (ACE2) protein and a cytokine release syndrome that results in indirect inflammatory damage to the heart. Patients with pre-existing cardiovascular disease and co-morbidities are generally more susceptible to the cardiac manifestations of COVID-19. However, studies have identified a variety of complications in low-risk individuals, including young adults and children. Myocarditis and paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS) are among the adverse events reported in the acute phase of infection. Furthermore, patients have reported cardiac symptoms persisting beyond the acute phase in post-COVID syndrome. This review summarises the acute and chronic cardiac consequences of COVID-19 in low-risk patients, explores the pathophysiology behind them, and discusses new predictive factors for poor outcomes.
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Affiliation(s)
- Akash Srinivasan
- Department of Medicine, Faculty of Medicine, Imperial College London, London SW7 2AD, UK; (A.S.); (F.W.)
| | - Felyx Wong
- Department of Medicine, Faculty of Medicine, Imperial College London, London SW7 2AD, UK; (A.S.); (F.W.)
| | - Liam S. Couch
- King’s College London BHF Centre, The Rayne Institute, St Thomas’ Hospital, London SE1 7EH, UK;
| | - Brian X. Wang
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London SW7 2AZ, UK
- Correspondence:
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32
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Landry V, Coburn P, Kost K, Liu X, Li-Jessen NYK. Diagnostic Accuracy of Liquid Biomarkers in Airway Diseases: Toward Point-of-Care Applications. Front Med (Lausanne) 2022; 9:855250. [PMID: 35733871 PMCID: PMC9207186 DOI: 10.3389/fmed.2022.855250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 05/04/2022] [Indexed: 12/30/2022] Open
Abstract
Background Liquid biomarkers have shown increasing utility in the clinical management of airway diseases. Salivary and blood samples are particularly amenable to point-of-care (POC) testing due to simple specimen collection and processing. However, very few POC tests have successfully progressed to clinical application due to the uncertainty and unpredictability surrounding their diagnostic accuracy. Objective To review liquid biomarkers of airway diseases with well-established diagnostic accuracies and discuss their prospects for future POC applications. Methodology A literature review of publications indexed in Medline or Embase was performed to evaluate the diagnostic accuracy of liquid biomarkers for chronic obstructive pulmonary disease (COPD), asthma, laryngopharyngeal reflux (LPR), and COVID-19. Results Of 3,628 studies, 71 fulfilled the inclusion criteria. Sputum and blood eosinophils were the most frequently investigated biomarkers for the management of asthma and COPD. Salivary pepsin was the only biomarker with a well-documented accuracy for the diagnosis of LPR. Inflammatory blood biomarkers (e.g., CRP, D-dimers, ferritin) were found to be useful to predict the severity, complications, and mortality related to COVID-19 infection. Conclusion Multiple liquid biomarkers have well-established diagnostic accuracies and are thus amenable to POC testing in clinical settings.
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Affiliation(s)
- Vivianne Landry
- Faculty of Medicine, University of Montreal, Montreal, QC, Canada
- School of Communication Sciences & Disorders, McGill University, Montreal, QC, Canada
| | - Patrick Coburn
- School of Communication Sciences & Disorders, McGill University, Montreal, QC, Canada
| | - Karen Kost
- Department of Otolaryngology-Head & Neck Surgery, McGill University, Montreal, QC, Canada
| | - Xinyu Liu
- Department of Mechanical & Industrial Engineering, University of Toronto, Toronto, ON, Canada
| | - Nicole Y. K. Li-Jessen
- School of Communication Sciences & Disorders, McGill University, Montreal, QC, Canada
- Department of Otolaryngology-Head & Neck Surgery, McGill University, Montreal, QC, Canada
- Department of Biomedical Engineering, McGill University, Montreal, QC, Canada
- The Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- *Correspondence: Nicole Y. K. Li-Jessen,
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Babu A, Meng Z, Eden N, Lamb D, Nouza J, Bhatia R, Chis Ster I, Bennett J, Voon V. Evaluating the role of transthoracic echocardiography in hospitalised patients with COVID-19 infection. Open Heart 2022; 9:openhrt-2021-001854. [PMID: 35534093 PMCID: PMC9086279 DOI: 10.1136/openhrt-2021-001854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 03/28/2022] [Indexed: 12/29/2022] Open
Abstract
Objective To identify the most common transthoracic echocardiogram (TTE) parameters in patients hospitalised with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2/COVID-19) and their association with myocardial injury and outcomes. Methods A retrospective, single-centre, observational, exploratory cohort study was performed at the height of the COVID-19 pandemic. All SARS-CoV-2 polymerase chain reaction (PCR) positive patients who underwent a TTE during their inpatient admission between 1 March 2020 and 31 October 2020 were analysed. The most frequent cardiovascular risk factor profile and echocardiographic features were investigated. Results A total of 87 patients met the eligibility criteria. A salient 41.4% (n=36) of our cohort succumbed to this devastating virus. More than half of our hospital population (58.6%) were admitted to the intensive care unit (ITU) and this was significantly associated with inpatient mortality (OR: 7.14, CI 2.53 to 20.19, p<0.001). Hypertension was the most common cardiovascular risk factor (51.7%) with no additional prominence in non-survivors (OR: 2.33, CI 0.97 to 5.61, p=0.059). Remarkably, 90.8% of our cohort demonstrated a preserved left ventricular ejection fraction, although 69.1% had elevated troponin levels. Only 1 patient (1.1%) was given a diagnostic label of myocarditis. A raised pulmonary artery systolic pressure (36.8%) andright ventricle (RV) dysfunction (26.4%) were the most common echocardiographic features. In particular, the presence of RV dysfunction was significantly related to adverse outcomes (OR: 2.97, CI 1.11 to 7.94, p<0.03). Conclusions In this cohort of extremely unwell patients hospitalised with COVID-19 pneumonitis, the presence of RV dysfunction or admission to ITU was significantly associated with inpatient case fatality ratio. Moreover, COVID-19-induced myocarditis remains extremely rare.
