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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; 21:485-497. [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] [MESH Headings] [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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Gadd DA, Smith HM, Mullin D, Chybowska O, Hillary RF, Kimenai DM, Bernabeu E, Cheng Y, Fawns-Ritchie C, Campbell A, Page D, Taylor A, Corley J, Del C Valdés-Hernández M, Maniega SM, Bastin ME, Wardlaw JM, Walker RM, Evans KL, McIntosh AM, Hayward C, Russ TC, Harris SE, Welsh P, Sattar N, Cox SR, McCartney DL, Marioni RE. DNAm scores for serum GDF15 and NT-proBNP levels associate with a range of traits affecting the body and brain. Clin Epigenetics 2024; 16:124. [PMID: 39256775 PMCID: PMC11389299 DOI: 10.1186/s13148-024-01734-7] [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: 10/18/2023] [Accepted: 08/23/2024] [Indexed: 09/12/2024] Open
Abstract
BACKGROUND Plasma growth differentiation factor 15 (GDF15) and N-terminal proB-type natriuretic peptide (NT-proBNP) are cardiovascular biomarkers that associate with a range of diseases. Epigenetic scores (EpiScores) for GDF15 and NT-proBNP may provide new routes for risk stratification. RESULTS In the Generation Scotland cohort (N ≥ 16,963), GDF15 levels were associated with incident dementia, ischaemic stroke and type 2 diabetes, whereas NT-proBNP levels were associated with incident ischaemic heart disease, ischaemic stroke and type 2 diabetes (all PFDR < 0.05). Bayesian epigenome-wide association studies (EWAS) identified 12 and 4 DNA methylation (DNAm) CpG sites associated (Posterior Inclusion Probability [PIP] > 95%) with levels of GDF15 and NT-proBNP, respectively. EpiScores for GDF15 and NT-proBNP were trained in a subset of the population. The GDF15 EpiScore replicated protein associations with incident dementia, type 2 diabetes and ischaemic stroke in the Generation Scotland test set (hazard ratios (HR) range 1.36-1.41, PFDR < 0.05). The EpiScore for NT-proBNP replicated the protein association with type 2 diabetes, but failed to replicate an association with ischaemic stroke. EpiScores explained comparable variance in protein levels across both the Generation Scotland test set and the external LBC1936 test cohort (R2 range of 5.7-12.2%). In LBC1936, both EpiScores were associated with indicators of poorer brain health. Neither EpiScore was associated with incident dementia in the LBC1936 population. CONCLUSIONS EpiScores for serum levels of GDF15 and Nt-proBNP associate with body and brain health traits. These EpiScores are provided as potential tools for disease risk stratification.
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Affiliation(s)
- Danni A Gadd
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Hannah M Smith
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Donncha Mullin
- Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburgh, Edinburgh, UK
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
| | - Ola Chybowska
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Robert F Hillary
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Dorien M Kimenai
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Elena Bernabeu
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Yipeng Cheng
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Chloe Fawns-Ritchie
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
- Division of Psychology, University of Dundee, Dundee, Scotland, UK
| | - Archie Campbell
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Danielle Page
- Department of Psychology, Lothian Birth Cohorts, University of Edinburgh, Edinburgh, UK
| | - Adele Taylor
- Department of Psychology, Lothian Birth Cohorts, University of Edinburgh, Edinburgh, UK
| | - Janie Corley
- Department of Psychology, Lothian Birth Cohorts, University of Edinburgh, Edinburgh, UK
| | - Maria Del C Valdés-Hernández
- Department of Psychology, Lothian Birth Cohorts, University of Edinburgh, Edinburgh, UK
- Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE) Collaboration, Edinburgh, UK
- Centre for Clinical Brain Sciences, Edinburgh Imaging and UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Susana Muñoz Maniega
- Department of Psychology, Lothian Birth Cohorts, University of Edinburgh, Edinburgh, UK
- Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE) Collaboration, Edinburgh, UK
- Centre for Clinical Brain Sciences, Edinburgh Imaging and UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Mark E Bastin
- Department of Psychology, Lothian Birth Cohorts, University of Edinburgh, Edinburgh, UK
- Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE) Collaboration, Edinburgh, UK
- Centre for Clinical Brain Sciences, Edinburgh Imaging and UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Joanna M Wardlaw
- Department of Psychology, Lothian Birth Cohorts, University of Edinburgh, Edinburgh, UK
- Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE) Collaboration, Edinburgh, UK
- Centre for Clinical Brain Sciences, Edinburgh Imaging and UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
- Neurovascular Imaging Research Core, UCLA, Los Angeles, CA, USA
| | - Rosie M Walker
- Centre for Clinical Brain Sciences, Edinburgh Imaging and UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
- School of Psychology, University of Exeter, Perry Road, Exeter, UK
| | - Kathryn L Evans
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Andrew M McIntosh
- Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburgh, Edinburgh, UK
| | - Caroline Hayward
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
- Medical Research Council Human Genetics Unit, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Tom C Russ
- Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburgh, Edinburgh, UK
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
| | - Sarah E Harris
- Department of Psychology, Lothian Birth Cohorts, University of Edinburgh, Edinburgh, UK
| | - Paul Welsh
- School of Cardiovascular and Metabolic Health, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow, UK
| | - Naveed Sattar
- School of Cardiovascular and Metabolic Health, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow, UK
| | - Simon R Cox
- Department of Psychology, Lothian Birth Cohorts, University of Edinburgh, Edinburgh, UK
| | - Daniel L McCartney
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Riccardo E Marioni
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK.
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De Rop L, Bos DA, Stegeman I, Holtman G, Ochodo EA, Spijker R, Otieno JA, Alkhlaileh F, Deeks JJ, Dinnes J, Van den Bruel A, McInnes MD, Leeflang MM, Verbakel JY. Accuracy of routine laboratory tests to predict mortality and deterioration to severe or critical COVID-19 in people with SARS-CoV-2. Cochrane Database Syst Rev 2024; 8:CD015050. [PMID: 39105481 PMCID: PMC11301994 DOI: 10.1002/14651858.cd015050.pub2] [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: 08/07/2024]
Abstract
BACKGROUND Identifying patients with COVID-19 disease who will deteriorate can be useful to assess whether they should receive intensive care, or whether they can be treated in a less intensive way or through outpatient care. In clinical care, routine laboratory markers, such as C-reactive protein, are used to assess a person's health status. OBJECTIVES To assess the accuracy of routine blood-based laboratory tests to predict mortality and deterioration to severe or critical (from mild or moderate) COVID-19 in people with SARS-CoV-2. SEARCH METHODS On 25 August 2022, we searched the Cochrane COVID-19 Study Register, encompassing searches of various databases such as MEDLINE via PubMed, CENTRAL, Embase, medRxiv, and ClinicalTrials.gov. We did not apply any language restrictions. SELECTION CRITERIA We included studies of all designs that produced estimates of prognostic accuracy in participants who presented to outpatient services, or were admitted to general hospital wards with confirmed SARS-CoV-2 infection, and studies that were based on serum banks of samples from people. All routine blood-based laboratory tests performed during the first encounter were included. We included any reference standard used to define deterioration to severe or critical disease that was provided by the authors. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data from each included study, and independently assessed the methodological quality using the Quality Assessment of Prognostic Accuracy Studies tool. As studies reported different thresholds for the same test, we used the Hierarchical Summary Receiver Operator Curve model for meta-analyses to estimate summary curves in SAS 9.4. We estimated the sensitivity at points on the SROC curves that corresponded to the median and interquartile range boundaries of specificities in the included studies. Direct and indirect comparisons were exclusively conducted for biomarkers with an estimated sensitivity and 95% CI of ≥ 50% at a specificity of ≥ 50%. The relative diagnostic odds ratio was calculated as a summary of the relative accuracy of these biomarkers. MAIN RESULTS We identified a total of 64 studies, including 71,170 participants, of which 8169 participants died, and 4031 participants deteriorated to severe/critical condition. The studies assessed 53 different laboratory tests. For some tests, both increases and decreases relative to the normal range were included. There was important heterogeneity between tests and their cut-off values. None of the included studies had a low risk of bias or low concern for applicability for all domains. None of the tests included in this review demonstrated high sensitivity or specificity, or both. The five tests with summary sensitivity and specificity above 50% were: C-reactive protein increase, neutrophil-to-lymphocyte ratio increase, lymphocyte count decrease, d-dimer increase, and lactate dehydrogenase increase. Inflammation For mortality, summary sensitivity of a C-reactive protein increase was 76% (95% CI 73% to 79%) at median specificity, 59% (low-certainty evidence). For deterioration, summary sensitivity was 78% (95% CI 67% to 86%) at median specificity, 72% (very low-certainty evidence). For the combined outcome of mortality or deterioration, or both, summary sensitivity was 70% (95% CI 49% to 85%) at median specificity, 60% (very low-certainty evidence). For mortality, summary sensitivity of an increase in neutrophil-to-lymphocyte ratio was 69% (95% CI 66% to 72%) at median specificity, 63% (very low-certainty evidence). For deterioration, summary sensitivity was 75% (95% CI 59% to 87%) at median specificity, 71% (very low-certainty evidence). For mortality, summary sensitivity of a decrease in lymphocyte count was 67% (95% CI 56% to 77%) at median specificity, 61% (very low-certainty evidence). For deterioration, summary sensitivity of a decrease in lymphocyte count was 69% (95% CI 60% to 76%) at median specificity, 67% (very low-certainty evidence). For the combined outcome, summary sensitivity was 83% (95% CI 67% to 92%) at median specificity, 29% (very low-certainty evidence). For mortality, summary sensitivity of a lactate dehydrogenase increase was 82% (95% CI 66% to 91%) at median specificity, 60% (very low-certainty evidence). For deterioration, summary sensitivity of a lactate dehydrogenase increase was 79% (95% CI 76% to 82%) at median specificity, 66% (low-certainty evidence). For the combined outcome, summary sensitivity was 69% (95% CI 51% to 82%) at median specificity, 62% (very low-certainty evidence). Hypercoagulability For mortality, summary sensitivity of a d-dimer increase was 70% (95% CI 64% to 76%) at median specificity of 56% (very low-certainty evidence). For deterioration, summary sensitivity was 65% (95% CI 56% to 74%) at median specificity of 63% (very low-certainty evidence). For the combined outcome, summary sensitivity was 65% (95% CI 52% to 76%) at median specificity of 54% (very low-certainty evidence). To predict mortality, neutrophil-to-lymphocyte ratio increase had higher accuracy compared to d-dimer increase (RDOR (diagnostic Odds Ratio) 2.05, 95% CI 1.30 to 3.24), C-reactive protein increase (RDOR 2.64, 95% CI 2.09 to 3.33), and lymphocyte count decrease (RDOR 2.63, 95% CI 1.55 to 4.46). D-dimer increase had higher accuracy compared to lymphocyte count decrease (RDOR 1.49, 95% CI 1.23 to 1.80), C-reactive protein increase (RDOR 1.31, 95% CI 1.03 to 1.65), and lactate dehydrogenase increase (RDOR 1.42, 95% CI 1.05 to 1.90). Additionally, lactate dehydrogenase increase had higher accuracy compared to lymphocyte count decrease (RDOR 1.30, 95% CI 1.13 to 1.49). To predict deterioration to severe disease, C-reactive protein increase had higher accuracy compared to d-dimer increase (RDOR 1.76, 95% CI 1.25 to 2.50). The neutrophil-to-lymphocyte ratio increase had higher accuracy compared to d-dimer increase (RDOR 2.77, 95% CI 1.58 to 4.84). Lastly, lymphocyte count decrease had higher accuracy compared to d-dimer increase (RDOR 2.10, 95% CI 1.44 to 3.07) and lactate dehydrogenase increase (RDOR 2.22, 95% CI 1.52 to 3.26). AUTHORS' CONCLUSIONS Laboratory tests, associated with hypercoagulability and hyperinflammatory response, were better at predicting severe disease and mortality in patients with SARS-CoV-2 compared to other laboratory tests. However, to safely rule out severe disease, tests should have high sensitivity (> 90%), and none of the identified laboratory tests met this criterion. In clinical practice, a more comprehensive assessment of a patient's health status is usually required by, for example, incorporating these laboratory tests into clinical prediction rules together with clinical symptoms, radiological findings, and patient's characteristics.
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Affiliation(s)
- Liselore De Rop
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - David Ag Bos
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Inge Stegeman
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, Netherlands
- Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Gea Holtman
- Department of Primary- and Long-term Care, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
| | - Eleanor A Ochodo
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
- Centre for Evidence-based Health Care, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - René Spijker
- Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Medical Library, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health, Amsterdam, Netherlands
| | - Jenifer A Otieno
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Fade Alkhlaileh
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Jonathan J Deeks
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Jacqueline Dinnes
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Ann Van den Bruel
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Matthew Df McInnes
- Department of Radiology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - Mariska Mg Leeflang
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Jan Y Verbakel
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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Furmanek S, Salunkhe V, Pahwa S, Samanapally H, Nathala P, Xu Q, Han Y, Huang EC, Ali T, Deepti F, Glynn A, McGuffin T, Huang JJ, Farah I, Jones CM, Ramirez JA, Clifford SP, Arnold FW, Kong M, Roser L, Huang J. Association between echocardiographic features, troponin levels, and survival time in hospitalized COVID-19 patients with cardiovascular events. JOURNAL OF ANESTHESIA AND TRANSLATIONAL MEDICINE 2024; 3:36-44. [PMID: 38993392 PMCID: PMC11238549 DOI: 10.1016/j.jatmed.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
Introduction This study aims to explore the predictive roles of echocardiographic parameters and biomarkers in determining outcomes among hospitalized COVID-19 patients experiencing cardiovascular events. Methods A retrospective cohort study was conducted involving 49 COVID-19 patients who encountered cardiovascular events during hospitalization and underwent echocardiography. Our findings revealed notable associations between echocardiographic parameters and survival time. Results A decrease in left ventricular ejection fraction (LVEF) of 10% was linked to a 20% reduction in survival time (TR: 0.80, 95% CI: 0.67 - 0.96, p = .017). Similarly, an increase in left ventricular (LV) volume by 10 mL was associated with a 9% decrease in survival time (TR: 0.91, 95% CI: 0.84 - 0.98, p = .011). Moreover, an increase in left atrial (LA) volume by 10 mL corresponded to an 8% decrease in survival time (TR: 0.92, 95% CI: 0.86 - 0.99, p = .026). Additionally, each 1 cm increase in right ventricular (RV) diameter was linked to a 22% reduction in survival time (TR: 0.78, 95% CI: 0.61 - 0.99, p = .043). Furthermore, a 10 mL increase in right atrial (RA) volume was associated with a 12% decrease in survival time (TR: 0.88, 95% CI: 0.78 - 0.98, p = .017). Notably, a tenfold rise in troponin levels was linked to a 33% decrease in survival time (TR: 0.67, 95% CI: 0.48 - 0.93, p = .014). Conclusions Our study emphasizes the significant associations between various echocardiographic parameters and troponin levels with reduced survival time among COVID-19 patients experiencing cardiovascular events. These findings highlight the potential utility of echocardiography and troponin assessment in predicting outcomes and guiding management strategies in this patient population.
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Affiliation(s)
- Stephen Furmanek
- Division of Infectious Diseases, Center of Excellence for Research in Infectious Diseases (CERID), Department of Medicine, University of Louisville, 501 E Broadway, Louisville, KY 40202, USA
- Norton Infectious Diseases Institute, Norton Healthcare, 234 E Gray St, Louisville, KY 40202, USA
| | - Vidyulata Salunkhe
- Division of Infectious Diseases, Center of Excellence for Research in Infectious Diseases (CERID), Department of Medicine, University of Louisville, 501 E Broadway, Louisville, KY 40202, USA
| | - Siddharth Pahwa
- Department of Cardiovascular & Thoracic Surgery, University of Louisville, 201 Abraham Flexner Way, Louisville, KY 40202, USA
| | - Harideep Samanapally
- Division of Infectious Diseases, Center of Excellence for Research in Infectious Diseases (CERID), Department of Medicine, University of Louisville, 501 E Broadway, Louisville, KY 40202, USA
| | - Pavani Nathala
- Division of Infectious Diseases, Center of Excellence for Research in Infectious Diseases (CERID), Department of Medicine, University of Louisville, 501 E Broadway, Louisville, KY 40202, USA
| | - Qian Xu
- Department of Bioinformatics and Biostatistics, School of Public Health and Information Sciences, University of Louisville, 485 E Gray St, Louisville, KY 40202, USA
- Biometrics and Data Science, Fosun Pharma, Beijing 100026, China
| | - Yuchen Han
- Department of Bioinformatics and Biostatistics, School of Public Health and Information Sciences, University of Louisville, 485 E Gray St, Louisville, KY 40202, USA
| | - Emma C Huang
- Department of Anesthesiology, Duke University, Durham, NC 27710, USA
| | - T'shura Ali
- Division of Infectious Diseases, Center of Excellence for Research in Infectious Diseases (CERID), Department of Medicine, University of Louisville, 501 E Broadway, Louisville, KY 40202, USA
| | - Fnu Deepti
- Division of Infectious Diseases, Center of Excellence for Research in Infectious Diseases (CERID), Department of Medicine, University of Louisville, 501 E Broadway, Louisville, KY 40202, USA
| | - Alex Glynn
- Division of Infectious Diseases, Center of Excellence for Research in Infectious Diseases (CERID), Department of Medicine, University of Louisville, 501 E Broadway, Louisville, KY 40202, USA
| | - Trevor McGuffin
- School of Nursing, University of Louisville, 555 S Floyd St, Louisville, KY 40202, USA
| | - Justin J Huang
- Department of Anesthesiology & Perioperative Medicine, University of Louisville, 530 S Jackson St, Louisville, KY 40202, USA
| | - Ian Farah
- Department of Anesthesiology & Perioperative Medicine, University of Louisville, 530 S Jackson St, Louisville, KY 40202, USA
| | - Christopher M Jones
- Division of Transplantation, Department of Surgery, University of Louisville, 323 E Chestnut St, Louisville, KY 40202, USA
| | - Julio A Ramirez
- Division of Infectious Diseases, Center of Excellence for Research in Infectious Diseases (CERID), Department of Medicine, University of Louisville, 501 E Broadway, Louisville, KY 40202, USA
- Norton Infectious Diseases Institute, Norton Healthcare, 234 E Gray St, Louisville, KY 40202, USA
| | - Sean P Clifford
- Department of Anesthesiology & Perioperative Medicine, University of Louisville, 530 S Jackson St, Louisville, KY 40202, USA
| | - Forest W Arnold
- Division of Infectious Diseases, Center of Excellence for Research in Infectious Diseases (CERID), Department of Medicine, University of Louisville, 501 E Broadway, Louisville, KY 40202, USA
| | - Maiying Kong
- Department of Bioinformatics and Biostatistics, School of Public Health and Information Sciences, University of Louisville, 485 E Gray St, Louisville, KY 40202, USA
| | - Lynn Roser
- School of Nursing, University of Louisville, 555 S Floyd St, Louisville, KY 40202, USA
| | - Jiapeng Huang
- Division of Infectious Diseases, Center of Excellence for Research in Infectious Diseases (CERID), Department of Medicine, University of Louisville, 501 E Broadway, Louisville, KY 40202, USA
- Department of Anesthesiology & Perioperative Medicine, University of Louisville, 530 S Jackson St, Louisville, KY 40202, USA
- Department of Pharmacology & Toxicology, University of Louisville, 505 S Hancock St, Louisville, KY 40202, USA
- Department of Cardiovascular & Thoracic Surgery, University of Louisville, 201 Abraham Flexner Way, Louisville, KY 40202, USA
- Center for Integrative Environmental Health Sciences, University of Louisville, 500 S Preston St, Louisville, KY 40202, USA
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Singh R, Singh V, Ahmad MA, Pasricha C, Kumari P, Singh TG, Kaur R, Mujwar S, Wani TA, Zargar S. Unveiling the Role of PAR 1: A Crucial Link with Inflammation in Diabetic Subjects with COVID-19. Pharmaceuticals (Basel) 2024; 17:454. [PMID: 38675414 PMCID: PMC11055094 DOI: 10.3390/ph17040454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 03/27/2024] [Accepted: 03/27/2024] [Indexed: 04/28/2024] Open
Abstract
Inflammation is a distinguished clinical manifestation of COVID-19 and type 2 diabetes mellitus (T2DM), often associated with inflammatory dysfunctions, insulin resistance, metabolic dysregulation, and other complications. The present study aims to test the hypothesis that serum concentrations of PAR-1 levels differ between COVID-19 diabetic patients (T2DM) and non-diabetic COVID-19 patients and determine their association with different biochemical parameters and inflammatory biomarkers. T2DM patients with COVID-19 (n = 50) with glycated hemoglobin (HbA1c) levels of (9.23 ± 1.66) and non-diabetic COVID-19 patients (n = 50) with HbA1c levels (4.39 ± 0.57) were recruited in this study. The serum PAR-1 levels (ELISA method) were determined in both groups and correlated with parameters such as age, BMI, inflammatory markers including CRP, interleukin 6 (IL-6), tumor necrosis factor-alpha (TNF-α), D-dimer, homocysteine, and N-terminal pro-B-type natriuretic peptide (NT-proBNP). Demographic variables such as BMI (29.21 ± 3.52 vs. controls 21.30 ± 2.11) and HbA1c (9.23 ± 1.66 vs. controls 4.39 ± 0.57) were found to be statistically elevated in COVID-19 T2DM patients compared to non-diabetic COVID-19 patients. The concentrations of several inflammatory biomarkers and PAR-1 were remarkably increased in the COVID-19 T2DM group when compared with the non-diabetic COVID-19 group. The univariate analysis revealed that increased serum PAR-1 estimations were positively correlated with enhanced HbA1c, BMI, inflammatory cytokines, D-dimer, homocysteine, and NT-proBNP. The findings in the current study suggest that increased levels of serum PAR-1 in the bloodstream could potentially serve as an independent biomarker of inflammation in COVID-19 patients with T2DM.
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Affiliation(s)
- Ravinder Singh
- Chitkara College of Pharmacy, Chitkara University, Rajpura 140401, Punjab, India; (V.S.); (M.A.A.); (C.P.); (P.K.); (T.G.S.); (R.K.); (S.M.)
| | - Varinder Singh
- Chitkara College of Pharmacy, Chitkara University, Rajpura 140401, Punjab, India; (V.S.); (M.A.A.); (C.P.); (P.K.); (T.G.S.); (R.K.); (S.M.)
| | - Md. Altamash Ahmad
- Chitkara College of Pharmacy, Chitkara University, Rajpura 140401, Punjab, India; (V.S.); (M.A.A.); (C.P.); (P.K.); (T.G.S.); (R.K.); (S.M.)
| | - Chirag Pasricha
- Chitkara College of Pharmacy, Chitkara University, Rajpura 140401, Punjab, India; (V.S.); (M.A.A.); (C.P.); (P.K.); (T.G.S.); (R.K.); (S.M.)
| | - Pratima Kumari
- Chitkara College of Pharmacy, Chitkara University, Rajpura 140401, Punjab, India; (V.S.); (M.A.A.); (C.P.); (P.K.); (T.G.S.); (R.K.); (S.M.)
| | - Thakur Gurjeet Singh
- Chitkara College of Pharmacy, Chitkara University, Rajpura 140401, Punjab, India; (V.S.); (M.A.A.); (C.P.); (P.K.); (T.G.S.); (R.K.); (S.M.)
| | - Rupinder Kaur
- Chitkara College of Pharmacy, Chitkara University, Rajpura 140401, Punjab, India; (V.S.); (M.A.A.); (C.P.); (P.K.); (T.G.S.); (R.K.); (S.M.)
| | - Somdutt Mujwar
- Chitkara College of Pharmacy, Chitkara University, Rajpura 140401, Punjab, India; (V.S.); (M.A.A.); (C.P.); (P.K.); (T.G.S.); (R.K.); (S.M.)
| | - Tanveer A. Wani
- Department of Pharmaceutical Chemistry, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia;
| | - Seema Zargar
- Department of Biochemistry, College of Science, King Saud University, Riyadh 11495, Saudi Arabia;
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Sleem B, El Rassi C, Zareef R, Bitar F, Arabi M. NT-proBNP cardiac value in COVID-19: a focus on the paediatric population. Cardiol Young 2024:1-10. [PMID: 38528805 DOI: 10.1017/s1047951124000283] [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] [Indexed: 03/27/2024]
Abstract
NT-proBNP is a peptide related to brain natriuretic peptide, a cardiac biomarker and a member of the natriuretic family of peptides. NT-proBNP has demonstrated its clinical utility in the assessment of a wide spectrum of cardiac manifestations. It is also considered a more precise diagnostic and prognostic cardiac biomarker than brain natriuretic peptide. With the appearance of the Severe Acute Respiratory Syndrome Coronavirus 2 virus and the subsequent COVID-19 pandemic, diagnosis of heart implications began to pose an increasing struggle for the physician. Echocardiography is considered a central means of evaluating cardiac disorders like heart failure, and it is considered a reliable method. However, other diagnostic methods are currently being explored, one of which involves the assessment of NT-proBNP levels. In the literature that involves the adult population, significant positive correlations were drawn between the levels of NT-proBNP and COVID-19 outcomes such as high severity and fatality. In the paediatric population, however, the literature is scarce, and most of the investigations assess NT-proBNP in the context of Multiple Inflammatory Syndrome in Children, where studies have shown that cohorts with this syndrome had elevated levels of NT-proBNP when compared to non-syndromic cohorts. Thus, more large-scale studies on existing COVID-19 data should be carried out in the paediatric population to further understand the prognostic and diagnostic roles of NT-proBNP.
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Affiliation(s)
- Bshara Sleem
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Christophe El Rassi
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rana Zareef
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fadi Bitar
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Pediatric Department, Division of Pediatric Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mariam Arabi
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Pediatric Department, Division of Pediatric Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
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Li D, He W, Yu B, Wang DW, Ni L. NT-proBNP ratio is a potential predictor for COVID-19 outcomes in adult Chinese patients: a retrospective study. Sci Rep 2024; 14:5906. [PMID: 38467760 PMCID: PMC10928211 DOI: 10.1038/s41598-024-56329-2] [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: 10/26/2023] [Accepted: 03/05/2024] [Indexed: 03/13/2024] Open
Abstract
Despite the progressive decline in the virulence of the novel coronavirus, there has been no corresponding reduction in its associated hospital mortality. Our aim was to redefine an accurate predictor of mortality risk in COVID-19 patients, enabling effective management and resource allocation. We conducted a retrospective analysis of 2917 adult Chinese patients diagnosed with COVID-19 who were admitted to our hospital during two waves of epidemics, involving the Beta and Omicron variants. Upon admission, NT-proBNP levels were measured, and we collected demographic, clinical, and laboratory data. We introduced a new concept called the NT-proBNP ratio, which measures the NT-proBNP level relative to age-specific maximum normal values. The primary outcome was all-cause in-hospital mortality. Our analysis revealed a higher in-hospital mortality rate in 2022, as shown by the Kaplan-Meier Survival Curve. To assess the predictive value of the NT-proBNP ratio, we employed the time-dependent receiver operating characteristic (ROC) curve. Notably, the NT-proBNP ratio emerged as the strongest predictor of mortality in adult Chinese hospitalized COVID-19 patients (area under the curve, AUC = 0.826; adjusted hazard ratio [HR], 3.959; 95% confidence interval [CI] 3.001-5.221; P < 0.001). This finding consistently held true for both the 2020 and 2022 subgroups. The NT-proBNP ratio demonstrates potential predictive capability compared to several established risk factors, including NT-proBNP, hsCRP, and neutrophil-to-lymphocyte ratio, when it comes to forecasting in-hospital mortality among adult Chinese patients with COVID-19.Trial registration Clinical Trial Registration: www.clinicaltrials.gov NCT05615792.
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Affiliation(s)
- Dan Li
- Division of Cardiology, Department of Internal Medicine and Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095# Jiefang Ave., Wuhan, 430030, China
| | - Wu He
- Division of Cardiology, Department of Internal Medicine and Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095# Jiefang Ave., Wuhan, 430030, China
| | - Bo Yu
- Division of Cardiology, Department of Internal Medicine and Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095# Jiefang Ave., Wuhan, 430030, China
| | - Dao Wen Wang
- Division of Cardiology, Department of Internal Medicine and Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095# Jiefang Ave., Wuhan, 430030, China
| | - Li Ni
- Division of Cardiology, Department of Internal Medicine and Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095# Jiefang Ave., Wuhan, 430030, China.
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8
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Ozden MF, Sogut O, Az A, Dogan Y. Analysis of Age-Specific Predictors of Mortality in Patients with Coronavirus Disease 2019. Niger J Clin Pract 2024; 27:244-251. [PMID: 38409154 DOI: 10.4103/njcp.njcp_507_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 12/16/2023] [Indexed: 02/28/2024]
Abstract
AIM We investigated predictors of mortality, including demographic, clinical, and laboratory parameters, in hospitalized patients with coronavirus disease 2019 (COVID-19) pneumonia. PATIENTS AND METHODS This retrospective, single-center study included 651 consecutive Turkish adults who had been admitted to the emergency department with a diagnosis of COVID-19. We recorded the demographic, clinical, and laboratory parameters of the patients. The patients were divided into two groups: patients aged ≥65 years and patients aged <65 years. The predictors of mortality for hospitalized COVID-19 patients were evaluated. RESULTS The study included 651 patients (354 [54.4%] men and 297 [45.6%] women; mean age, 56.40 ± 15.70 years). The most common comorbidities were hypertension (37.6%), diabetes mellitus (28.9%), and coronary artery disease (CAD) (16.1%). The overall mortality rate was 10.6% (n = 69); the mortality rate was higher in men than in women. Advanced age; chronic renal failure (CRF); prolonged activated partial thromboplastin time; high serum neutrophil and platelet counts; high C-reactive protein to albumin (CRP/albumin) ratio; and high levels of albumin, lactate dehydrogenase (LDH), and high-sensitivity troponin I (TnI-hs) were independent predictors of mortality in all age groups. CONCLUSION Multivariate logistic regression analysis showed that chronic obstructive pulmonary disease (COPD), high serum platelet count, high CRP/albumin ratio, and high levels of albumin, TnI-hs, and D-dimer were independent predictors of mortality in patients aged <65 years. Conversely, advanced age, CAD, CRF, and high levels of serum CRP and LDH were independent predictors of mortality in patients aged ≥65 years.