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Affiliation(s)
- Aswin Babu
- Cardiology Department, Homerton University Hospital, London, UK
| | - Zhaoyi Meng
- Cardiology Department, Homerton University Hospital, London, UK
| | - Nadia Eden
- Cardiology Department, Homerton University Hospital, London, UK
| | - Daniel Lamb
- Cardiology Department, Homerton University Hospital, London, UK
| | - Jan Nouza
- Cardiology Department, Homerton University Hospital, London, UK
| | - Raghav Bhatia
- Department of Cardiology, St George's University of London, London, UK
| | - Irina Chis Ster
- Institute of Infection and Immunity, St George's University of London, London, UK
| | | | - Victor Voon
- Cardiology Department, Homerton University Hospital, London, UK
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Li Y, Pei H, Zhou C, Lou Y. Myocardial Injury Predicts Risk of Short-Term All-Cause Mortality in Patients With COVID-19: A Dose–Response Meta-Analysis. Front Cardiovasc Med 2022; 9:850447. [PMID: 35586652 PMCID: PMC9108210 DOI: 10.3389/fcvm.2022.850447] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/21/2022] [Indexed: 12/14/2022] Open
Abstract
ObjectivePredictive value of myocardial injury as defined by elevated cardiac tropnins (cTns) in patients with COVID-19 has not been fully investigated. We performed a meta-analysis to evaluate the dose–response relationship between myocardial injury and short-term all-cause mortality.MethodsPubmed, Embase, and the Cochrane Library database were searched for all the studies which evaluated the relationship between cTns and the risk of short-term all-cause mortality in patients with COVID-19.ResultsCompared with patients without myocardial injury, the group with elevated cTns was associated with increased short-term mortality (11 studies, 29,128 subjects, OR 3.17, 95% CI 2.19–4.59, P = 0.000, I2 = 92.4%, P for heterogeneity 0.00). For the dose–response analysis, the elevation of cTns 1 × 99th percentile upper reference limit (URL) was associated with increased short-term mortality (OR 1.99, 95% CI 1.53–2.58, P = 0.000). The pooled OR of short-term mortality for each 1 × URL increment of cTns was 1.25 (95% CI 1.22–1.28, P = 0.000).ConclusionWe found a positive dose–response relationship between myocardial injury and the risk of short-term all-cause mortality, and propose elevation of cTns > 1 × 99th percentile URL was associated with the increased short-term risk of mortality.
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Affiliation(s)
- Yuehua Li
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hanjun Pei
- Department of Cardiology, The First Affiliated Hospital of Baotou Medical College, Baotou, China
| | - Chenghui Zhou
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Chenghui Zhou
| | - Ying Lou
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Ying Lou
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Welty FK, Rajai N, Amangurbanova M. Comprehensive Review of Cardiovascular Complications of Coronavirus Disease 2019 and Beneficial Treatments. Cardiol Rev 2022; 30:145-157. [PMID: 35384908 PMCID: PMC8983616 DOI: 10.1097/crd.0000000000000422] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 and was first reported in December 2019 in Wuhan, China. Since then, it caused a global pandemic with 212,324,054 confirmed cases and 4,440,840 deaths worldwide as of August 22, 2021. The disease spectrum of COVID-19 ranges from asymptomatic subclinical infection to clinical manifestations predominantly affecting the respiratory system. However, it is now evident that COVID-19 is a multiorgan disease with a broad spectrum of manifestations leading to multiple organ injuries including the cardiovascular system. We review studies that have shown that the relationship between cardiovascular diseases and COVID-19 is indeed bidirectional, implicating that preexisting cardiovascular comorbidities increase the morbidity and mortality of COVID-19, and newly emerging cardiac injuries occur in the settings of acute COVID-19 in patients with no preexisting cardiovascular disease. We present the most up-to-date literature summary to explore the incidence of new-onset cardiac complications of coronavirus and their role in predicting the severity of COVID-19. We review the association of elevated troponin with the severity of COVID-19 disease, which includes mild compared to severe disease, in nonintensive care unit compared to intensive care unit patients and in those discharged from the hospital compared to those who die. The role of serum troponin levels in predicting prognosis are compared in survivors and non-survivors. The association between COVID-19 disease and myocarditis, heart failure and coagulopathy are reviewed. Finally, an update on beneficial treatments is discussed.
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Affiliation(s)
- Francine K. Welty
- From the Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Nazanin Rajai
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Maral Amangurbanova
- From the Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Niu P, Jiang J, Liu K, Wang S, Jing J, Xu T, Wang T, Liu Y, Liu T. Fiber-integrated WGM optofluidic chip enhanced by microwave photonic analyzer for cardiac biomarker detection with ultra-high resolution. Biosens Bioelectron 2022; 208:114238. [PMID: 35390720 DOI: 10.1016/j.bios.2022.114238] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/28/2022] [Accepted: 03/29/2022] [Indexed: 12/30/2022]
Abstract
Cardiac troponin I (cTnI) plays an important role in emergency diagnosis of cardiovascular diseases, which exists predominately in the form of cardiac troponin I-C (cTnI-C) complex. We proposed a fiber-integrated optofluidic chip immunosensor with time-delay-dispersion based microwave photonic analyzer (MPA) for cTnI-C detection. The whispering gallery mode (WGM) fiber probe was fabricated by embedding a polydopamine functionalized hollow glass microsphere (HGMS) into the etched capillary-fiber structure, and the WGMs could be excited through the efficient coupling between the thin-wall capillary and the HGMS. The reflective WGM optofluidic chip functioned as a wavelength tuner to construct fiber ring laser cavity, whose laser output wavelength was cTnI-C concentration-dependent. The tiny wavelength variation of sensing laser was converted into a radio-frequency (RF) response, which was retrieved by measuring the change of RF-domain free spectrum range (FSR) in time-delay-dispersion based MPA, and the quantitative detection of cTnI-C complex can be achieved with high resolution. Experimental results show that this immunosensor had a limit of detection (LOD) of 0.59 ng/mL, and a detection resolution of 1.2 fg/mL. The relative resolving power was 102-104-fold higher than that of others optical fiber cTnI biosensors. The proposed fiber-integrated optofluidic chip provides an innovative lab-on-chip diagnostic tool for myocardial damage.
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Affiliation(s)
- Panpan Niu
- School of Precision Instrument and Opto-electronics Engineering, Tianjin University, Tianjin, 300072, China; Key Laboratory of Opto-electronics Information Technology (Tianjin University), Key Laboratory of Micro Opto-electro Mechanical System Technology (Tianjin University), Ministry of Education, Tianjin, 300072, China; Tianjin Optical Fiber Sensing Engineering Center, Institute of Optical Fiber Sensing of Tianjin University, Tianjin, 300072, China
| | - Junfeng Jiang
- School of Precision Instrument and Opto-electronics Engineering, Tianjin University, Tianjin, 300072, China; Key Laboratory of Opto-electronics Information Technology (Tianjin University), Key Laboratory of Micro Opto-electro Mechanical System Technology (Tianjin University), Ministry of Education, Tianjin, 300072, China; Tianjin Optical Fiber Sensing Engineering Center, Institute of Optical Fiber Sensing of Tianjin University, Tianjin, 300072, China.