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Affiliation(s)
- M F Ozden
- Department of Emergency Medicine, University of Health Sciences, Haseki Training and Research Hospital, Istanbul, Turkey
| | - O Sogut
- Department of Emergency Medicine, University of Health Sciences, Haseki Training and Research Hospital, Istanbul, Turkey
| | - A Az
- Department of Emergency Medicine, Istanbul Beylikdüzü State Hospital, Istanbul, Turkey
| | - Y Dogan
- Department of Emergency Medicine, Mus State Hospital, Mus, Turkey
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9
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Mojón-Álvarez D, Giralt T, Carreras-Mora J, Calvo-Fernández A, Izquierdo A, Soler C, Cabero P, Pérez-Fernández S, Vaquerizo B, Ribas Barquet N. Baseline NT-proBNP levels as a predictor of short-and long-term prognosis in COVID-19 patients: a prospective observational study. BMC Infect Dis 2024; 24:58. [PMID: 38191350 PMCID: PMC10773093 DOI: 10.1186/s12879-024-08980-3] [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: 07/17/2023] [Accepted: 01/03/2024] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Up to 20% of COVID-19 patients can suffer COVID-19-related myocardial injury. Elevated cardiac biomarkers, such as hs-cTnT and NT-proBNP, have been related to worse short-term prognosis. However, data on NT-proBNP and long-term prognosis are scarce. We have evaluated the potential association of baseline age-adjusted NT-proBNP levels and outcomes at one-year follow-up in COVID-19 patients. METHODS This was a single-center prospective study of 499 COVID-19 patients in whom NT-proBNP was assessed at hospital admission. NT-proBNP levels were age-adjusted and patients were classified as high or low NT-proBNP. Clinical and demographic characteristics, comorbidities, laboratory results, and in-hospital complications and mortality were compared between the two groups. Survivors of the acute phase of COVID-19 were followed up for one year from admission to detect readmissions and mortality. RESULTS The 68 patients with high NT-proBNP levels at hospital admission were older, with more cardiovascular risk factors, cardiovascular disease, comorbidities, myocardial injury, and higher levels of inflammatory markers than patients with low NT-proBNP levels. They also had more in-hospital complications and a higher acute-phase mortality rate (60.3% vs. 10.2%, p < 0.001). High NT-proBNP levels were an independent marker of death during hospitalization (HR 1.95; CI 1.07-3.52). At one-year follow-up, high NT-proBNP levels were independently associated with mortality (HR 2.69; CI 1.47-4.89). Among survivors of the acute phase of COVID-19, there were no differences in hospital readmissions between those with high vs. low NT-proBNP levels, but survivors with high baseline NT-proBNP levels showed a higher 1-year mortality rate (7.4% vs. 1.3%, p = 0.018). CONCLUSIONS High age-adjusted NT-proBNP levels at the time of hospital admission for COVID-19 are associated with poor short and long-term prognosis. High NT-proBNP seems also to be related to worse prognosis in survivors of the acute phase of COVID-19. A closer follow-up on these patients may be crucial.
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Affiliation(s)
- Diana Mojón-Álvarez
- Cardiology Department, Hospital del Mar, Passeig Marítim de la Barceloneta 25-29, Barcelona, 08003, Spain
- Medicine Department, Autonomous University of Barcelona, Bellaterra, Barcelona, 08193, Spain
| | - Teresa Giralt
- Cardiology Department, Hospital del Mar, Passeig Marítim de la Barceloneta 25-29, Barcelona, 08003, Spain
- Medicine Department, Pompeu Fabra University, Barcelona, 08005, Spain
| | - José Carreras-Mora
- Cardiology Department, Hospital del Mar, Passeig Marítim de la Barceloneta 25-29, Barcelona, 08003, Spain
- Medicine Department, Pompeu Fabra University, Barcelona, 08005, Spain
| | - Alicia Calvo-Fernández
- Cardiology Department, Hospital del Mar, Passeig Marítim de la Barceloneta 25-29, Barcelona, 08003, Spain
- Medicine Department, Autonomous University of Barcelona, Bellaterra, Barcelona, 08193, Spain
- Medicine Department, Pompeu Fabra University, Barcelona, 08005, Spain
| | - Andrea Izquierdo
- Medicine Department, Autonomous University of Barcelona, Bellaterra, Barcelona, 08193, Spain
| | - Cristina Soler
- Cardiology Department, Hospital del Mar, Passeig Marítim de la Barceloneta 25-29, Barcelona, 08003, Spain
| | - Paula Cabero
- Cardiology Department, Hospital del Mar, Passeig Marítim de la Barceloneta 25-29, Barcelona, 08003, Spain
| | - Silvia Pérez-Fernández
- Scientific Coordination Facility, Biocruces Bizkaia Health Research Institute, Barakaldo, 48903, Spain
| | - Beatriz Vaquerizo
- Cardiology Department, Hospital del Mar, Passeig Marítim de la Barceloneta 25-29, Barcelona, 08003, Spain
- Medicine Department, Autonomous University of Barcelona, Bellaterra, Barcelona, 08193, Spain
- Medicine Department, Pompeu Fabra University, Barcelona, 08005, Spain
- Heart Disease Biomedical Research Group (GREC), IMIM (Hospital del Mar Medical Research Institute), Barcelona, 08003, Spain
- CIBER of Cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III (ISCIII), Madrid, 28029, Spain
| | - Núria Ribas Barquet
- Cardiology Department, Hospital del Mar, Passeig Marítim de la Barceloneta 25-29, Barcelona, 08003, Spain.
- Medicine Department, Pompeu Fabra University, Barcelona, 08005, Spain.
- Heart Disease Biomedical Research Group (GREC), IMIM (Hospital del Mar Medical Research Institute), Barcelona, 08003, Spain.
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10
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Alsagaff MY, Wardhani LFK, Nugraha RA, Putra TS, Khrisna BPD, Al-Farabi MJ, Gunadi RI, Azmi Y, Budianto CP, Fagi RA, Luthfah N, Subagjo A, Oktaviono YH, Lefi A, Dharmadjati BB, Alkaff FF, Pikir BS. Quantification of hs-Troponin Levels and Global Longitudinal Strain among Critical COVID-19 Patients with Myocardial Involvement. J Clin Med 2024; 13:352. [PMID: 38256486 PMCID: PMC10816186 DOI: 10.3390/jcm13020352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 12/29/2023] [Accepted: 12/30/2023] [Indexed: 01/24/2024] Open
Abstract
Background. Myocardial involvement among critically ill patients with coronavirus disease 2019 (COVID-19) often has worse outcomes. An imbalance in the oxygen supply causes the excessive release of pro-inflammatory cytokines, which results in increased ventilation requirements and the risk of death in COVID-19 patients. Purpose. We evaluated the association between the hs-troponin I levels and global longitudinal strain (GLS) as evidence of myocardial involvement among critical COVID-19 patients. Methods. We conducted a prospective cohort study from 1 February to 31 July 2021 at RSUD Dr. Soetomo, Surabaya, as a COVID-19 referral center. Of the 65 critical COVID-19 patients included, 41 (63.1%) were men, with a median age (interquartile range) of 51.0 years (20.0-75.0). Subjects were recruited based on WHO criteria for severe COVID-19, and myocardial involvement in the form of myocarditis was assessed using CDC criteria. Subjects were examined using echocardiography to measure the GLS, and blood samples were taken to measure the hs-troponin. Subjects were then followed for their need for mechanical ventilation and in-hospital mortality. Results. Severe COVID-19 patients with cardiac injury were associated with an increased need for intubation (78.5%) and an increased incidence of myocarditis (50.8%). There was a relationship between the use of intubation and the risk of death in patients (66.7% vs. 33.3%, p-value < 0.001). Decreased GLS and increased hs-troponin were associated with increased myocarditis (p values < 0.001 and 0.004, respectively). Decreased GLS was associated with a higher need for mechanical ventilation (12.17 + 4.79 vs. 15.65 + 4.90, p-value = 0.02) and higher mortality (11.36 + 4.64 vs. 14.74 + 4.82; p-value = 0.005). Elevated hs-troponin was associated with a higher need for mechanical ventilation (25.33% vs. 3.56%, p-value = 0.002) and higher mortality (34.57% vs. 5.76%, p-value = 0.002). Conclusions. Critically ill COVID-19 patients with myocardial involvement and elevated cardiac troponin levels are associated with a higher need for mechanical ventilation and higher mortality.
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Affiliation(s)
- Mochamad Yusuf Alsagaff
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga—Dr. Soetomo General Hospital, Jalan Mayjend Prof. Dr. Moestopo 6-8, Surabaya 60286, Indonesia; (L.F.K.W.); (R.A.N.); (T.S.P.); (B.P.D.K.); (M.J.A.-F.); (R.I.G.); (Y.A.); (C.P.B.); (R.A.F.); (N.L.); (A.S.); (Y.H.O.); (A.L.); (B.B.D.); (B.S.P.)
| | - Louisa Fadjri Kusuma Wardhani
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga—Dr. Soetomo General Hospital, Jalan Mayjend Prof. Dr. Moestopo 6-8, Surabaya 60286, Indonesia; (L.F.K.W.); (R.A.N.); (T.S.P.); (B.P.D.K.); (M.J.A.-F.); (R.I.G.); (Y.A.); (C.P.B.); (R.A.F.); (N.L.); (A.S.); (Y.H.O.); (A.L.); (B.B.D.); (B.S.P.)
| | - Ricardo Adrian Nugraha
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga—Dr. Soetomo General Hospital, Jalan Mayjend Prof. Dr. Moestopo 6-8, Surabaya 60286, Indonesia; (L.F.K.W.); (R.A.N.); (T.S.P.); (B.P.D.K.); (M.J.A.-F.); (R.I.G.); (Y.A.); (C.P.B.); (R.A.F.); (N.L.); (A.S.); (Y.H.O.); (A.L.); (B.B.D.); (B.S.P.)
| | - Tony Santoso Putra
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga—Dr. Soetomo General Hospital, Jalan Mayjend Prof. Dr. Moestopo 6-8, Surabaya 60286, Indonesia; (L.F.K.W.); (R.A.N.); (T.S.P.); (B.P.D.K.); (M.J.A.-F.); (R.I.G.); (Y.A.); (C.P.B.); (R.A.F.); (N.L.); (A.S.); (Y.H.O.); (A.L.); (B.B.D.); (B.S.P.)
| | - Bagus Putra Dharma Khrisna
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga—Dr. Soetomo General Hospital, Jalan Mayjend Prof. Dr. Moestopo 6-8, Surabaya 60286, Indonesia; (L.F.K.W.); (R.A.N.); (T.S.P.); (B.P.D.K.); (M.J.A.-F.); (R.I.G.); (Y.A.); (C.P.B.); (R.A.F.); (N.L.); (A.S.); (Y.H.O.); (A.L.); (B.B.D.); (B.S.P.)
| | - Makhyan Jibril Al-Farabi
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga—Dr. Soetomo General Hospital, Jalan Mayjend Prof. Dr. Moestopo 6-8, Surabaya 60286, Indonesia; (L.F.K.W.); (R.A.N.); (T.S.P.); (B.P.D.K.); (M.J.A.-F.); (R.I.G.); (Y.A.); (C.P.B.); (R.A.F.); (N.L.); (A.S.); (Y.H.O.); (A.L.); (B.B.D.); (B.S.P.)
| | - Ruth Irena Gunadi
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga—Dr. Soetomo General Hospital, Jalan Mayjend Prof. Dr. Moestopo 6-8, Surabaya 60286, Indonesia; (L.F.K.W.); (R.A.N.); (T.S.P.); (B.P.D.K.); (M.J.A.-F.); (R.I.G.); (Y.A.); (C.P.B.); (R.A.F.); (N.L.); (A.S.); (Y.H.O.); (A.L.); (B.B.D.); (B.S.P.)
| | - Yusuf Azmi
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga—Dr. Soetomo General Hospital, Jalan Mayjend Prof. Dr. Moestopo 6-8, Surabaya 60286, Indonesia; (L.F.K.W.); (R.A.N.); (T.S.P.); (B.P.D.K.); (M.J.A.-F.); (R.I.G.); (Y.A.); (C.P.B.); (R.A.F.); (N.L.); (A.S.); (Y.H.O.); (A.L.); (B.B.D.); (B.S.P.)
| | - Christian Pramudita Budianto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga—Dr. Soetomo General Hospital, Jalan Mayjend Prof. Dr. Moestopo 6-8, Surabaya 60286, Indonesia; (L.F.K.W.); (R.A.N.); (T.S.P.); (B.P.D.K.); (M.J.A.-F.); (R.I.G.); (Y.A.); (C.P.B.); (R.A.F.); (N.L.); (A.S.); (Y.H.O.); (A.L.); (B.B.D.); (B.S.P.)
| | - Rosi Amrilla Fagi
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga—Dr. Soetomo General Hospital, Jalan Mayjend Prof. Dr. Moestopo 6-8, Surabaya 60286, Indonesia; (L.F.K.W.); (R.A.N.); (T.S.P.); (B.P.D.K.); (M.J.A.-F.); (R.I.G.); (Y.A.); (C.P.B.); (R.A.F.); (N.L.); (A.S.); (Y.H.O.); (A.L.); (B.B.D.); (B.S.P.)
| | - Nadya Luthfah
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga—Dr. Soetomo General Hospital, Jalan Mayjend Prof. Dr. Moestopo 6-8, Surabaya 60286, Indonesia; (L.F.K.W.); (R.A.N.); (T.S.P.); (B.P.D.K.); (M.J.A.-F.); (R.I.G.); (Y.A.); (C.P.B.); (R.A.F.); (N.L.); (A.S.); (Y.H.O.); (A.L.); (B.B.D.); (B.S.P.)
| | - Agus Subagjo
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga—Dr. Soetomo General Hospital, Jalan Mayjend Prof. Dr. Moestopo 6-8, Surabaya 60286, Indonesia; (L.F.K.W.); (R.A.N.); (T.S.P.); (B.P.D.K.); (M.J.A.-F.); (R.I.G.); (Y.A.); (C.P.B.); (R.A.F.); (N.L.); (A.S.); (Y.H.O.); (A.L.); (B.B.D.); (B.S.P.)
| | - Yudi Her Oktaviono
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga—Dr. Soetomo General Hospital, Jalan Mayjend Prof. Dr. Moestopo 6-8, Surabaya 60286, Indonesia; (L.F.K.W.); (R.A.N.); (T.S.P.); (B.P.D.K.); (M.J.A.-F.); (R.I.G.); (Y.A.); (C.P.B.); (R.A.F.); (N.L.); (A.S.); (Y.H.O.); (A.L.); (B.B.D.); (B.S.P.)
| | - Achmad Lefi
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga—Dr. Soetomo General Hospital, Jalan Mayjend Prof. Dr. Moestopo 6-8, Surabaya 60286, Indonesia; (L.F.K.W.); (R.A.N.); (T.S.P.); (B.P.D.K.); (M.J.A.-F.); (R.I.G.); (Y.A.); (C.P.B.); (R.A.F.); (N.L.); (A.S.); (Y.H.O.); (A.L.); (B.B.D.); (B.S.P.)
| | - Budi Baktijasa Dharmadjati
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga—Dr. Soetomo General Hospital, Jalan Mayjend Prof. Dr. Moestopo 6-8, Surabaya 60286, Indonesia; (L.F.K.W.); (R.A.N.); (T.S.P.); (B.P.D.K.); (M.J.A.-F.); (R.I.G.); (Y.A.); (C.P.B.); (R.A.F.); (N.L.); (A.S.); (Y.H.O.); (A.L.); (B.B.D.); (B.S.P.)
| | | | - Budi Susetyo Pikir
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga—Dr. Soetomo General Hospital, Jalan Mayjend Prof. Dr. Moestopo 6-8, Surabaya 60286, Indonesia; (L.F.K.W.); (R.A.N.); (T.S.P.); (B.P.D.K.); (M.J.A.-F.); (R.I.G.); (Y.A.); (C.P.B.); (R.A.F.); (N.L.); (A.S.); (Y.H.O.); (A.L.); (B.B.D.); (B.S.P.)
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11
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Eftekhar Z, Haybar H, Mohebbi A, Saki N. Cardiac Complications and COVID-19: A Review of Life-threatening Co-morbidities. Curr Cardiol Rev 2024; 20:1-12. [PMID: 38415433 PMCID: PMC11284692 DOI: 10.2174/011573403x279782240206091322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/23/2023] [Accepted: 01/19/2024] [Indexed: 02/29/2024] Open
Abstract
The novel 2019 coronavirus disease (COVID-19) was first reported in the last days of December 2019 in Wuhan, China. The presence of certain co-morbidities, including cardiovascular diseases (CVDs), are the basis for worse outcomes in patients with COVID-19. Relevant English-language literature was searched and retrieved from the Google Scholar search engine and PubMed database up to 2023 using COVID-19, SARS-CoV-2, Heart failure, Myocardial infarction, and Arrhythmia and Cardiac complication as keywords. Increased hemodynamic load, ischemia-related dysfunction, ventricular remodeling, excessive neurohumoral stimulation, abnormal myocyte calcium cycling, and excessive or insufficient extracellular matrix proliferation are associated with heart failure (HF) in COVID-19 patients. Inflammatory reaction due to the excessive release of inflammatory cytokines, leads to myocardial infarction (MI) in these patients. The virus can induce heart arrhythmia through cardiac complications, hypoxia, decreased heart hemodynamics, and remarkable inflammatory markers. Moreover, studies have linked cardiac complications in COVID-19 with poor outcomes, extended hospitalization time, and increased mortality rate. Patients with COVID-19 and CVDs are at higher mortality risk and they should be given high priority when receiving the treatment and intensive care during hospitalization.
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Affiliation(s)
- Zeinab Eftekhar
- Thalassemia & Hemoglobinopathy Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Habib Haybar
- Atherosclerosis Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Alireza Mohebbi
- Department of Hematology and Blood Banking, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Najmaldin Saki
- Thalassemia & Hemoglobinopathy Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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12
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Marta CI, Craina M, Nitu R, Maghiari AL, Abu-Awwad SA, Boscu L, Diaconu M, Dumitru C, Dahma G, Yasar II, Babes K. A Comparative Analysis of NT-proBNP Levels in Pregnant Women and the Impact of SARS-CoV-2 Infection: Influence on Birth Outcome. Diseases 2023; 12:10. [PMID: 38248361 PMCID: PMC10814387 DOI: 10.3390/diseases12010010] [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: 11/29/2023] [Revised: 12/26/2023] [Accepted: 12/29/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND The cardiac biomarker NT-proBNP is released by the ventricles in response to increased cardiac wall tension, showing cardiac activity in heart failure. The primary objective of this comparative study was to analyze the variations of NT-proBNP levels among pregnant patients and to determine the potential influence of SARS-CoV-2 infection on these values. Secondly, the study focused on NT-proBNP levels and their influence on the type of birth. METHODS Blood samples were taken from 160 pregnant mothers in order to determine, through the solid-phase enzyme-linked immunosorbent assay (ELISA) method, the NT-proBNP concentrations from the plasma. The cohort was separated into two distinct groups based on SARS-CoV-2 diagnostic results: negative to the infection, and positive to the infection. RESULTS The SARS-CoV-2-positive group of patients presented with higher levels of NT-proBNP and had higher rates of cesarean sections. (4) Conclusions: Our research highlights the crucial relationship between elevated NT-proBNP values and the mode of giving birth, natural delivery or cesarean section, and also the influence of SARS-CoV-2 viral infection and this biomarker.
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Affiliation(s)
- Carmen-Ioana Marta
- Doctoral School, Faculty of Medicine and Pharmacy of Oradea, University of Oradea, 410087 Oradea, Romania;
- Clinic of Obstetrics and Gynecology, “Pius Brinzeu” County Clinical Emergency Hospital, 300723 Timisoara, Romania; (M.C.); (M.D.); (C.D.); (G.D.)
- Department of Obstetrics and Gynecology, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Marius Craina
- Clinic of Obstetrics and Gynecology, “Pius Brinzeu” County Clinical Emergency Hospital, 300723 Timisoara, Romania; (M.C.); (M.D.); (C.D.); (G.D.)
- Department of Obstetrics and Gynecology, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Razvan Nitu
- Clinic of Obstetrics and Gynecology, “Pius Brinzeu” County Clinical Emergency Hospital, 300723 Timisoara, Romania; (M.C.); (M.D.); (C.D.); (G.D.)
- Department of Obstetrics and Gynecology, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Anca Laura Maghiari
- Department I—Discipline of Anatomy and Embryology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Simona-Alina Abu-Awwad
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (S.-A.A.-A.); (L.B.); (I.-I.Y.)
| | - Lioara Boscu
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (S.-A.A.-A.); (L.B.); (I.-I.Y.)
| | - Mircea Diaconu
- Clinic of Obstetrics and Gynecology, “Pius Brinzeu” County Clinical Emergency Hospital, 300723 Timisoara, Romania; (M.C.); (M.D.); (C.D.); (G.D.)
- Department of Obstetrics and Gynecology, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Catalin Dumitru
- Clinic of Obstetrics and Gynecology, “Pius Brinzeu” County Clinical Emergency Hospital, 300723 Timisoara, Romania; (M.C.); (M.D.); (C.D.); (G.D.)
- Department of Obstetrics and Gynecology, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - George Dahma
- Clinic of Obstetrics and Gynecology, “Pius Brinzeu” County Clinical Emergency Hospital, 300723 Timisoara, Romania; (M.C.); (M.D.); (C.D.); (G.D.)
- Department of Obstetrics and Gynecology, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (S.-A.A.-A.); (L.B.); (I.-I.Y.)
| | - Ionela-Iasmina Yasar
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (S.-A.A.-A.); (L.B.); (I.-I.Y.)
- Department IX: Surgery I, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Katalin Babes
- Faculty of Medicine and Pharmacy of Oradea, University of Oradea, 410087 Oradea, Romania;
- Clinical County Emergency Hospital of Oradea, 410167 Oradea, Romania
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Rosca EC, Cornea A, Simu M. Emerging Trends in Complications Associated with SARS-CoV-2 Infection. Biomedicines 2023; 12:4. [PMID: 38275366 PMCID: PMC10813045 DOI: 10.3390/biomedicines12010004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 12/14/2023] [Indexed: 01/27/2024] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has presented a remarkable challenge to global health, sparking a surge in research aimed at understanding the multifaceted impacts of the virus [...].
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Affiliation(s)
- Elena Cecilia Rosca
- Department of Neurology, Victor Babes University of Medicine and Pharmacy Timisoara, Eftimie Murgu Sq. no. 2, 300041 Timisoara, Romania; (A.C.); (M.S.)
- Department of Neurology, Clinical Emergency County Hospital Timisoara, Bd. Iosif Bulbuca no. 10, 300736 Timisoara, Romania
| | - Amalia Cornea
- Department of Neurology, Victor Babes University of Medicine and Pharmacy Timisoara, Eftimie Murgu Sq. no. 2, 300041 Timisoara, Romania; (A.C.); (M.S.)
- Department of Neurology, Clinical Emergency County Hospital Timisoara, Bd. Iosif Bulbuca no. 10, 300736 Timisoara, Romania
| | - Mihaela Simu
- Department of Neurology, Victor Babes University of Medicine and Pharmacy Timisoara, Eftimie Murgu Sq. no. 2, 300041 Timisoara, Romania; (A.C.); (M.S.)
- Department of Neurology, Clinical Emergency County Hospital Timisoara, Bd. Iosif Bulbuca no. 10, 300736 Timisoara, Romania
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Mazandarani M, Sharififar R, Lashkarbolouk N, Ghorbani S. Evaluation of cardiac diagnostic tests findings based on pro-BNP levels in COVID-19 pregnant patients. BMC Infect Dis 2023; 23:790. [PMID: 37957564 PMCID: PMC10644487 DOI: 10.1186/s12879-023-08764-1] [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: 06/10/2023] [Accepted: 10/28/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Pro-b-type natriuretic peptide (Pro-BNP) is an inflammatory marker that indicates cardiac damage and inflammation. The elevation of this marker in COVID-19 patients can be used as a predictive factor in the prognosis of these patients. METHOD Our cross-sectional study investigated the evaluation of cardiac diagnostic test findings based on pro-BNP levels in pregnant COVID-19 patients in Sayyad Shirazi Hospital, Gorgan, Iran, in 2020-2022. A hundred and ten pregnant patients diagnosed with COVID-19 infection were evaluated for cardiac diagnostic tests (electrocardiogram (ECG) and echocardiography (Echo)) and pro-BNP levels. Data were analyzed using SPSS 25 software. Chi-square and Student's t-test will be used to test and compare the relationship between variables and compare them. A P-value less than 0.05 is considered statistically significant. The chi-square test was used to compare the ratio of qualitative variables among the groups if the presuppositions of chi-square distribution were established. Otherwise, Fisher's exact test was used. RESULT The mean age of participants were 31.06 ± 5.533 years and 49.1% of patients had pro-BNP levels above the cut-off value for predicting an adverse outcome of COVID-19. The mean ± standard deviation of pro-BNP levels in the low group was 46.125 ± 17.523 pg/mL and in the high group was 878.814 ± 1038.060 pg/mL. This study revealed that patients with higher pro-BNP plasma levels had a significant relation between, myocardial infarction (MI), pericardial effusion (PE), urgent Caesarean section (C/S), and mortality. In addition, no significant relation between gravid, trimester, vaccination, arrhythmia, heart block, and valves diseases with high pro-BNP levels was found. CONCLUSION The current research showed that pro-BNP levels can be used as a diagnostic and valuable prognostic tool in pregnant women to diagnose cardiac complications by using ECG and Echo.
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Affiliation(s)
- Mahdi Mazandarani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Golestan University of Medical Sciences, Gorgan, Iran
| | - Rahmat Sharififar
- Infectious Diseases Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Narges Lashkarbolouk
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
- Golestan University of Medical Sciences, Gorgan, Iran.
| | - Somayeh Ghorbani
- Assistant Professor of Biostatistics, Golestan University of Medical Sciences, Gorgan, Iran
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Zhao Y, Gao G, Li W, Xu Z, Wang X, Chang R. Inflammatory predictors (eosinophil, C-RP and IL-6) and effectiveness of oral Azvudine tablets treatment in COVID-19 hospitalized patients: A retrospective, self-controlled study. Heliyon 2023; 9:e21941. [PMID: 38034620 PMCID: PMC10682612 DOI: 10.1016/j.heliyon.2023.e21941] [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: 06/16/2023] [Revised: 10/31/2023] [Accepted: 10/31/2023] [Indexed: 12/02/2023] Open
Abstract
Background Although vaccinations and antiviral drugs are widely used in the clinical treatment worldwide, there is little investigation on the clinical outcomes and effectiveness of oral Azvudine tablets (FNC) treatment in COVID-19 hospitalized patients. The previous data showed Azvudine treatment was closely related to reduced virus shedding time, but the potential role of Azvudine on inflammatory response is scarce. Thus, this study is to investigate inflammatory predictors and effectiveness of oral Azvudine tablets treatment in COVID-19 hospitalized patients. Methods A total of 600 out of hospitalized patients were retrospectively collected over a 2-month period, of whom 60 out of hospitalized patients infected SARS-CoV-2. 32 of hospitalized patients who received Azvudine tablets were collected and the rest did not. Oral Azvudine tablets treatment: 5 mg/day for 7-14 days. We analyzed the routine blood tests, blood coagulation test, NT-proBNP, Troponin (cTNl), Creatine kinase MB (CK-MB) after oral Azvudine tablets treatment compared with that in before oral Azvudine tablets treatment. Also, we compared the CT chest and length of Stay after Azvudine treatment. Results We found that the number and percentage of eosinophil increased significantly, but the levels of C-reactive protein (C-RP) and IL-6 reduced remarkably after Azvudine treatment. In blood coagulation tests, the results showed that activated partial thromboplastin time (APTT) (mean ± SEM: 2.950 ± 2.268s) and fibrinogen (mean ± SEM: 0.8910 ± 0.5134g/L) downregulated slightly, while there was similar in the level of D-Dimer (mean ± SEM: 0.1660 ± 0.3108 μg/mL) before and after Azvudine treatment. The expression of NT-proBNP reduced in Azvudine treatment (mean ± SEM: 897.1 ± 557.1pg/mL). Chest computed tomography (CT) scan reports also demonstrated that Azvudine treatment improved lung symptoms in COVID-19 hospitalized patients. Moreover, there is no difference in the average of length of stay in Azvudine treatment (the average of LOS days: 9.0) and no treatment (the average of LOS days: 9.0). Conclusion Oral Azvudine tablets treatment was associated with decreased inflammatory response and improved blood coagulation function, which should be substantial clinical benefits in COVID-19 hospitalized patients.
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Affiliation(s)
- Yanli Zhao
- Department of Cardiovascular Medicine, Shenzhen Longhua District Central Hospital, Shenzhen, 518110, China
- Department of Medical Laboratory, Shenzhen Longhua District Central Hospital, Shenzhen, 518110, China
| | - Gan Gao
- Department of Cardiovascular Medicine, Shenzhen Longhua District Central Hospital, Shenzhen, 518110, China
| | - Wenhui Li
- Department of Cardiovascular Medicine, Shenzhen Longhua District Central Hospital, Shenzhen, 518110, China
| | - Zuqing Xu
- Department of Cardiovascular Medicine, Shenzhen Longhua District Central Hospital, Shenzhen, 518110, China
| | - Xiao Wang
- Department of Cardiovascular Medicine, Shenzhen Longhua District Central Hospital, Shenzhen, 518110, China
| | - Rong Chang
- Department of Cardiovascular Medicine, Shenzhen Longhua District Central Hospital, Shenzhen, 518110, China
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16
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Stavileci B. The differences in troponin values among gender in COVID-19 patients. Medicine (Baltimore) 2023; 102:e35553. [PMID: 37904399 PMCID: PMC10615494 DOI: 10.1097/md.0000000000035553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 09/18/2023] [Indexed: 11/01/2023] Open
Abstract
The aim of this study is to investigate the differences on admission troponin values among gender in hospital outcomes and in the 2-year follow-up period in coronavirus disease (COVID-19) patients. Data of 826 patients with moderate-to-severe COVID-19 disease were analyzed retrospectively. All patients had nasal and oropharyngeal swab samples taken according to Ministry of Health guidelines on admission. Patients were divided into female (n = 438) and male (n = 388) groups and were follow-up for 2 years. Clinical events such as need for intensive care unit, respiratory failure, need for inotropic initiation, acute renal failure, cardiac injury, and in-hospital mortality were also recorded. The cumulative endpoints were determined as all-cause mortality, re-hospitalization, and stroke during the 2-year follow-up period. Also, factors affecting the cumulative endpoints were investigated. In clinical events and cumulative endpoints, the differences of troponin values between the gender were investigated and the factors causing cardiac injury were determined separately in men and women. Mean age (59.43 ± 19.15 vs 58.14 ± 16.66) and comorbidities were significantly higher in the female group. There were no differences between genders in terms of clinical events except respiratory failure, which was more frequent in the male group (P = .016). In-hospital survivor rate in the female group was 16 ± 2.5 days (95% confidence interval: 11.08-20.91), in the male group was 14 ± 0.92 days (95% confidence interval: 12.18-15.81) P = .008, while there were no differences between groups among in-hospital morality rates (P = .208). During the 2-year follow-up period cumulative endpoints were more in the male group (P < .05). Troponin value in female ≥ 93 pg/mL, in male ≥ 28 pg/mL was related with cardiac injury. All clinical events occur at lower troponin values in the male group. In both groups, independent risk factors for in-hospital mortality were troponin and the existence of fragmented QRS; for cumulative endpoints were respiratory failure, cardiac injury, and age. We observed that in COVID-19 disease, troponin value differs by gender. A lesser increase in troponin levels in men was indicative of cardiac injury. Even slight increases in troponin levels in men should alert clinicians for cardiac injury and other clinical events.