| | - Kun Liu
- School of Precision Instrument and Opto-electronics Engineering, Tianjin University, Tianjin, 300072, China; Key Laboratory of Opto-electronics Information Technology (Tianjin University), Key Laboratory of Micro Opto-electro Mechanical System Technology (Tianjin University), Ministry of Education, Tianjin, 300072, China; Tianjin Optical Fiber Sensing Engineering Center, Institute of Optical Fiber Sensing of Tianjin University, Tianjin, 300072, China
| | - Shuang Wang
- School of Precision Instrument and Opto-electronics Engineering, Tianjin University, Tianjin, 300072, China; Key Laboratory of Opto-electronics Information Technology (Tianjin University), Key Laboratory of Micro Opto-electro Mechanical System Technology (Tianjin University), Ministry of Education, Tianjin, 300072, China; Tianjin Optical Fiber Sensing Engineering Center, Institute of Optical Fiber Sensing of Tianjin University, Tianjin, 300072, China
| | - Jianying Jing
- School of Precision Instrument and Opto-electronics Engineering, Tianjin University, Tianjin, 300072, China; Key Laboratory of Opto-electronics Information Technology (Tianjin University), Key Laboratory of Micro Opto-electro Mechanical System Technology (Tianjin University), Ministry of Education, Tianjin, 300072, China; Tianjin Optical Fiber Sensing Engineering Center, Institute of Optical Fiber Sensing of Tianjin University, Tianjin, 300072, China
| | - Tianhua Xu
- School of Precision Instrument and Opto-electronics Engineering, Tianjin University, Tianjin, 300072, China; Key Laboratory of Opto-electronics Information Technology (Tianjin University), Key Laboratory of Micro Opto-electro Mechanical System Technology (Tianjin University), Ministry of Education, Tianjin, 300072, China; Tianjin Optical Fiber Sensing Engineering Center, Institute of Optical Fiber Sensing of Tianjin University, Tianjin, 300072, China
| | - Tong Wang
- School of Precision Instrument and Opto-electronics Engineering, Tianjin University, Tianjin, 300072, China; Key Laboratory of Opto-electronics Information Technology (Tianjin University), Key Laboratory of Micro Opto-electro Mechanical System Technology (Tianjin University), Ministry of Education, Tianjin, 300072, China; Tianjin Optical Fiber Sensing Engineering Center, Institute of Optical Fiber Sensing of Tianjin University, Tianjin, 300072, China
| | - Yize Liu
- School of Precision Instrument and Opto-electronics Engineering, Tianjin University, Tianjin, 300072, China; Key Laboratory of Opto-electronics Information Technology (Tianjin University), Key Laboratory of Micro Opto-electro Mechanical System Technology (Tianjin University), Ministry of Education, Tianjin, 300072, China; Tianjin Optical Fiber Sensing Engineering Center, Institute of Optical Fiber Sensing of Tianjin University, Tianjin, 300072, China
| | - Tiegen Liu
- School of Precision Instrument and Opto-electronics Engineering, Tianjin University, Tianjin, 300072, China; Key Laboratory of Opto-electronics Information Technology (Tianjin University), Key Laboratory of Micro Opto-electro Mechanical System Technology (Tianjin University), Ministry of Education, Tianjin, 300072, China; Tianjin Optical Fiber Sensing Engineering Center, Institute of Optical Fiber Sensing of Tianjin University, Tianjin, 300072, China
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Iorio A, Lombardi CM, Specchia C, Merlo M, Nuzzi V, Ferraro I, Peveri G, Oriecuia C, Pozzi A, Inciardi RM, Carubelli V, Bellasi A, Canale C, Camporotondo R, Catagnano F, Dalla Vecchia L, Giovinazzo S, Maccagni G, Mapelli M, Margonato D, Monzo L, Provenzale G, Sarullo F, Tomasoni D, Ameri P, Gnecchi M, Leonardi S, Agostoni P, Carugo S, Danzi GB, Guazzi M, La Rovere MT, Mortara A, Piepoli M, Porto I, Volterrani M, Sinagra G, Senni M, Metra M. Combined Role of Troponin and Natriuretic Peptides Measurements in Patients With Covid-19 (from the Cardio-COVID-Italy Multicenter Study). Am J Cardiol 2022; 167:125-132. [PMID: 35063263 PMCID: PMC8767953 DOI: 10.1016/j.amjcard.2021.11.054] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 11/27/2021] [Accepted: 11/30/2021] [Indexed: 12/14/2022]
Abstract
Data concerning the combined prognostic role of natriuretic peptide (NP) and troponin in patients with COVID-19 are lacking. The aim of the study is to evaluate the combined prognostic value of NPs and troponin in hospitalized COVID-19 patients. From March 1, 2020 to April 9, 2020, consecutive patients with COVID-19 and available data on cardiac biomarkers at admission were recruited. Patients admitted for acute coronary syndrome were excluded. Troponin levels were defined as elevated when greater than the 99th percentile of normal values. NPs were considered elevated if above the limit for ruling in acute heart failure (HF). A total of 341 patients were included in this study, mean age 68 ± 13 years, 72% were men. During a median follow-up period of 14 days, 81 patients (24%) died. In the Cox regression analysis, patients with elevated both NPs and troponin levels had higher risk of death compared with those with normal levels of both (hazard ratio 2.94; 95% confidence interval 1.31 to 6.64; p = 0.009), and this remained significant after adjustment for age, gender, oxygen saturation, HF history, and chronic kidney disease. Interestingly, NPs provided risk stratification also in patients with normal troponin values (hazard ratio 2.86; 95% confidence interval 1.21 to 6.72; p = 0.016 with high NPs levels). These data show the combined prognostic role of troponin and NPs in COVID-19 patients. NPs value may be helpful in identifying patients with a worse prognosis among those with normal troponin values. Further, NPs’ cut-point used for diagnosis of acute HF has a predictive role in patients with COVID-19.
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Biomarkers Associated with Cardiovascular Disease in COVID-19. Cells 2022; 11:cells11060922. [PMID: 35326373 PMCID: PMC8946710 DOI: 10.3390/cells11060922] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/20/2022] [Accepted: 03/05/2022] [Indexed: 02/08/2023] Open
Abstract
Coronavirus disease-19 (COVID-19) emerged late December 2019 in the city of Wuhan, China and has since spread rapidly all over the world causing a global pandemic. While the respiratory system is the primary target of disease manifestation, COVID-19 has been shown to also affect several other organs, making it a rather complex, multi-system disease. As such, cardiovascular involvement has been a topic of discussion since the beginning of the COVID-19 pandemic, primarily due to early reports of excessive myocardial injury in these patients. Treating physicians are faced with multiple challenges in the management and early triage of patients with COVID-19, as disease severity is highly variable ranging from an asymptomatic infection to critical cases rapidly deteriorating to intensive care treatment or even fatality. Laboratory biomarkers provide important prognostic information which can guide decision making in the emergency department, especially in patients with atypical presentations. Several cardiac biomarkers, most notably high-sensitive cardiac troponin (hs-cTn) and N-terminal pro-B-type natriuretic peptide (NT-proBNP), have emerged as valuable predictors of prognosis in patients with COVID-19. The purpose of this review was to offer a concise summary on prognostic cardiac biomarkers in COVID-19 and discuss whether routine measurements of these biomarkers are warranted upon hospital admission.