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Affiliation(s)
- Berna Stavileci
- Faculty of Medicine, Department of Cardiology, Biruni University, İstanbul, Turkey
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Paciorek M, Bieńkowski C, Kowalska JD, Skrzat-Klapaczyńska A, Bednarska A, Krogulec D, Cholewińska G, Kowalski J, Podlasin R, Ropelewska-Łącka K, Wasilewski P, Boros PW, Martusiewicz-Boros MM, Pulik P, Pihowicz A, Horban A. Hospital Admission Factors Independently Affecting the Risk of Mortality of COVID-19 Patients. J Clin Med 2023; 12:6264. [PMID: 37834907 PMCID: PMC10573469 DOI: 10.3390/jcm12196264] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/18/2023] [Accepted: 09/24/2023] [Indexed: 10/15/2023] Open
Abstract
INTRODUCTION COVID-19 is a disease characterized by high in-hospital mortality, which seems to be dependent on many predisposing factors. OBJECTIVES The aim of this study was to analyze the clinical symptoms, abnormalities in the results of laboratory tests, and coexisting chronic diseases that independently affected the risk of in-hospital mortality in patients with COVID-19. PATIENTS AND METHODS We analyzed the records of patients with COVID-19 who were hospitalized from 6 March 2020 to 30 November 2021. RESULTS Out of the entire group of 2138 patients who were analyzed, 12.82% died during hospitalization. In-hospital mortality was independently associated with older age (OR 1.53, 95% CI 1.20-1.97); lower arterial blood oxygen saturation (OR 0.95, 95% CI 0.92-0.99); the presence of a neoplasm (OR 4.45, 95% CI 2.01-9.62), a stomach ulcer (OR 3.35, 95% CI 0.94-11.31), and dementia (OR 3.40, 95% CI 1.36-8.26); a higher score on the SOFA scale (OR 1.73, 95% CI 1.52-1.99); higher lactate dehydrogenase (LDH) (OR 1.08, 95% CI 1.05-1.12); higher N-terminal pro-brain natriuretic peptide (NT pro BNP) (OR 1.06, 95% CI 1.01-1.11); and lower total bilirubin in blood concentration (OR 0.94, 95% CI 0.90-0.99). CONCLUSIONS We found that low oxygen saturation, old age, and the coexistence of cancer, gastric ulcers, and dementia syndrome were variables that independently increased mortality during hospitalization due to COVID-19. Moreover, we found that decreased platelet count and bilirubin concentration and increased levels of LDH and NT-proBNP were laboratory test results that independently indicated a higher risk of mortality. We also confirmed the usefulness of the SOFA scale in predicting treatment results. The ability to identify mortality risk factors on admission to hospital will facilitate both adjusting the intensity of treatment and the monitoring of patients infected with SARS-CoV-2.
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Affiliation(s)
- Marcin Paciorek
- Department of Adults’ Infectious Diseases, Medical University of Warsaw, 02-001 Warsaw, Poland; (M.P.); (J.D.K.); (A.S.-K.); (A.B.); (D.K.); (A.H.)
- Hospital for Infectious Diseases in Warsaw, 01-201 Warsaw, Poland; (G.C.); (J.K.); (R.P.); (K.R.-Ł.); (P.W.); (P.P.); (A.P.)
| | - Carlo Bieńkowski
- Department of Adults’ Infectious Diseases, Medical University of Warsaw, 02-001 Warsaw, Poland; (M.P.); (J.D.K.); (A.S.-K.); (A.B.); (D.K.); (A.H.)
- Hospital for Infectious Diseases in Warsaw, 01-201 Warsaw, Poland; (G.C.); (J.K.); (R.P.); (K.R.-Ł.); (P.W.); (P.P.); (A.P.)
| | - Justyna Dominika Kowalska
- Department of Adults’ Infectious Diseases, Medical University of Warsaw, 02-001 Warsaw, Poland; (M.P.); (J.D.K.); (A.S.-K.); (A.B.); (D.K.); (A.H.)
- Hospital for Infectious Diseases in Warsaw, 01-201 Warsaw, Poland; (G.C.); (J.K.); (R.P.); (K.R.-Ł.); (P.W.); (P.P.); (A.P.)
| | - Agata Skrzat-Klapaczyńska
- Department of Adults’ Infectious Diseases, Medical University of Warsaw, 02-001 Warsaw, Poland; (M.P.); (J.D.K.); (A.S.-K.); (A.B.); (D.K.); (A.H.)
- Hospital for Infectious Diseases in Warsaw, 01-201 Warsaw, Poland; (G.C.); (J.K.); (R.P.); (K.R.-Ł.); (P.W.); (P.P.); (A.P.)
| | - Agnieszka Bednarska
- Department of Adults’ Infectious Diseases, Medical University of Warsaw, 02-001 Warsaw, Poland; (M.P.); (J.D.K.); (A.S.-K.); (A.B.); (D.K.); (A.H.)
- Hospital for Infectious Diseases in Warsaw, 01-201 Warsaw, Poland; (G.C.); (J.K.); (R.P.); (K.R.-Ł.); (P.W.); (P.P.); (A.P.)
| | - Dominika Krogulec
- Department of Adults’ Infectious Diseases, Medical University of Warsaw, 02-001 Warsaw, Poland; (M.P.); (J.D.K.); (A.S.-K.); (A.B.); (D.K.); (A.H.)
- Hospital for Infectious Diseases in Warsaw, 01-201 Warsaw, Poland; (G.C.); (J.K.); (R.P.); (K.R.-Ł.); (P.W.); (P.P.); (A.P.)
| | - Grażyna Cholewińska
- Hospital for Infectious Diseases in Warsaw, 01-201 Warsaw, Poland; (G.C.); (J.K.); (R.P.); (K.R.-Ł.); (P.W.); (P.P.); (A.P.)
- Department of Infectious Diseases, Collegium Medicum, Cardinal Stefan Wyszynski University in Warsaw, 01-815 Warsaw, Poland
| | - Jacek Kowalski
- Hospital for Infectious Diseases in Warsaw, 01-201 Warsaw, Poland; (G.C.); (J.K.); (R.P.); (K.R.-Ł.); (P.W.); (P.P.); (A.P.)
- Department of Infectious Diseases, Collegium Medicum, Cardinal Stefan Wyszynski University in Warsaw, 01-815 Warsaw, Poland
| | - Regina Podlasin
- Hospital for Infectious Diseases in Warsaw, 01-201 Warsaw, Poland; (G.C.); (J.K.); (R.P.); (K.R.-Ł.); (P.W.); (P.P.); (A.P.)
- Department of Infectious Diseases, Collegium Medicum, Cardinal Stefan Wyszynski University in Warsaw, 01-815 Warsaw, Poland
| | - Katarzyna Ropelewska-Łącka
- Hospital for Infectious Diseases in Warsaw, 01-201 Warsaw, Poland; (G.C.); (J.K.); (R.P.); (K.R.-Ł.); (P.W.); (P.P.); (A.P.)
- Department of Infectious Diseases, Collegium Medicum, Cardinal Stefan Wyszynski University in Warsaw, 01-815 Warsaw, Poland
| | - Piotr Wasilewski
- Hospital for Infectious Diseases in Warsaw, 01-201 Warsaw, Poland; (G.C.); (J.K.); (R.P.); (K.R.-Ł.); (P.W.); (P.P.); (A.P.)
- Department of Infectious Diseases, Collegium Medicum, Cardinal Stefan Wyszynski University in Warsaw, 01-815 Warsaw, Poland
| | - Piotr W. Boros
- Lung Pathophysiology Department, National TB & Lung Diseases Research Institute, 01-138 Warsaw, Poland;
| | | | - Piotr Pulik
- Hospital for Infectious Diseases in Warsaw, 01-201 Warsaw, Poland; (G.C.); (J.K.); (R.P.); (K.R.-Ł.); (P.W.); (P.P.); (A.P.)
| | - Andrzej Pihowicz
- Hospital for Infectious Diseases in Warsaw, 01-201 Warsaw, Poland; (G.C.); (J.K.); (R.P.); (K.R.-Ł.); (P.W.); (P.P.); (A.P.)
| | - Andrzej Horban
- Department of Adults’ Infectious Diseases, Medical University of Warsaw, 02-001 Warsaw, Poland; (M.P.); (J.D.K.); (A.S.-K.); (A.B.); (D.K.); (A.H.)
- Hospital for Infectious Diseases in Warsaw, 01-201 Warsaw, Poland; (G.C.); (J.K.); (R.P.); (K.R.-Ł.); (P.W.); (P.P.); (A.P.)
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Mwangi VI, Netto RLA, de Morais CEP, Silva AS, Silva BM, Lima AB, Neves JCF, Borba MGS, Val FFDAE, de Almeida ACG, Costa AG, Sampaio VDS, Gardinassi LG, de Lacerda MVG, Monteiro WM, de Melo GC. Temporal patterns of cytokine and injury biomarkers in hospitalized COVID-19 patients treated with methylprednisolone. Front Immunol 2023; 14:1229611. [PMID: 37662953 PMCID: PMC10468998 DOI: 10.3389/fimmu.2023.1229611] [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: 05/26/2023] [Accepted: 07/26/2023] [Indexed: 09/05/2023] Open
Abstract
Background The novel coronavirus disease 2019 (COVID-19) presents with complex pathophysiological effects in various organ systems. Following the COVID-19, there are shifts in biomarker and cytokine equilibrium associated with altered physiological processes arising from viral damage or aggressive immunological response. We hypothesized that high daily dose methylprednisolone improved the injury biomarkers and serum cytokine profiles in COVID-19 patients. Methods Injury biomarker and cytokine analysis was performed on 50 SARS-Cov-2 negative controls and 101 hospitalized severe COVID-19 patients: 49 methylprednisolone-treated (MP group) and 52 placebo-treated serum samples. Samples from the treated groups collected on days D1 (pre-treatment) all the groups, D7 (2 days after ending therapy) and D14 were analyzed. Luminex assay quantified the biomarkers HMGB1, FABP3, myoglobin, troponin I and NTproBNP. Immune mediators (CXCL8, CCL2, CXCL9, CXCL10, TNF, IFN-γ, IL-17A, IL-12p70, IL-10, IL-6, IL-4, IL-2, and IL-1β) were quantified using cytometric bead array. Results At pretreatment, the two treatment groups were comparable demographically. At pre-treatment (D1), injury biomarkers (HMGB1, TnI, myoglobin and FABP3) were distinctly elevated. At D7, HMGB1 was significantly higher in the MP group (p=0.0448) compared to the placebo group, while HMGB1 in the placebo group diminished significantly by D14 (p=0.0115). Compared to healthy control samples, several immune mediators (IL-17A, IL-6, IL-10, MIG, MCP-1, and IP-10) were considerably elevated at baseline (all p≤0.05). At D7, MIG and IP-10 of the MP-group were significantly lower than in the placebo-group (p=0.0431, p=0.0069, respectively). Longitudinally, IL-2 (MP-group) and IL-17A (placebo-group) had increased significantly by D14. In placebo group, IL-2 and IL-17A continuously increased, as IL-12p70, IL-10 and IP-10 steadily decreased during follow-up. The MP treated group had IL-2, IFN-γ, IL-17A and IL-12p70 progressively increase while IL-1β and IL-10 gradually decreased towards D14. Moderate to strong positive correlations between chemokines and cytokines were observed on D7 and D14. Conclusion These findings suggest MP treatment could ameliorate levels of myoglobin and FABP3, but appeared to have no impact on HMGB1, TnI and NTproBNP. In addition, methylprednisolone relieves the COVID-19 induced inflammatory response by diminishing MIG and IP-10 levels. Overall, corticosteroid (methylprednisolone) use in COVID-19 management influences the immunological molecule and injury biomarker profile in COVID-19 patients.
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Affiliation(s)
- Victor Irungu Mwangi
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil
| | | | - Carlos Eduardo Padron de Morais
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil
- Fundação de Medicina Tropical Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
| | - Arineia Soares Silva
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil
| | - Bernardo Maia Silva
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil
- Fundação de Medicina Tropical Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
| | - Amanda Barros Lima
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Instituto de Ciências Biológicas, Universidade Federal do Amazonas (UFAM), Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus, Brazil
| | | | - Mayla Gabriela Silva Borba
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil
- Fundação de Medicina Tropical Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
| | - Fernando Fonseca de Almeida e Val
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil
- Fundação de Medicina Tropical Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
| | - Anne Cristine Gomes de Almeida
- Fundação de Medicina Tropical Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás (UFG), Goiânia, Brazil
| | - Allyson Guimarães Costa
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil
- Fundação de Medicina Tropical Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Instituto de Ciências Biológicas, Universidade Federal do Amazonas (UFAM), Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus, Brazil
- Escola de Enfermagem de Manaus, Universidade Federal do Amazonas (UFAM), Manaus, Brazil
- Programa de Pós-Graduação em Ciências Aplicadas à Hematologia, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM) Universidade do Estado do Amazonas (UEA), Manaus, Brazil
| | - Vanderson de Souza Sampaio
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil
- Fundação de Medicina Tropical Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
- Instituto Todos pela Saúde, São Paulo, São Paulo, Brazil
| | - Luiz Gustavo Gardinassi
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás (UFG), Goiânia, Brazil
| | - Marcus Vinicius Guimarães de Lacerda
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil
- Fundação de Medicina Tropical Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
- Instituto Leônidas & Maria Deane/Fundação Oswaldo Cruz (ILMD/Fiocruz Amazônia), Manaus, Brazil
| | - Wuelton Marcelo Monteiro
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil
- Fundação de Medicina Tropical Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
| | - Gisely Cardoso de Melo
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil
- Fundação de Medicina Tropical Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
- Programa de Pós-Graduação em Ciências Aplicadas à Hematologia, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM) Universidade do Estado do Amazonas (UEA), Manaus, Brazil
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19
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Wu H, Ruan W, Wang J, Zheng D, Liu B, Geng Y, Chai X, Chen J, Li K, Li S, Helal S. Interpretable Machine Learning for COVID-19: An Empirical Study on Severity Prediction Task. IEEE TRANSACTIONS ON ARTIFICIAL INTELLIGENCE 2023; 4:764-777. [PMID: 37954545 PMCID: PMC10620962 DOI: 10.1109/tai.2021.3092698] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 02/07/2021] [Accepted: 06/08/2021] [Indexed: 11/14/2023]
Abstract
The black-box nature of machine learning models hinders the deployment of some high-accuracy medical diagnosis algorithms. It is risky to put one's life in the hands of models that medical researchers do not fully understand or trust. However, through model interpretation, black-box models can promptly reveal significant biomarkers that medical practitioners may have overlooked due to the surge of infected patients in the COVID-19 pandemic. This research leverages a database of 92 patients with confirmed SARS-CoV-2 laboratory tests between 18th January 2020 and 5th March 2020, in Zhuhai, China, to identify biomarkers indicative of infection severity prediction. Through the interpretation of four machine learning models, decision tree, random forests, gradient boosted trees, and neural networks using permutation feature importance, partial dependence plot, individual conditional expectation, accumulated local effects, local interpretable model-agnostic explanations, and Shapley additive explanation, we identify an increase in N-terminal pro-brain natriuretic peptide, C-reaction protein, and lactic dehydrogenase, a decrease in lymphocyte is associated with severe infection and an increased risk of death, which is consistent with recent medical research on COVID-19 and other research using dedicated models. We further validate our methods on a large open dataset with 5644 confirmed patients from the Hospital Israelita Albert Einstein, at São Paulo, Brazil from Kaggle, and unveil leukocytes, eosinophils, and platelets as three indicative biomarkers for COVID-19.
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Affiliation(s)
- Han Wu
- University of ExeterEX4 4PYExeterU.K.
| | | | | | | | - Bei Liu
- Department of Gastroenterology910 Hospital of PLABeijingChina
| | - Yayuan Geng
- Scientific Research Department BeijingHY Medical TechnologyBeijing100192China
| | - Xiangfei Chai
- Scientific Research Department BeijingHY Medical TechnologyBeijing100192China
| | - Jian Chen
- Department of RadiologyHospital of Sun Yat-sen UniversityZhuhai519000China
| | - Kunwei Li
- Department of RadiologyHospital of Sun Yat-sen UniversityZhuhai519000China
| | - Shaolin Li
- Department of Radiology, and Guangdong Provincial Key Laboratory of Biomedical ImagingHospital of Sun Yat-sen UniversityZhuhai519000China
| | - Sumi Helal
- University of FloridaGainesvilleFL32611USA
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20
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Yaluri N, Stančáková Yaluri A, Žeňuch P, Žeňuchová Z, Tóth Š, Kalanin P. Cardiac Biomarkers and Their Role in Identifying Increased Risk of Cardiovascular Complications in COVID-19 Patients. Diagnostics (Basel) 2023; 13:2508. [PMID: 37568870 PMCID: PMC10417576 DOI: 10.3390/diagnostics13152508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/03/2023] [Accepted: 07/17/2023] [Indexed: 08/13/2023] Open
Abstract
Cardiovascular disease (CVD) is a global health concern, causing significant morbidity and mortality. Both lifestyle and genetics influence the development of CVD. It is often diagnosed late, when the treatment options are limited. Early diagnosis of CVD with help of biomarkers is necessary to prevent adverse outcomes. SARS-CoV-2 infection can cause cardiovascular complications even in patients with no prior history of CVD. This review highlights cardiovascular biomarkers, including novel ones, and their applications as diagnostic and prognostic markers of cardiovascular complications related to SARS-CoV-2 infection. Patients with severe SARS-CoV-2 infection were shown to have elevated levels of cardiac biomarkers, namely N-terminal pro-brain natriuretic peptide (NT-pro-BNP), creatine kinase-myocardial band (CK-MB), and troponins, indicating acute myocardial damage. These biomarkers were also associated with higher mortality rates and therefore should be used throughout COVID-19 patient care to identify high-risk patients promptly to optimize their outcomes. Additionally, microRNAs (miRNAs) are also considered as potential biomarkers and predictors of cardiac and vascular damage in SARS-CoV-2 infection. Identifying molecular pathways contributing to cardiovascular manifestations in COVID-19 is essential for development of early biomarkers, identification of new therapeutic targets, and better prediction and management of cardiovascular outcomes.
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Affiliation(s)
- Nagendra Yaluri
- Center of Clinical and Preclinical Research, University Research Park Medipark, P. J. Šafárik University, 040 01 Košice, Slovakia
| | | | - Pavol Žeňuch
- Center of Clinical and Preclinical Research, University Research Park Medipark, P. J. Šafárik University, 040 01 Košice, Slovakia
| | - Zuzana Žeňuchová
- Center of Clinical and Preclinical Research, University Research Park Medipark, P. J. Šafárik University, 040 01 Košice, Slovakia
| | - Štefan Tóth
- Center of Clinical and Preclinical Research, University Research Park Medipark, P. J. Šafárik University, 040 01 Košice, Slovakia
| | - Peter Kalanin
- Center of Clinical and Preclinical Research, University Research Park Medipark, P. J. Šafárik University, 040 01 Košice, Slovakia
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21
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Bime C, Carr GE, Pu J, Kou S, Wang Y, Simons M. Delayed intubation associated with in-hospital mortality in patients with COVID-19 respiratory failure who fail heated and humified high flow nasal canula. BMC Anesthesiol 2023; 23:234. [PMID: 37438685 PMCID: PMC10337200 DOI: 10.1186/s12871-023-02198-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 07/05/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Advanced respiratory support modalities such as non-invasive positive pressure ventilation (NiPPV) and heated and humidified high flow nasal canula (HFNC) served as useful alternatives to invasive mechanical ventilatory support for acute respiratory failure (ARF) during the peak of the SARS-CoV-2/COVID-19 pandemic. Unlike NiPPV, HFNC is a newer modality and its role in the treatment of patients with severe ARF is not yet clearly defined. Furthermore, the characteristics of responders versus non-responders to HFNC have not been determined. Although recent evidence indicates that many patients with ARF treated with HFNC survive without needing intubation, those who fail and are subsequently intubated have worse outcomes. Given that prolonged use of HFNC in patients with ARF might exacerbate patient self-inflicted lung injury, we hypothesized that among those patients with ARF due to COVID-19 pneumonia, prolonged HFNC beyond 24 h before intubation would be associated with increased in-hospital mortality. METHODS This was a retrospective, multicenter, observational cohort study of 2720 patients treated for ARF secondary to SARS-CoV-2/COVID-19 pneumonia and initially managed with HFNC within the Banner Health system during the period from March 1st, 2020, to July 31st, 2021. In the subgroup of patients for went from HFNC to IMV, we assessed the effect of the duration of HFNC prior to intubation on mortality. RESULTS 1392 (51%) were successfully treated with HFNC alone and 1328 (49%) failed HFNC and were intubated (HFNC to IMV). When adjusted for the covariates, HFNC duration less than 24 h prior to intubation was significantly associated with reduced mortality. CONCLUSIONS Among patients with ARF due to COVID-19 pneumonia who fail HFNC, delay of intubation beyond 24 h is associated with increased mortality.
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Affiliation(s)
- Christian Bime
- University of Arizona College of Medicine, Tucson, AZ, USA.
| | - Gordon E Carr
- University of Arizona College of Medicine, Tucson, AZ, USA
- Banner Health, Phoenix, AZ, USA
| | - Jie Pu
- Banner Health, Phoenix, AZ, USA
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22
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Bojti I, Przewosnik AS, Luxenburger H, Hofmann M, Neumann-Haefelin C, Esser JS, Siegel PM, Maier A, Kovacs SB, Kardos L, Csanádi Z, Rieder M, Duerschmied D, Lother A, Bode C, Szabó GT, Czuriga D. Decreased level of serum NT-proCNP associates with disease severity in COVID-19. Respir Res 2023; 24:174. [PMID: 37386635 PMCID: PMC10311835 DOI: 10.1186/s12931-023-02469-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 06/05/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND C-type natriuretic peptide (CNP) is an endothelium-derived paracrine molecule with an important role in vascular homeostasis. In septic patients, the serum level of the amino-terminal propeptide of CNP (NT-proCNP) shows a strong positive correlation with inflammatory biomarkers and, if elevated, correlates with disease severity and indicates a poor outcome. It is not yet known whether NT-proCNP also correlates with the clinical outcome of patients suffering from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In the current study, we aimed to determine possible changes in the NT-proCNP levels of patients with coronavirus disease 2019 (COVID-19), with special regard to disease severity and outcome. METHODS In this retrospective analysis, we determined the serum level of NT-proCNP in hospitalized patients with symptoms of upper respiratory tract infection, using their blood samples taken on admission, stored in a biobank. The NT-proCNP levels of 32 SARS-CoV-2 positive and 35 SARS-CoV-2 negative patients were measured to investigate possible correlation with disease outcome. SARS-CoV-2 positive patients were then divided into two groups based on their need for intensive care unit treatment (severe and mild COVID-19). RESULTS The NT-proCNP was significantly different in the study groups (e.g. severe and mild COVID-19 and non-COVID-19 patients), but showed inverse changes compared to previous observations in septic patients: lowest levels were detected in critically ill COVID-19 patients, while highest levels in the non-COVID-19 group. A low level of NT-proCNP on admission was significantly associated with severe disease outcome. CONCLUSIONS Low-level NT-proCNP on hospital admission is associated with a severe COVID-19 disease course. The pathomechanism underlying this observation remains to be elucidated, while future studies in larger patient cohorts are necessary to confirm these observations and reveal therapeutic importance. Trial registration DRKS00026655 Registered 26. November 2021.
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Affiliation(s)
- Istvan Bojti
- Department of Cardiology and Angiology, University Heart Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Anne-Sophie Przewosnik
- Department of Cardiology and Angiology, University Heart Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Hendrik Luxenburger
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- IMM-PACT, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Maike Hofmann
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christoph Neumann-Haefelin
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jennifer S Esser
- Department of Cardiology and Angiology, University Heart Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Patrick M Siegel
- Department of Cardiology and Angiology, University Heart Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Alexander Maier
- Department of Cardiology and Angiology, University Heart Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sarolta Bojtine Kovacs
- IMM-PACT, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Section of Molecular Hematology, Department of Medicine I, Hematology, Oncology and Stem Cell Transplantation, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Laszlo Kardos
- Clinical Department of Infectious Diseases, Clinical Center, University of Debrecen, Debrecen, Hungary
| | - Zoltan Csanádi
- Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Marina Rieder
- Department of Cardiology and Angiology, University Heart Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Daniel Duerschmied
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Achim Lother
- Institute of Experimental and Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Interdisciplinary Medical Intensive Care, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christoph Bode
- Department of Cardiology and Angiology, University Heart Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Gabor Tamas Szabó
- Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Daniel Czuriga
- Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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23
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Tastemur M, Olcucuoğlu E, Arik G, Ates I, Silay K. Pulmonary artery diameter and NT-proBNP in patients with Covid-19: Predicting prognosis and mortality. Afr Health Sci 2023; 23:553-564. [PMID: 38223639 PMCID: PMC10782310 DOI: 10.4314/ahs.v23i2.64] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024] Open
Abstract
Background The diverse and complex presentations of COVID-19 continue to impact the world. Factors related to prognosis and mortality are still not fully illuminated. Objectives We aimed to asses the relationship of N-terminal pro B-type natriuretic peptide (NT-proBNP) and main pulmonary artery diameter (MPAD) with COVID-19 prognosis and mortality. Methods 152 COVID-19 patients over the age of 18, were included in the study. Thoracic CT, NT-proBNP values, laboratory and demographic data of these patients were obtained by retrospectively examining the patient files and scanning the results through the patient registry. Results According to multivariate logistic regression (LR) analysis, high NT-proBNP level (OR=3.542; 95% CI=1.745-9.463; p=0.021) and MPAD/ascending aortic diameter (AAD) ratio>0.75 (OR=2.692; 95% CI=1.264-9.312; p=0.036) were determined as independent risk factors predicting mortality in COVID-19 patients. A significant positive correlation was observed between NT-proBNP level and MPA diameter (r=0.296, p<0.001). The cut-off value was measured as 27.5 mm for MPA diameter and 742 pg/ml for NT-proBNP. Conclusions Accurate and effective interpretation of available radiological and laboratory data is essential to reveal the factors predicting prognosis and mortality in COVID-19. In this study,we evaluated that the thorax CTs and determined that the MPAD/AAD and NT-proBNP level were independent risk factors in predicting mortality.
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Affiliation(s)
- Mercan Tastemur
- Ministry of Health, Ankara City Hospital, Department of Geriatrics Medicine
| | - Esin Olcucuoğlu
- Ministry of Health, Ankara City Hospital, Department of Radiology
| | - Gunes Arik
- Ministry of Health, Ankara City Hospital, Department of Geriatrics Medicine
| | - Ihsan Ates
- Ministry of Health, Ankara City Hospital, Department of Internal Medicine
| | - Kamile Silay
- Ministry of Health, Ankara City Hospital, Department of Geriatrics Medicine
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24
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Yugar-Toledo JC, Yugar LBT, Sedenho-Prado LG, Schreiber R, Moreno H. Pathophysiological effects of SARS-CoV-2 infection on the cardiovascular system and its clinical manifestations-a mini review. Front Cardiovasc Med 2023; 10:1162837. [PMID: 37260945 PMCID: PMC10229057 DOI: 10.3389/fcvm.2023.1162837] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 04/18/2023] [Indexed: 06/02/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a viral infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 may have a mild presentation, with few symptoms, or progress to a severe condition, characterized by generalized inflammation, systemic microvascular involvement, coagulopathy, and pulmonary and cardiovascular complications. Men present with more severe symptoms than women, especially men who are older and who present with comorbidities such as hypertension, diabetes mellitus, and a history of atherosclerotic diseases. Owing to its association with endothelial dysfunction, inflammation, thrombosis, and microvascular obstruction, SARS-CoV-2 infection can cause lesions in several organs, including the myocardium and the coronary arterial bed, which can result in clinical manifestations involving the cardiovascular system. In this mini review, we summarize the effects of SARS-CoV-2 infection on the cardiovascular system in both children and adults and characterize the various clinical manifestations associated with this disease.