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Alizadehsani R, Eskandarian R, Behjati M, Zahmatkesh M, Roshanzamir M, Izadi NH, Shoeibi A, Haddadi A, Khozeimeh F, Sani FA, Sani ZA, Roshanzamir Z, Khosravi A, Nahavandi S, Sarrafzadegan N, Islam SMS. Factors associated with mortality in hospitalized cardiovascular disease patients infected with COVID‐19. Immun Inflamm Dis 2022; 10:e561. [PMID: 35048534 PMCID: PMC8926510 DOI: 10.1002/iid3.561] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 10/25/2021] [Accepted: 10/28/2021] [Indexed: 12/01/2022] Open
Abstract
Introduction To reduce mortality in hospitalized patients with COVID‐19 and cardiovascular disease (CVD), it is necessary to understand the relationship between patient's symptoms, risk factors, and comorbidities with their mortality rate. To the best of our knowledge, this paper is the first which take into account the determinants like risk factors, symptoms, and comorbidities leading to mortality in CVD patients who are hospitalized with COVID‐19. Methods This study was conducted on 660 hospitalized patients with CVD and COVID‐19 recruited between January 2020 and January 2021 in Iran. All patients were diagnosed with the previous history of CVD like angina, myocardial infarction, heart failure, cardiomyopathy, abnormal heart rhythms, and congenital heart disease before they were hospitalized for COVID‐19. We collected data on patient's signs and symptoms, clinical and paraclinical examinations, and any underlying comorbidities. t test was used to determine the significant difference between the two deceased and alive groups. In addition, the relation between pairs of symptoms and pairs of comorbidities has been determined via correlation computation. Results Our findings suggest that signs and symptoms such as fever, cough, myalgia, chest pain, chills, abdominal pain, nausea, vomiting, diarrhea, and anorexia had no impact on patients' mortality. There was a significant correlation between COVID‐19 cardiovascular patients' mortality rate and symptoms such as headache, loss of consciousness (LOC), oxygen saturation less than 93%, and need for mechanical ventilation. Conclusions Our results might help physicians identify early symptoms, comorbidities, and risk factors related to mortality in CVD patients hospitalized for COVID‐19.
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Affiliation(s)
- Roohallah Alizadehsani
- Institute for Intelligent Systems Research and Innovation (IISRI) Deakin University Geelong Australia
| | - Rahimeh Eskandarian
- Internal Medicine Research Center Semnan University of Medical Sciences Semnan Iran
| | - Mohaddeseh Behjati
- Rajaei Cardiovascular Medical and Research Center Iran University of Medical Sciences Tehran Iran
| | - Mehrdad Zahmatkesh
- Internal Medicine Research Center Semnan University of Medical Sciences Semnan Iran
| | | | - Navid H. Izadi
- Department of Electrical and Computer Engineering Isfahan University of Technology Isfahan Iran
| | - Afshin Shoeibi
- Computer Engineering Department Ferdowsi University of Mashhad Mashhad Iran
- Faculty of Electrical and Computer Engineering, Biomedical Data Acquisition Lab K. N. Toosi University of Technology Tehran Iran
| | - Azadeh Haddadi
- Department of Biology, Faculy of Basic Sciences, Shahrekord Branch Islamic Azad University Shahrekord Iran
| | - Fahime Khozeimeh
- Institute for Intelligent Systems Research and Innovation (IISRI) Deakin University Geelong Australia
| | - Fariba A. Sani
- Faculty of Medicine Mashhad University of Medical Science Mashhad Iran
| | | | - Zahra Roshanzamir
- Pediatric Respiratory and Sleep Medicine Research Center, Children's Medical Center Tehran University of Medical Sciences Tehran Iran
| | - Abbas Khosravi
- Institute for Intelligent Systems Research and Innovation (IISRI) Deakin University Geelong Australia
| | - Saeid Nahavandi
- Institute for Intelligent Systems Research and Innovation (IISRI) Deakin University Geelong Australia
| | - Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute Isfahan University of Medical Sciences Isfahan Iran
- Faculty of Medicine, SPPH University of British Columbia Vancouver British Columbia Canada
| | - Sheikh Mohammed Shariful Islam
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences Deakin University Geelong Victoria Australia
- Cardiovascular Division The George Institute for Global Health Newtown Australia
- Sydney Medical School University of Sydney Camperdown Australia
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Cardiac biomarkers alterations in patients with SARS-CoV-2 infection. ROMANIAN JOURNAL OF INTERNAL MEDICINE = REVUE ROUMAINE DE MEDECINE INTERNE 2022; 60:6-13. [PMID: 34610232 DOI: 10.2478/rjim-2021-0037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Indexed: 12/21/2022]
Abstract
Reliable biomarkers are necessary for the risk stratification of patients infected with SARS-CoV-2. This novel coronavirus is now established to affect several organs in addition to the lungs, most prominently the heart. This is achieved through direct damage to the myocardium and indirect immune-associated effects during the cytokine storm. We performed a literature review aiming to identify the prognostic value of alterations of cardiac biomarkers in SARS-CoV-2 infection. Cardiac biomarkers are significantly elevated in patients with severe COVID-19 and are independent predictors of mortality. High-sensitivity troponin I and T are correlated with multiple inflammatory indexes and poor outcomes. Although cut-off values have been established for most of cardiac biomarkers, lower limits for troponins may have better prognostic values and longitudinal monitoring of cardiac biomarkers can help the clinician assess the patient's course. Additional measurements of NT-proBNP, can detect the subgroup of patients with poor prognosis.
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Castro-Castro MJ, García-Tejada L, Arbiol-Roca A, Sánchez-Navarro L, Rapún-Mas L, Cachon-Suárez I, Álvarez-Álvarez M, Dot-Bach D, Güell-Miró R, de Bassea ACB, Dastis-Arias M, Sancho-Cerro A, Díaz-Troyano N, Escartín-Diez T, Muñoz-Provencio D, Navarro-Badal R. Dynamic profiles and predictive values of some biochemical and haematological quantities in COVID-19 inpatients. Biochem Med (Zagreb) 2022; 32:010706. [PMID: 35210926 PMCID: PMC8833247 DOI: 10.11613/bm.2022.010706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 12/22/2021] [Indexed: 12/21/2022] Open
Abstract
Introduction Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in some hospitalized patients has shown some important alterations in laboratory tests. The aim of this study was to establish the most relevant quantities associated with the worst prognosis related to COVID-19. Materials and methods This was a descriptive, longitudinal, observational and retrospective study, in a cohort of 845 adult inpatients from Bellvitge University Hospital (L’Hospitalet de Llobregat, Barcelona, Spain). A multivariate regression analysis was carried out in demographic, clinical and laboratory data, comparing survivors (SURV) and non-survivors (no-SURV). A receiver operating characteristic analysis was also carried out to establish the cut-off point for poor prognostic with better specificity and sensibility. Dynamic changes in clinical laboratory measurements were tracked from day 1 to day 28 after the onset of symptoms. Results During their hospital stay, 18% of the patients died. Age, kidney disease, creatinine (CREA), lactate-dehydrogenase (LD), C-reactive-protein (CRP) and lymphocyte (LYM) concentration showed the strongest independent associations with the risk of death in the multivariate regression analysis. Established cut-off values for poor prognosis for CREA, LD, CRP and LYM concentrations were 75.0 μmol /L, 320 U/L, 80.9 mg/L and 0.69 x109/L. Dynamic profile of laboratory findings, were in agreement with the consequences of organ damage and tissue destruction. Conclusions Age, kidney disease, CREA, LD, CRP and LYM concentrations in COVID-19 patients from the southern region of Catalonia provide important information for their prognosis. Measurement of LD has demonstrated to be very good indicator of poor prognosis at initial evaluation because of its stability over time.