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Affiliation(s)
| | | | | | - Roberto Schreiber
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas (UNICAMP), São Paulo, Brazil
| | - Heitor Moreno
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas (UNICAMP), São Paulo, Brazil
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25
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Bukreieva T, Kyryk V, Nikulina V, Svitina H, Vega A, Chybisov O, Shablii I, Mankovska O, Lobyntseva G, Nemtinov P, Skrypkina I, Shablii V. Dynamic changes in radiological parameters, immune cells, selected miRNAs, and cytokine levels in peripheral blood of patients with severe COVID‑19. Biomed Rep 2023; 18:33. [PMID: 37034572 PMCID: PMC10074022 DOI: 10.3892/br.2023.1615] [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: 12/07/2022] [Accepted: 03/07/2023] [Indexed: 04/11/2023] Open
Abstract
The present study aimed to investigate the dynamic changes in peripheral blood leucocyte subpopulations, cytokine and miRNA levels, and changes in computed tomography (CT) scores in patients with severe coronavirus disease 2019 (COVID-19) (n=14) and age-matched non-COVID-19 volunteers (n=17), which were included as a reference control group. All data were collected on the day of patient admission (day 0) and on the 7th, 14th and 28th days of follow-up while CT of the lungs was performed on weeks 2, 8, 24 and 48. On day 0, lymphopenia and leucopenia were detected in most patients with COVID-19, as well as an increase in the percentage of banded neutrophils, B cells, and CD4+ Treg cells, and a decrease in the content of PD-1low T cells, classical, plasmacytoid, and regulatory dendritic cells. On day 7, the percentage of T and natural killer cells decreased with a concurrent increase in B cells, but returned to the initial level after treatment discharge. The content of different T and dendritic cell subsets among CD45+ cells increased during two weeks and remained elevated, suggesting the activation of an adaptive immune response. The increase of PD-1-positive subpopulations of T and non-T cells and regulatory CD4 T cells in patients with COVID-19 during the observation period suggests the development of an inflammation control mechanism. The levels of interferon γ-induced protein 10 (IP-10), tumor necrosis factor-α (TNF-α) and interleukin (IL)-6 decreased on day 7, but increased again on days 14 and 28. C-reactive protein and granulocyte colony-stimulating factor (G-CSF) levels decreased gradually throughout the observation period. The relative expression levels of microRNA (miR)-21-5p, miR-221-3p, miR-27a-3p, miR-146a-5p, miR-133a-3p, and miR-126-3p were significantly higher at the beginning of hospitalization compared to non-COVID-19 volunteers. The plasma levels of all miRs, except for miR-126-3p, normalized within one week of treatment. At week 48, CT scores were most prominently correlated with the content of lymphocytes, senescent memory T cells, CD127+ T cells and CD57+ T cells, and increased concentrations of G-CSF, IP-10, and macrophage inflammatory protein-1α.
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Affiliation(s)
- Tetiana Bukreieva
- Laboratory of Biosynthesis of Nucleic Acids, Department of Functional Genomics, Institute of Molecular Biology and Genetics, National Academy of Sciences of Ukraine, Kyiv 03143, Ukraine
- Placenta Stem Cell Laboratory, Cryobank, Institute of Cell Therapy, Kyiv 03126, Ukraine
| | - Vitalii Kyryk
- Laboratory of Cell and Tissue Cultures, Department of Cell and Tissue Technologies, State Institute of Genetic and Regenerative Medicine, National Academy of Medical Sciences of Ukraine, Kyiv 04114, Ukraine
- Laboratory of Pathophysiology and Immunology, D.F. Chebotarev State Institute of Gerontology of The National Academy of Medical Sciences of Ukraine, Kyiv 04114, Ukraine
| | - Viktoriia Nikulina
- Placenta Stem Cell Laboratory, Cryobank, Institute of Cell Therapy, Kyiv 03126, Ukraine
| | - Hanna Svitina
- Laboratory of Biosynthesis of Nucleic Acids, Department of Functional Genomics, Institute of Molecular Biology and Genetics, National Academy of Sciences of Ukraine, Kyiv 03143, Ukraine
- Placenta Stem Cell Laboratory, Cryobank, Institute of Cell Therapy, Kyiv 03126, Ukraine
| | - Alyona Vega
- Department of Infectious Diseases, Shupyk National Healthcare University of Ukraine, Kyiv 04112, Ukraine
| | - Oleksii Chybisov
- Endoscopic Unit, CNE Kyiv City Clinical Hospital No. 4, Kyiv 03110, Ukraine
| | - Iuliia Shablii
- Laboratory of Biosynthesis of Nucleic Acids, Department of Functional Genomics, Institute of Molecular Biology and Genetics, National Academy of Sciences of Ukraine, Kyiv 03143, Ukraine
| | - Oksana Mankovska
- Department of Molecular Oncogenetics, Institute of Molecular Biology and Genetics, National Academy of Sciences of Ukraine, Kyiv 03143, Ukraine
| | - Galyna Lobyntseva
- Placenta Stem Cell Laboratory, Cryobank, Institute of Cell Therapy, Kyiv 03126, Ukraine
| | - Petro Nemtinov
- Placenta Stem Cell Laboratory, Cryobank, Institute of Cell Therapy, Kyiv 03126, Ukraine
| | - Inessa Skrypkina
- Laboratory of Biosynthesis of Nucleic Acids, Department of Functional Genomics, Institute of Molecular Biology and Genetics, National Academy of Sciences of Ukraine, Kyiv 03143, Ukraine
| | - Volodymyr Shablii
- Laboratory of Biosynthesis of Nucleic Acids, Department of Functional Genomics, Institute of Molecular Biology and Genetics, National Academy of Sciences of Ukraine, Kyiv 03143, Ukraine
- Placenta Stem Cell Laboratory, Cryobank, Institute of Cell Therapy, Kyiv 03126, Ukraine
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26
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Clinical and Cytokine Profile of Children With COVID-19: A Report From Turkey. Cureus 2023; 15:e37139. [PMID: 37034144 PMCID: PMC10078166 DOI: 10.7759/cureus.37139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 04/07/2023] Open
Abstract
Background We aimed to analyze the expression of infection-related biomarkers and inflammatory cytokines in laboratory-confirmed cases and compare the differences between clinically severe and non-severe ones. Method We randomly selected 35 patients who were hospitalized with the diagnosis of coronavirus disease 2019 (COVID-19). Blood serum was obtained at the time of admission to the hospital, on the third to the fifth day, and at the time of discharge. Result The median age of our patients was 56.5±69.7 months (range: 1-205 months). The mean pro-B-type natriuretic peptide (pro-BNP) was significantly higher at the time of admission than on the third to the fifth day of illness. The mean pro-B-type natriuretic peptide levels at three time points were significantly higher in patients with severe cases than in mild-moderate cases. However, there was no significant difference between the clinical severity with regard to the cytokine levels at disease onset and recovery. Conclusion In the study, it was shown that cytokines play an important role in the pathogenesis of COVID-19. Therefore, it may be beneficial to use agents such as tocilizumab in the treatment.
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27
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Orlando L, Bagnato G, Ioppolo C, Franzè MS, Perticone M, Versace AG, Sciacqua A, Russo V, Cicero AFG, De Gaetano A, Dattilo G, Fogacci F, Tringali MC, Di Micco P, Squadrito G, Imbalzano E. Natural Course of COVID-19 and Independent Predictors of Mortality. Biomedicines 2023; 11:939. [PMID: 36979918 PMCID: PMC10046319 DOI: 10.3390/biomedicines11030939] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/12/2023] [Accepted: 03/13/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND During the SARS-CoV-2 pandemic, several biomarkers were shown to be helpful in determining the prognosis of COVID-19 patients. The aim of our study was to evaluate the prognostic value of N-terminal pro-Brain Natriuretic Peptide (NT-pro-BNP) in a cohort of patients with COVID-19. METHODS One-hundred and seven patients admitted to the Covid Hospital of Messina University between June 2022 and January 2023 were enrolled in our study. The demographic, clinical, biochemical, instrumental, and therapeutic parameters were recorded. The primary outcome was in-hospital mortality. A comparison between patients who recovered and were discharged and those who died during the hospitalization was performed. The independent parameters associated with in-hospital death were assessed by multivariable analysis and a stepwise regression logistic model. RESULTS A total of 27 events with an in-hospital mortality rate of 25.2% occurred during our study. Those who died during hospitalization were older, with lower GCS and PaO2/FiO2 ratio, elevated D-dimer values, INR, creatinine values and shorter PT (prothrombin time). They had an increased frequency of diagnosis of heart failure (p < 0.0001) and higher NT-pro-BNP values. A multivariate logistic regression analysis showed that higher NT-pro-BNP values and lower PT and PaO2/FiO2 at admission were independent predictors of mortality during hospitalization. CONCLUSIONS This study shows that NT-pro-BNP levels, PT, and PaO2/FiO2 ratio are independently associated with in-hospital mortality in subjects with COVID-19 pneumonia. Further longitudinal studies are warranted to confirm the results of this study.
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Affiliation(s)
- Luana Orlando
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy
| | - Gianluca Bagnato
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy
| | - Carmelo Ioppolo
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy
| | - Maria Stella Franzè
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy
| | - Maria Perticone
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy
| | | | - Angela Sciacqua
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy
| | - Vincenzo Russo
- Department of Medical Translational Sciences, Division of Cardiology, Monaldi Hospital, University of Campania “Luigi Vanvitelli”, 80100 Naples, Italy
| | - Arrigo Francesco Giuseppe Cicero
- IRCCS Policlinico S. Orsola—Malpighi, Hypertension and Cardiovascular risk Research Center, DIMEC, University of Bologna, 40100 Bologna, Italy
| | - Alberta De Gaetano
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy
| | - Giuseppe Dattilo
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy
| | - Federica Fogacci
- IRCCS Policlinico S. Orsola—Malpighi, Hypertension and Cardiovascular risk Research Center, DIMEC, University of Bologna, 40100 Bologna, Italy
| | - Maria Concetta Tringali
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy
| | - Pierpaolo Di Micco
- Department of Medicine, PO Santa Maria delle Grazie Pozzuoli, 80100 Naples, Italy
| | - Giovanni Squadrito
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy
| | - Egidio Imbalzano
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy
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Ishikura H, Maruyama J, Nakashio M, Hoshino K, Morimoto S, Izutani Y, Noake J, Yamagaito T, Yoshida M, Kitamura T, Nakamura Y. Daily combined measurement of platelet count and presepsin concentration can predict in-hospital death of patients with severe coronavirus disease 2019 (COVID-19). Int J Hematol 2023; 117:845-855. [PMID: 36920687 PMCID: PMC10016182 DOI: 10.1007/s12185-023-03555-5] [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: 12/16/2022] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 03/16/2023]
Abstract
The purpose of this study was to classify patients with severe COVID-19 into more detailed risk groups using coagulation/fibrinolysis, inflammation/immune response, and alveolar/myocardial damage biomarkers, as well as to identify prognostic markers for these patients. These biomarkers were measured every day for eight intensive care unit days in 54 adult patients with severe COVID-19. The patients were classified into survivor (n = 40) and non-survivor (n = 14) groups. Univariate and multivariate analyses showed that the combined measurement of platelet count and presepsin concentrations may be the most valuable for predicting in-hospital death, and receiver operating characteristic curve analysis further confirmed this result (area under the curve = 0.832). Patients were consequently classified into three groups (high-, medium-, and low-risk) on the basis of their cutoff values (platelet count 53 × 103/µL, presepsin 714 pg/mL). The Kaplan-Meier curve for 90-day survival by each group showed that the 90-day mortality rate significantly increased as risk level increased (P < 0.01 by the log-rank test). Daily combined measurement of platelet count and presepsin concentration may be useful for predicting in-hospital death and classifying patients with severe COVID-19 into more detailed risk groups.
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Affiliation(s)
- Hiroyasu Ishikura
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan.
| | - Junichi Maruyama
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Maiko Nakashio
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Kota Hoshino
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Shinichi Morimoto
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Yoshito Izutani
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Junta Noake
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | | | - Maho Yoshida
- Sysmex Scientific Affairs, 1-3-2 Murotani, Nishi-ku, Kobe, Japan
| | - Taisuke Kitamura
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Yoshihiko Nakamura
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
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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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Can we predict risk for cardiac involvement in paediatric inflammatory multi-system syndrome? Cardiol Young 2022; 32:1944-1951. [PMID: 35067268 DOI: 10.1017/s1047951121005242] [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] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Increasing recognition of paediatric inflammatory multi-system syndrome is a cause of concern. This study aimed to evaluate children with paediatric inflammatory multi-system syndrome and compare the clinical and laboratory features of children with and without cardiac involvement. MATERIAL AND METHODS We conducted a prospective single-centre study including 57 (male 37, 65%) patients with paediatric inflammatory multi-system syndrome at a tertiary care hospital between November, 2020 and March, 2021. The mean age was 8.8 ± 4.5 years (range, 10 months-16.7 years). RESULTS The most frequent symptoms were fever (100%), abdominal pain (65%) and diarrhoea (42%). SARS-CoV-2 PCR and serology tests were positive in 3 (5%) and 52 (91%) patients, respectively. Eight patients required intensive care support. Nineteen patients (33%) had cardiac involvement (valvular regurgitation in 15, left ventricular systolic dysfunction in 11 and coronary artery dilation in 1). The presence and duration of cough and intensive care admissions were significantly higher in children with cardiac involvement than those without it. The cut-off values of troponin T, pro-brain natriuretic peptide and interleukin 6 for predicting cardiac involvement were 11.65 ng/L (95% confidence interval, 0.63-0.90; sensitivity, 0.63; specificity, 0.84; area under the curve: 0.775, p = 0.009), 849.5 pg/mL (95% CI, 0.54-0.86; sensitivity, 0.63; specificity, 0.63; area under the curve: 0.706, p = 0.009) and 39.8 pg/mL (95% CI, 0.54-0.85; sensitivity, 0.63; specificity, 0.60; area under the curve: 0.698, p = 0.023), respectively. CONCLUSIONS Cardiac involvement in children with paediatric inflammatory multi-system syndrome is common. The risk of cardiac involvement can be predicted by troponin T, pro-brain natriuretic peptide and interleukin 6 levels.
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Palazzuoli A, Metra M, Collins SP, Adamo M, Ambrosy AP, Antohi LE, Ben Gal T, Farmakis D, Gustafsson F, Hill L, Lopatin Y, Tramonte F, Lyon A, Masip J, Miro O, Moura B, Mullens W, Radu RI, Abdelhamid M, Anker S, Chioncel O. Heart failure during the COVID-19 pandemic: clinical, diagnostic, management, and organizational dilemmas. ESC Heart Fail 2022; 9:3713-3736. [PMID: 36111511 PMCID: PMC9773739 DOI: 10.1002/ehf2.14118] [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: 03/25/2022] [Revised: 07/13/2022] [Accepted: 08/04/2022] [Indexed: 01/19/2023] Open
Abstract
The coronavirus 2019 (COVID-19) infection pandemic has affected the care of patients with heart failure (HF). Several consensus documents describe the appropriate diagnostic algorithm and treatment approach for patients with HF and associated COVID-19 infection. However, few questions about the mechanisms by which COVID can exacerbate HF in patients with high-risk (Stage B) or symptomatic HF (Stage C) remain unanswered. Therefore, the type of HF occurring during infection is poorly investigated. The diagnostic differentiation and management should be focused on the identification of the HF phenotype, underlying causes, and subsequent tailored therapy. In this framework, the relationship existing between COVID and onset of acute decompensated HF, isolated right HF, and cardiogenic shock is questioned, and the specific management is mainly based on local hospital organization rather than a standardized model. Similarly, some specific populations such as advanced HF, heart transplant, patients with left ventricular assist device (LVAD), or valve disease remain under investigated. In this systematic review, we examine recent advances regarding the relationships between HF and COVID-19 pandemic with respect to epidemiology, pathogenetic mechanisms, and differential diagnosis. Also, according to the recent HF guidelines definition, we highlight different clinical profile identification, pointing out the main concerns in understudied HF populations.