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Affiliation(s)
- María José Castro-Castro
- Biochemistry Core of the Clinical Laboratory, Bellvitge University Hospital, Barcelona, Spain
- Corresponding author:
| | - Laura García-Tejada
- Biochemistry Core of the Clinical Laboratory, Bellvitge University Hospital, Barcelona, Spain
| | - Ariadna Arbiol-Roca
- Biochemistry Core of the Clinical Laboratory, Bellvitge University Hospital, Barcelona, Spain
| | - Lourdes Sánchez-Navarro
- Haematological Core of the Clinical Laboratory, Bellvitge University Hospital, Barcelona, Spain
| | - Loreto Rapún-Mas
- Biochemistry Core of the Clinical Laboratory, Bellvitge University Hospital, Barcelona, Spain
| | - Isabel Cachon-Suárez
- Biochemistry Core of the Clinical Laboratory, Bellvitge University Hospital, Barcelona, Spain
| | - Marta Álvarez-Álvarez
- Biochemistry Core of the Clinical Laboratory, Bellvitge University Hospital, Barcelona, Spain
| | - Dolors Dot-Bach
- Biochemistry Core of the Clinical Laboratory, Bellvitge University Hospital, Barcelona, Spain
| | - Roser Güell-Miró
- Haematological Core of the Clinical Laboratory, Bellvitge University Hospital, Barcelona, Spain
| | | | - Macarena Dastis-Arias
- Biochemistry Core of the Clinical Laboratory, Bellvitge University Hospital, Barcelona, Spain
| | - Ana Sancho-Cerro
- Haematological Core of the Clinical Laboratory, Bellvitge University Hospital, Barcelona, Spain
| | - Noelia Díaz-Troyano
- Biochemistry Core of the Clinical Laboratory, Bellvitge University Hospital, Barcelona, Spain
| | - Teresa Escartín-Diez
- Biochemistry Core of the Clinical Laboratory, Bellvitge University Hospital, Barcelona, Spain
| | - Diego Muñoz-Provencio
- Biochemistry Core of the Clinical Laboratory, Bellvitge University Hospital, Barcelona, Spain
| | - Rosa Navarro-Badal
- Biochemistry Core of the Clinical Laboratory, Bellvitge University Hospital, Barcelona, Spain
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Lin Y, Yan K, Chen L, Wu Y, Liu J, Chen Y, Hou B, Zhong P. Role of a lower cutoff of high sensitivity troponin I in identification of early cardiac damage in non-severe patients with COVID-19. Sci Rep 2022; 12:2389. [PMID: 35149778 PMCID: PMC8837665 DOI: 10.1038/s41598-022-06378-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 01/27/2022] [Indexed: 01/19/2023] Open
Abstract
Cardiac damage in non-severe patients with coronavirus disease 2019 (COVID-19) is poorly explored. This study aimed to explore the manifestations of cardiac damage at presentation in non-severe patients with COVID-19. In this study, 113 non-severe patients with COVID-19 were grouped according to the duration from symptoms onset to hospital admission: group 1 (≤ 1 week, n = 27), group 2 (> 1 to 2 weeks, n = 28), group 3 (> 2 to 3 weeks, n = 27), group 4 (> 3 weeks, n = 31). Clinical, cardiovascular, and radiological data on hospital admission were compared across the four groups. The level of high sensitivity troponin I (hs-cTnI) in group 2 [10.25 (IQR 6.75-15.63) ng/L] was significantly higher than those in group 1 [1.90 (IQR 1.90-8.80) ng/L] and group 4 [1.90 (IQR 1.90-5.80) ng/L] (all Pbonferroni < 0.05). The proportion of patients who had a level of hs-cTnI ≥ 5 ng/L in group 2 (85.71%) was significantly higher than those in the other three groups (37.04%, 51.85%, and 25.81%, respectively) (all Pbonferroni < 0.05). Compared with patients with hs-cTnI under 5 ng/L, those with hs-cTnI ≥ 5 ng/L had lower lymphocyte count (P = 0.000) and SpO2 (P = 0.002) and higher CRP (P = 0.000). Patients with hs-cTnI ≥ 5 ng/L had a higher incidence of bilateral pneumonia (P = 0.000) and longer hospital length of stay (P = 0.000). In conclusion, non-severe patients with COVID-19 in the second week after symptoms onset were most likely to suffer cardiac damage. A detectable level of hs-cTnI ≥ 5 ng/L might be a manifestation of early cardiac damage in the patients.
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Affiliation(s)
- Yiting Lin
- Department of Respiratory and Critical Care Medicine, Xiamen Haicang Hospital, Xiamen, China
| | - Kun Yan
- Department of Respiratory and Critical Care Medicine, Xiamen Haicang Hospital, Xiamen, China
| | - Lingling Chen
- Department of Respiratory and Critical Care Medicine, Xiamen Haicang Hospital, Xiamen, China
| | - Yiqun Wu
- Department of Respiratory Section II, The Third Hospital of Xiamen Affiliated to Fujian University of Traditional Chinese Medicine, Xiamen, China
| | - Jielan Liu
- Department of Internal Medicine, Xiamen Lotus Hospital, Xiamen, China
| | - Yingying Chen
- Department of Cardiac and Cerebral Function, Xiamen Xian Yue Hospital, Xiamen, China
| | - Bingbo Hou
- Department of Cardiology, Xiamen University Zhongshan Hospital, No.201-209 Hubinnan Road, Xiamen, 361003, Fujian, People's Republic of China.
| | - Ping Zhong
- BE and Phase I Clinical Trial Center, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, NO.55 Zhenhai Road, Xiamen, 361002, Fujian, People's Republic of China.
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Rabbani MY, Rappaport J, Gupta MK. Activation of Immune System May Cause Pathophysiological Changes in the Myocardium of SARS-CoV-2 Infected Monkey Model. Cells 2022; 11:cells11040611. [PMID: 35203260 PMCID: PMC8869860 DOI: 10.3390/cells11040611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/03/2022] [Accepted: 02/06/2022] [Indexed: 02/01/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is an extremely contagious disease whereby the virus damages the host’s respiratory tract via entering through the ACE2 receptor. Cardiovascular disorder is being recognized in the majority of COVID-19 patients; yet, the relationship between SARS-CoV-2 and heart failure has not been established. In the present study, SARS-CoV-2 infection was induced in the monkey model. Thereafter, heart tissue samples were collected, and pathological changes were analyzed in the left ventricular tissue by hematoxylin and eosin, trichrome, and immunohistochemical staining specific to T lymphocytes and macrophages. The findings revealed that SARS-CoV-2 infection induces several pathological changes in the heart, which cause cardiomyocyte disarray, mononuclear infiltrates of inflammatory cells, and hypertrophy. Furthermore, collagen-specific staining showed the development of cardiac fibrosis in the interstitial and perivascular regions in the hearts of infected primates. Moreover, the myocardial tissue samples displayed multiple foci of inflammatory cells positive for T lymphocytes and macrophages within the myocardium. These findings suggest the progression of the disease, which can lead to the development of severe complications, including heart failure. Additionally, SARS-CoV-2 antigen staining detected the presence of virus particles in the myocardium. Thus, we found that SARS-CoV-2 infection is characterized by an exaggerated inflammatory immune response in the heart, which possibly contributes to myocardial remodeling and subsequent fibrosis.
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Affiliation(s)
- Maryam Yahya Rabbani
- Division of Metabolic and Cardiovascular Sciences, Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, FL 32827, USA;
| | - Jay Rappaport
- Division of Pathology, Tulane National Primate Research Center, Covington, LA 70433, USA;
| | - Manish Kumar Gupta
- Division of Metabolic and Cardiovascular Sciences, Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, FL 32827, USA;
- Correspondence: ; Tel.: +1-407-266-7121
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Rossouw TM, Anderson R, Manga P, Feldman C. Emerging Role of Platelet-Endothelium Interactions in the Pathogenesis of Severe SARS-CoV-2 Infection-Associated Myocardial Injury. Front Immunol 2022; 13:776861. [PMID: 35185878 PMCID: PMC8854752 DOI: 10.3389/fimmu.2022.776861] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 01/19/2022] [Indexed: 12/21/2022] Open
Abstract
Cardiovascular dysfunction and disease are common and frequently fatal complications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Indeed, from early on during the SARS-CoV-2 virus pandemic it was recognized that cardiac complications may occur, even in patients with no underlying cardiac disorders, as part of the acute infection, and that these were associated with more severe disease and increased morbidity and mortality. The most common cardiac complication is acute cardiac injury, defined by significant elevation of cardiac troponins. The potential mechanisms of cardiovascular complications include direct viral myocardial injury, systemic inflammation induced by the virus, sepsis, arrhythmia, myocardial oxygen supply-demand mismatch, electrolyte abnormalities, and hypercoagulability. This review is focused on the prevalence, risk factors and clinical course of COVID-19-related myocardial injury, as well as on current data with regard to disease pathogenesis, specifically the interaction of platelets with the vascular endothelium. The latter section includes consideration of the role of SARS-CoV-2 proteins in triggering development of a generalized endotheliitis that, in turn, drives intense activation of platelets. Most prominently, SARS-CoV-2–induced endotheliitis involves interaction of the viral spike protein with endothelial angiotensin-converting enzyme 2 (ACE2) together with alternative mechanisms that involve the nucleocapsid and viroporin. In addition, the mechanisms by which activated platelets intensify endothelial activation and dysfunction, seemingly driven by release of the platelet-derived calcium-binding proteins, SA100A8 and SA100A9, are described. These events create a SARS-CoV-2–driven cycle of intravascular inflammation and coagulation, which contributes significantly to a poor clinical outcome in patients with severe disease.
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Affiliation(s)
- Theresa M. Rossouw
- Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- *Correspondence: Theresa M. Rossouw,
| | - Ronald Anderson
- Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Pravin Manga
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Charles Feldman
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Effects of the NF-κB Signaling Pathway Inhibitor BAY11-7082 in the Replication of ASFV. Viruses 2022; 14:v14020297. [PMID: 35215890 PMCID: PMC8877168 DOI: 10.3390/v14020297] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/20/2022] [Accepted: 01/28/2022] [Indexed: 02/01/2023] Open
Abstract
African swine fever virus (ASFV) mainly infects the monocyte/macrophage lineage of pigs and regulates the production of cytokines that influence host immune responses. Several studies have reported changes in cytokine production after infection with ASFV, but the regulatory mechanisms have not yet been elucidated. Therefore, the aim of this study was to examine the immune response mechanism of ASFV using transcriptomic and proteomic analyses. Through multi-omics joint analysis, it was found that ASFV infection regulates the expression of the host NF-B signal pathway and related cytokines. Additionally, changes in the NF-κB signaling pathway and IL-1β and IL-8 expression in porcine alveolar macrophages (PAMs) infected with ASFV were examined. Results show that ASFV infection activates the NF-κB signaling pathway and up-regulates the expression of IL-1β and IL-8. The NF-κB inhibitor BAY11-7082 inhibited the expression profiles of phospho-NF-κB p65, p-IκB, and MyD88 proteins, and inhibited ASFV-induced NF-κB signaling pathway activation. Additionally, the results show that the NF-κB inhibitor BAY11-7082 can inhibit the replication of ASFV and can inhibit IL-1β and, IL-8 expression. Overall, the findings of this study indicate that ASFV infection activates the NF-κB signaling pathway and up-regulates the expression of IL-1β and IL-8, and inhibits the replication of ASFV by inhibiting the NF-κB signaling pathway and interleukin-1 beta and interleukin-8 production. These findings not only provide new insights into the molecular mechanism of the association between the NF-κB signaling pathway and ASFV infection, but also indicate that the NF-κB signaling pathway is a potential immunomodulatory pathway that controls ASF.
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Siddiq MM, Chan AT, Miorin L, Yadaw AS, Beaumont KG, Kehrer T, Cupic A, White KM, Tolentino RE, Hu B, Stern AD, Tavassoly I, Hansen J, Sebra R, Martinez P, Prabha S, Dubois N, Schaniel C, Iyengar-Kapuganti R, Kukar N, Giustino G, Sud K, Nirenberg S, Kovatch P, Albrecht RA, Goldfarb J, Croft L, McLaughlin MA, Argulian E, Lerakis S, Narula J, García-Sastre A, Iyengar R. Functional Effects of Cardiomyocyte Injury in COVID-19. J Virol 2022; 96:e0106321. [PMID: 34669512 PMCID: PMC8791272 DOI: 10.1128/jvi.01063-21] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 10/18/2021] [Indexed: 01/19/2023] Open
Abstract
COVID-19 affects multiple organs. Clinical data from the Mount Sinai Health System show that substantial numbers of COVID-19 patients without prior heart disease develop cardiac dysfunction. How COVID-19 patients develop cardiac disease is not known. We integrated cell biological and physiological analyses of human cardiomyocytes differentiated from human induced pluripotent stem cells (hiPSCs) infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the presence of interleukins (ILs) with clinical findings related to laboratory values in COVID-19 patients to identify plausible mechanisms of cardiac disease in COVID-19 patients. We infected hiPSC-derived cardiomyocytes from healthy human subjects with SARS-CoV-2 in the absence and presence of IL-6 and IL-1β. Infection resulted in increased numbers of multinucleated cells. Interleukin treatment and infection resulted in disorganization of myofibrils, extracellular release of troponin I, and reduced and erratic beating. Infection resulted in decreased expression of mRNA encoding key proteins of the cardiomyocyte contractile apparatus. Although interleukins did not increase the extent of infection, they increased the contractile dysfunction associated with viral infection of cardiomyocytes, resulting in cessation of beating. Clinical data from hospitalized patients from the Mount Sinai Health System show that a significant portion of COVID-19 patients without history of heart disease have elevated troponin and interleukin levels. A substantial subset of these patients showed reduced left ventricular function by echocardiography. Our laboratory observations, combined with the clinical data, indicate that direct effects on cardiomyocytes by interleukins and SARS-CoV-2 infection might underlie heart disease in COVID-19 patients. IMPORTANCE SARS-CoV-2 infects multiple organs, including the heart. Analyses of hospitalized patients show that a substantial number without prior indication of heart disease or comorbidities show significant injury to heart tissue, assessed by increased levels of troponin in blood. We studied the cell biological and physiological effects of virus infection of healthy human iPSC-derived cardiomyocytes in culture. Virus infection with interleukins disorganizes myofibrils, increases cell size and the numbers of multinucleated cells, and suppresses the expression of proteins of the contractile apparatus. Viral infection of cardiomyocytes in culture triggers release of troponin similar to elevation in levels of COVID-19 patients with heart disease. Viral infection in the presence of interleukins slows down and desynchronizes the beating of cardiomyocytes in culture. The cell-level physiological changes are similar to decreases in left ventricular ejection seen in imaging of patients' hearts. These observations suggest that direct injury to heart tissue by virus can be one underlying cause of heart disease in COVID-19.
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Affiliation(s)
- Mustafa M. Siddiq
- Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Institute for Systems Biomedicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Angel T. Chan
- Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Institute for Systems Biomedicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Medicine and Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Lisa Miorin
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Global Health and Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Arjun S. Yadaw
- Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Institute for Systems Biomedicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kristin G. Beaumont
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Black Family Stem Cell Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Icahn Institute for Data Science and Genomic Technology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Thomas Kehrer
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Global Health and Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Anastasija Cupic
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Global Health and Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kris M. White
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Global Health and Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rosa E. Tolentino
- Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Institute for Systems Biomedicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Bin Hu
- Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Institute for Systems Biomedicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alan D. Stern
- Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Institute for Systems Biomedicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Iman Tavassoly
- Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Institute for Systems Biomedicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jens Hansen
- Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Institute for Systems Biomedicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Robert Sebra
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Black Family Stem Cell Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Icahn Institute for Data Science and Genomic Technology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Sema4, a Mount Sinai Venture, Stamford, Connecticut, USA
| | - Pedro Martinez
- Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Institute for Systems Biomedicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Som Prabha
- Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Institute for Systems Biomedicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Nicole Dubois
- Department of Cell Developmental and Regenerative Biology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Black Family Stem Cell Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Christoph Schaniel
- Black Family Stem Cell Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Division of Hematology & Oncology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rupa Iyengar-Kapuganti
- Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Nina Kukar
- Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Gennaro Giustino
- Black Family Stem Cell Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Division of Hematology & Oncology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Karan Sud
- Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sharon Nirenberg
- Department of Scientific Computing and Data Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Patricia Kovatch
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Scientific Computing and Data Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Randy A. Albrecht
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Global Health and Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Joseph Goldfarb
- Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Institute for Systems Biomedicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Lori Croft
- Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Maryann A. McLaughlin
- Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Edgar Argulian
- Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Stamatios Lerakis
- Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jagat Narula
- Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Adolfo García-Sastre
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Global Health and Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ravi Iyengar
- Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Institute for Systems Biomedicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Ogungbe O, Kumbe B, Fadodun O, Latha T, Meyer D, Asala A, Davidson PM, Dennison Himmelfarb CR, Post WS, Commodore-Mensah Y. Subclinical myocardial injury, coagulopathy, and inflammation in COVID-19: A meta-analysis of 41,013 hospitalized patients. INTERNATIONAL JOURNAL OF CARDIOLOGY. HEART & VASCULATURE 2022; 40:100950. [PMID: 35005211 PMCID: PMC8723832 DOI: 10.1016/j.ijcha.2021.100950] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 12/08/2021] [Accepted: 12/29/2021] [Indexed: 12/24/2022]
Abstract
Background Infection with the SARS-CoV-2 virus can lead to myocardial injury, evidenced by increases in specific biomarkers and imaging. Objective To quantify the association between biomarkers of myocardial injury, coagulation, and severe COVID-19 and death in hospitalized patients. Methods Studies were identified through a systematic search of indexed articles in PubMed, Embase, CINAHL, Cochrane, Web of Science, and Scopus, published between December 2019 to August 2021. Effect estimates from individual studies for association between markers of myocardial injury (Troponin), myocardial stretch (N-terminal-pro hormone BNP, NT-proBNP), and coagulopathy (D-Dimer) and death or severe/critical COVID-19 were pooled using inverse variance weighted random-effects model. Odds Ratios (OR), Hazard Ratios (HR), and 95% Confidence Intervals (CI) were pooled separately and reported by outcomes of critical/severe COVID-19 and death. A meta-analysis of proportions was also performed to summarize the pooled prevalence of co-morbidities in patients hospitalized with COVID-19. Results We included 62 articles, with a total of 41,013 patients. The pooled proportion of patients with history of hypertension was 39% (95% CI: 34-44%); diabetes, 21% (95% CI: 18%-24%); coronary artery disease, 13% (95% CI: 10-16%); chronic obstructive pulmonary disease, 7% (95% CI: 5-8%), and history of cancer, 5% (95% CI: 4-7%). Elevated troponin was associated with higher pooled odds of critical/severe COVID-19 and death [Odds Ratio (OR: 1.76, 95% CI: 1.42-2.16)]; and also separately for death (OR: 1.72, 95% CI: 1.32-2.25), and critical/severe COVID-1919 (OR: 1.93, 95% CI: 1.45-2.40). Elevations in NT-proBNP were also associated with higher severe COVID-19 and death (OR: 3.00, 95% CI: 1.58-5.70). Increases in D-dimer levels was also significantly associated with critical/severe COVID-19 and death (pooled OR: 1.38, 95% CI: 1.07-1.79). Conclusions This meta-analysis synthesizes existing evidence showing that myocardial injury, and coagulopathy are complications of COVID-19. The durability of these complications and their contributions to long-term cardiac implications of the disease is still being investigated. Patients who have recovered from COVID-19 may benefit from minimally invasive assessment for markers of myocardial injury, stretch and coagulopathy for early risk stratification purposes.
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Affiliation(s)
| | - Baridosia Kumbe
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | | | - T Latha
- Manipal Academy of Higher Education, Manipal, India
| | - Diane Meyer
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | | | - Patricia M Davidson
- Johns Hopkins University School of Nursing, Baltimore, MD, USA.,University of Wollongong, Wollongong, Australia
| | - Cheryl R Dennison Himmelfarb
- Johns Hopkins University School of Nursing, Baltimore, MD, USA.,Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Wendy S Post
- Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Yvonne Commodore-Mensah
- Johns Hopkins University School of Nursing, Baltimore, MD, USA.,Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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Rezabakhsh A, Sadat‐Ebrahimi S, Ala A, Nabavi SM, Banach M, Ghaffari S. A close-up view of dynamic biomarkers in the setting of COVID-19: Striking focus on cardiovascular system. J Cell Mol Med 2022; 26:274-286. [PMID: 34894069 PMCID: PMC8743667 DOI: 10.1111/jcmm.17122] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 10/15/2021] [Accepted: 12/01/2021] [Indexed: 01/08/2023] Open
Abstract
Based on the recent reports, cardiovascular events encompass a large portion of the mortality caused by the COVID-19 pandemic, which drawn cardiologists into the management of the admitted ill patients. Given that common laboratory values may provide key insights into the illness caused by the life-threatening SARS-CoV-2 virus, it would be more helpful for screening, clinical management and on-time therapeutic strategies. Commensurate with these issues, this review article aimed to discuss the dynamic changes of the common laboratory parameters during COVID-19 and their association with cardiovascular diseases. Besides, the values that changed in the early stage of the disease were considered and monitored during the recovery process. The time required for returning biomarkers to basal levels was also discussed. Finally, of particular interest, we tended to abridge the latest updates regarding the cardiovascular biomarkers as prognostic and diagnostic criteria to determine the severity of COVID-19.
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Affiliation(s)
- Aysa Rezabakhsh
- Cardiovascular Research CenterTabriz University of Medical SciencesTabrizIran
| | | | - Alireza Ala
- Emergency Medicine Research TeamTabriz University of Medical SciencesTabrizIran
| | - Seyed Mohammad Nabavi
- Applied Biotechnology Research CenterBaqiyatallah University of Medical SciencesTehranIran
| | - Maciej Banach
- Department of Hypertension, Chair of Nephrology and HypertensionMedical University of LodzLodzPoland
- Polish Mother’s Memorial Hospital Research Institute (PMMHRI)LodzPoland
| | - Samad Ghaffari
- Cardiovascular Research CenterTabriz University of Medical SciencesTabrizIran
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49
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Liu W, Yang C, Liao YG, Wan F, Lin L, Huang X, Zhang BH, Yuan Y, Zhang P, Zhang XJ, She ZG, Wang L, Li H. Risk factors for COVID-19 progression and mortality in hospitalized patients without pre-existing comorbidities. J Infect Public Health 2022; 15:13-20. [PMID: 34861603 PMCID: PMC8598256 DOI: 10.1016/j.jiph.2021.11.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/25/2021] [Accepted: 11/09/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) pandemic continues to escalate intensively worldwide. Massive studies on general populations with SARS-CoV-2 infection have revealed that pre-existing comorbidities were a major risk factor for the poor prognosis of COVID-19. Notably, 49-75% of COVID-19 patients had no comorbidities, but this cohort would also progress to severe COVID-19 or even death. However, risk factors contributing to disease progression and death in patients without chronic comorbidities are largely unknown; thus, specific clinical interventions for those patients are challenging. METHODS A multicenter, retrospective study based on 4806 COVID-19 patients without chronic comorbidities was performed to identify potential risk factors contributing to COVID-19 progression and death using LASSO and a stepwise logistic regression model. RESULTS Among 4806 patients without pre-existing comorbidities, the proportions with severe progression and mortality were 34.29% and 2.10%, respectively. The median age was 47.00 years [interquartile range, 36.00-56.00], and 2162 (44.99%) were men. Among 51 clinical parameters on admission, age ≥ 47, oxygen saturation < 95%, increased lactate dehydrogenase, neutrophil count, direct bilirubin, creatine phosphokinase, blood urea nitrogen levels, dyspnea, increased blood glucose and prothrombin time levels were associated with COVID-19 mortality in the entire cohort. Of the 3647 patients diagnosed with non-severe COVID-19 on admission, 489(13.41%) progressed to severe disease. The risk factors associated with COVID-19 progression from non-severe to severe illness were increased procalcitonin levels, SpO2 < 95%, age ≥ 47, increased LDH, activated partial thromboplastin time levels, decreased high-density lipoprotein cholesterol levels, dyspnea and increased D-dimer levels. CONCLUSIONS COVID-19 patients without pre-existing chronic comorbidities have specific traits and disease patterns. COVID-19 accompanied by severe bacterial infections, as indicated by increased procalcitonin levels, was highly associated with disease progression from non-severe to severe. Aging, impaired respiratory function, coagulation dysfunction, tissue injury, and lipid metabolism dysregulation were also associated with disease progression. Once factors for multi-organ damage were elevated and glucose increased at admission, these findings indicated a higher risk for mortality. This study provides information that helps to predict COVID-19 prognosis specifically in patients without chronic comorbidities.
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Affiliation(s)
- Weifang Liu
- Department of Neurology, Huanggang Central Hospital, Huanggang, China; Huanggang Institute of Translational Medicine, Huanggang, China; School of Basic Medical Sciences, Wuhan University, Wuhan, China; Institute of Model Animal of Wuhan University, Wuhan, China
| | - Chengzhang Yang
- Institute of Model Animal of Wuhan University, Wuhan, China; Department of Cardiology, Renmin Hospital, Wuhan University, Wuhan, China
| | - Yuan-Gao Liao
- Department of Neurology, Huanggang Central Hospital, Huanggang, China; Huanggang Institute of Translational Medicine, Huanggang, China
| | - Feng Wan
- Department of Neurology, Huanggang Central Hospital, Huanggang, China; Huanggang Institute of Translational Medicine, Huanggang, China
| | - Lijin Lin
- Institute of Model Animal of Wuhan University, Wuhan, China; Department of Cardiology, Renmin Hospital, Wuhan University, Wuhan, China
| | - Xuewei Huang
- Institute of Model Animal of Wuhan University, Wuhan, China; Department of Cardiology, Renmin Hospital, Wuhan University, Wuhan, China
| | - Bing-Hong Zhang
- Neonatology Department, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yufeng Yuan
- Department of Hepatobiliary and Pancreatic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Peng Zhang
- School of Basic Medical Sciences, Wuhan University, Wuhan, China; Institute of Model Animal of Wuhan University, Wuhan, China
| | - Xiao-Jing Zhang
- School of Basic Medical Sciences, Wuhan University, Wuhan, China; Institute of Model Animal of Wuhan University, Wuhan, China
| | - Zhi-Gang She
- Institute of Model Animal of Wuhan University, Wuhan, China; Department of Cardiology, Renmin Hospital, Wuhan University, Wuhan, China
| | - Lei Wang
- Huanggang Institute of Translational Medicine, Huanggang, China; Department of Neurosurgery, Huanggang Central Hospital, Huanggang, China.
| | - Hongliang Li
- Huanggang Institute of Translational Medicine, Huanggang, China; Institute of Model Animal of Wuhan University, Wuhan, China; Department of Cardiology, Renmin Hospital, Wuhan University, Wuhan, China; Medical Science Research Center, Zhongnan Hospital of Wuhan University, Wuhan, China.
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Alcaide E, Álvarez Bota L, Salas R. Relevance of myocardial injury biomarkers to the prognosis of COVID-19 patients. REVISTA ESPAÑOLA DE CARDIOLOGÍA (ENGLISH EDITION) 2022; 75:105. [PMID: 34565698 PMCID: PMC8403660 DOI: 10.1016/j.rec.2021.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 07/20/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Eric Alcaide
- Departament de Medicina, Universitat de Barcelona, Barcelona, Spain.
| | | | - Rosario Salas
- Servicio de Medicina Interna, Hospital Universitari Sagrat Cor-Grupo Quirónsalud, Barcelona, Spain
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