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Affiliation(s)
- Alberto Palazzuoli
- Cardiovascular Diseases Unit, Cardio Thoracic and Vascular Department, S. Maria alle Scotte HospitalUniversity of Siena53100SienaItaly
| | - Marco Metra
- Cardiology, Cardio‐Thoracic Department, Civil Hospitals, Brescia, Italy; Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of BresciaBresciaItaly
| | - Sean P. Collins
- Department of Emergency MedicineVanderbilt University Medical CentreNashvilleTNUSA
| | - Marianna Adamo
- Cardiology, Cardio‐Thoracic Department, Civil Hospitals, Brescia, Italy; Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of BresciaBresciaItaly
| | - Andrew P. Ambrosy
- Department of CardiologyKaiser Permanente San Francisco Medical CenterSan FranciscoCAUSA,Division of ResearchKaiser Permanente Northern CaliforniaOaklandCAUSA
| | - Laura E. Antohi
- Emergency Institute for Cardiovascular Diseases “Prof. Dr. C.C.Iliescu” BucharestBucharestRomania
| | - Tuvia Ben Gal
- Department of Cardiology, Rabin Medical Center (Beilinson Campus), Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Dimitrios Farmakis
- Cardio‐Oncology Clinic, Heart Failure Unit, “Attikon” University HospitalNational and Kapodistrian University of Athens Medical SchoolAthensGreece,University of Cyprus Medical SchoolNicosiaCyprus
| | | | - Loreena Hill
- School of Nursing and MidwiferyQueen's UniversityBelfastUK
| | - Yuri Lopatin
- Volgograd Medical UniversityCardiology CentreVolgogradRussia
| | - Francesco Tramonte
- Cardiovascular Diseases Unit, Cardio Thoracic and Vascular Department, S. Maria alle Scotte HospitalUniversity of Siena53100SienaItaly
| | - Alexander Lyon
- Cardio‐Oncology ServiceRoyal Brompton Hospital and Imperial College LondonLondonUK
| | - Josep Masip
- Intensive Care Department, Consorci Sanitari IntegralUniversity of BarcelonaBarcelonaSpain,Department of CardiologyHospital Sanitas CIMABarcelonaSpain
| | - Oscar Miro
- Emergency Department, Hospital Clínic de BarcelonaUniversity of BarcelonaBarcelonaSpain
| | - Brenda Moura
- Armed Forces Hospital, Porto, & Faculty of MedicineUniversity of PortoPortoPortugal
| | - Wilfried Mullens
- Cardiovascular PhysiologyHasselt University, Belgium, & Heart Failure and Cardiac Rehabilitation Specialist, Ziekenhuis Oost‐LimburgGenkBelgium
| | - Razvan I. Radu
- Emergency Institute for Cardiovascular Diseases “Prof. Dr. C.C.Iliescu” BucharestBucharestRomania
| | - Magdy Abdelhamid
- Cardiology Department, Kasr Alainy School of MedicineCairo UniversityNew Cairo, 5th settlementCairo11865Egypt
| | - Stefan Anker
- Department of Cardiology (CVK), Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin BerlinBerlinGermany
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases “Prof. Dr. C.C. Iliescu” Bucharest; University for Medicine and Pharmacy “Carol Davila” BucharestBucharestRomania
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Vigneshwar NG, Masood MF, Vasic I, Krause M, Bartels K, Lucas MT, Bronsert M, Selzman CH, Thompson S, Rove JY, Reece TB, Cleveland JC, Pal JD, Fullerton DA, Aftab M. Venovenous extracorporeal membrane oxygenation support in patients with COVID-19 respiratory failure: A multicenter study. JTCVS OPEN 2022; 12:211-220. [PMID: 36097635 PMCID: PMC9451935 DOI: 10.1016/j.xjon.2022.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 07/07/2022] [Accepted: 07/11/2022] [Indexed: 01/08/2023]
Abstract
Objective The COVID-19 pandemic presents a high mortality rate amongst patients who develop severe acute respiratory distress syndrome (ARDS). The purpose of this study was to evaluate the outcomes of venovenous extracorporeal membrane oxygenation (VV-ECMO) in COVID-19-related ARDS and identify the patients who benefit the most from this procedure. Methods Adult patients with COVID-19 and severe ARDS requiring VV-ECMO support at 4 academic institutions between March and October 2020 were included. Data were collected through retrospective chart reviews. Bivariate and multivariable analyses were performed with the primary outcome of in-hospital mortality. Results Fifty-one consecutive patients underwent VV-ECMO with a mean age of 50.4 years; 64.7% were men. Survival to hospital discharge was 62.8%. Median intensive care unit and hospitalization duration were 27.4 days (interquartile range [IQR], 17-37 days) and 34.5 days (IQR, 23-43 days), respectively. Survivors and nonsurvivors had a median ECMO cannulation time of 11 days (IQR, 8-18) and 17 days (IQR, 12-25 days). The average postdecannulation length of stay was 17.5 days (IQR, 12.4-25 days) for survivors and 0 days for nonsurvivors (IQR, 0-6 days). Only 1 nonsurvivor was able to be decannulated. Clinical characteristics associated with mortality between nonsurviors and survivors included increasing age (P = .0048), hemorrhagic stroke (P = .0014), and postoperative dialysis (P = .0013) were associated with mortality in a bivariate model and retained statistical significance in a multivariable model. Conclusions This multicenter study confirms the effectiveness of VV-ECMO in selected critically ill patients with COVID-19-related severe ARDS. The survival of these patients is comparable to non-COVID-19-related ARDS.
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Affiliation(s)
- Navin G. Vigneshwar
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colo
| | - Muhammad F. Masood
- Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, Mo
| | - Ivana Vasic
- University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colo
| | - Martin Krause
- Department of Anesthesiology, University of San Diego, San Diego, Calif
| | - Karsten Bartels
- Division of Critical Care, Department of Anesthesiology, University of Nebraska Medical Center, Omaha, Neb
| | - Mark T. Lucas
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colo
| | - Michael Bronsert
- Colorado Health Outcomes Program, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colo
| | - Craig H. Selzman
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health, Salt Lake City, Utah
| | - Shaun Thompson
- Division of Critical Care, Department of Anesthesiology, University of Nebraska Medical Center, Omaha, Neb
| | - Jessica Y. Rove
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colo
| | - Thomas B. Reece
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colo
| | - Joseph C. Cleveland
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colo
| | - Jay D. Pal
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colo
| | - David A. Fullerton
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colo
| | - Muhammad Aftab
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colo,Address for reprints: Muhammad Aftab, MD, Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, 12631 E 17th Ave, C-310, Room 6602, Aurora, CO 80045.
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Abbasi AF, Marinkovic A, Prakash S, Sanyaolu A, Smith S. COVID-19 and the Human Gut Microbiome: An Under-Recognized Association. Chonnam Med J 2022; 58:96-101. [PMID: 36245770 PMCID: PMC9535107 DOI: 10.4068/cmj.2022.58.3.96] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/28/2022] [Accepted: 08/02/2022] [Indexed: 11/06/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is an infectious disease with a wide range of respiratory and extrapulmonary symptoms, as well as gastrointestinal symptoms. Despite recent research linking gut microbiota to infectious diseases like influenza, minimal information is known about the gut microbiota's function in COVID-19 pathogenesis. Studies suggest that dysbiosis of the gut microbiota and gut barrier dysfunction may play a role in COVID-19 pathogenesis by disrupting host immune homeostasis. Regardless of whether patients had taken medication or disease severity, the gut microbiota composition was significantly altered in COVID-19 patients compared to non-COVID-19 individuals. Several gut commensals with recognized immunomodulatory potential, such as Faecalibacterium prausnitzii, Eubacterium rectale, and bifidobacteria, were underrepresented in patients and remained low in samples taken several weeks after disease resolution. Furthermore, even with disease resolution, dysbiosis in the gut microbiota may contribute to chronic symptoms, underscoring the need to learn more about how gut microbes play a role in inflammation and COVID-19.
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Affiliation(s)
| | | | | | | | - Stella Smith
- Nigerian Institute of Medical Research, Lagos, Nigeria
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Benhuri B, Aikawa T, Takagi H, Benhuri D, Kuno T. Elevated Natriuretic Peptides in Patients With Severe or Critical COVID-19: A Meta-Analysis. Tex Heart Inst J 2022; 49:e207404. [PMID: 36223219 PMCID: PMC9632402 DOI: 10.14503/thij-20-7404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
BACKGROUND The worldwide COVID-19 pandemic caused by SARS-CoV-2 has resulted in an extraordinary increase in the number of patients who are severely critically ill. For many of these patients, cardiovascular risk factors are key contributors to the development of severe illness. Laboratory markers for cardiac damage and failure, such as natriuretic peptides, are reported to be elevated in patients with severe COVID-19. METHODS We conducted a systematic review and meta-analysis to compare natriuretic peptide levels in patients with severe COVID-19 vs those with nonsevere COVID-19. PubMed and medRxiv were searched through April 7, 2020. The outcome of interest was the difference in B-type natriuretic peptide (BNP) or N-terminal-proBNP levels in patients with severe vs nonsevere COVID-19. RESULTS We identified 9 retrospective cohort studies that had a total of 1,575 patients with COVID-19 who had their natriuretic peptides measured and were classified by disease severity. All studies were conducted in China. Patients with severe COVID-19 had significantly higher BNP levels than patients with nonsevere COVID-19 (mean difference, 69.56 pg/mL; 95% CI, 1.77-137.35 pg/mL; P = .04, I2 = 83%). Similarly, patients with severe COVID-19 had significantly higher N-terminal-proBNP levels than patients with nonsevere COVID-19 (mean difference, 518.65 pg/mL; 95% CI, 152.40-884.90 pg/mL; P = .006, I2 = 86%). CONCLUSIONS In this study, Chinese patients with severe COVID-19 had higher natriuretic peptide levels than those with nonsevere COVID-19. Studies from all countries affected by the virus will help to further delineate whether the cause is directly or indirectly of cardiac origin and whether preexisting heart failure has an influence on this disparity.
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Affiliation(s)
- Benjamin Benhuri
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, New York
| | - Tadao Aikawa
- Department of Cardiology, Hokkaido Cardiovascular Hospital, Sapporo, Japan
| | - Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
| | - Daniel Benhuri
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, New York
| | - Toshiki Kuno
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York
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Zwaenepoel B, Dhont S, Schaubroeck H, Gevaert S. The use of cardiac troponins and B-type natriuretic peptide in COVID-19. Acta Cardiol 2022; 77:567-572. [PMID: 34459705 PMCID: PMC8425434 DOI: 10.1080/00015385.2021.1970403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 08/07/2021] [Accepted: 08/14/2021] [Indexed: 11/09/2022]
Abstract
Coronavirus disease 2019 (COVID-19) is still challenging health care systems worldwide. Over time, it has become clear that respiratory disease is not the only important entity as critically ill patients are also more prone to develop complications, such as acute cardiac injury. Despite extensive research, the mainstay of treatment still relies on supportive care and targeted therapy of these complications. The development of a prognostic model which helps clinicians to diverge patients to an appropriate level of care is thus crucial. As a result, several prognostic markers have been studied in the past few months. Among them are the cardiac biomarkers, especially cardiac troponins T/I and brain natriuretic peptide, which seem to have important prognostic values as several reports have confirmed their strong association with adverse clinical outcomes and death. The use of these biomarkers as part of a prognostic tool could potentially result in more precise risk stratification of COVID-19 patients and divergence to an adequate level of care. However, several caveats persist causing international guidelines to still recommend in favour of a more conservative approach to cardiac biomarker testing for prognostic purposes.
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Affiliation(s)
- Bert Zwaenepoel
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Sebastiaan Dhont
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Hannah Schaubroeck
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
| | - Sofie Gevaert
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
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Ghamar Talepoor A, Doroudchi M. Immunosenescence in atherosclerosis: A role for chronic viral infections. Front Immunol 2022; 13:945016. [PMID: 36059478 PMCID: PMC9428721 DOI: 10.3389/fimmu.2022.945016] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/26/2022] [Indexed: 01/10/2023] Open
Abstract
Immune system is a versatile and dynamic body organ which offers survival and endurance of human beings in their hostile living environment. However, similar to other cells, immune cells are hijacked by senescence. The ageing immune cells lose their beneficial functions but continue to produce inflammatory mediators which draw other immune and non-immune cells to the senescence loop. Immunosenescence has been shown to be associated with different pathological conditions and diseases, among which atherosclerosis has recently come to light. There are common drivers of both immunosenescence and atherosclerosis; e.g. inflammation, reactive oxygen species (ROS), chronic viral infections, genomic damage, oxidized-LDL, hypertension, cigarette smoke, hyperglycaemia, and mitochondrial failure. Chronic viral infections induce inflammaging, sustained cytokine signaling, ROS generation and DNA damage which are associated with atherogenesis. Accumulating evidence shows that several DNA and RNA viruses are stimulators of immunosenescence and atherosclerosis in an interrelated network. DNA viruses such as CMV, EBV and HBV upregulate p16, p21 and p53 senescence-associated molecules; induce inflammaging, metabolic reprogramming of infected cells, replicative senescence and telomere shortening. RNA viruses such as HCV and HIV induce ROS generation, DNA damage, induction of senescence-associated secretory phenotype (SASP), metabolic reprogramming of infected cells, G1 cell cycle arrest, telomere shortening, as well as epigenetic modifications of DNA and histones. The newly emerged SARS-CoV-2 virus is also a potent inducer of cytokine storm and SASP. The spike protein of SARS-CoV-2 promotes senescence phenotype in endothelial cells by augmenting p16, p21, senescence-associated β-galactosidase (SA-β-Gal) and adhesion molecules expression. The impact of SARS-CoV-2 mega-inflammation on atherogenesis, however, remains to be investigated. In this review we focus on the common processes in immunosenescence and atherogenesis caused by chronic viral infections and discuss the current knowledge on this topic.
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Henning RJ. Cardiovascular complications of COVID-19 severe acute respiratory syndrome. AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2022; 12:170-191. [PMID: 36147783 PMCID: PMC9490160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/15/2022] [Indexed: 06/16/2023]
Abstract
603,711,760 confirmed cases of COVID-19 have been reported throughout the world and 6,484,136 individuals have died from complications of COVID-19 as of September 7, 2022. Significantly, the Omicron variant has produced the largest number of COVID-19 associated hospitalizations since the beginning of the pandemic. Cardiac injury occurs in ≥20% of the hospitalized patients with COVID-19 and is associated with cardiac dysrhythmias in 17 to 44%, cardiac injury with increases in blood troponin in 22 to 40%, myocarditis in 2 to 7%, heart failure in 4 to 21%, and thromboembolic events in 15 to 39%. Risk factors for cardiac complications include age >70 years, male sex, BMI ≥30 kg/m2, diabetes, pre-existing cardiovascular disease, and moderate to severe pneumonia at hospital presentation. Patients with prior cardiovascular disease who contract COVID-19 and experience a significant increase in their blood troponin concentration are at risk for mortality rates as high as 69%. This review focuses on the prevalence, the pathophysiologic mechanisms of CoV-2 injury to the cardiovascular system and the current recommended treatments in hospitalized patients with COVID-19 in order that medical personnel can decrease the morbidity and mortality of patients with COVID-19 and effectively treat patients with Covid and post Covid syndrome.
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Affiliation(s)
- Robert J Henning
- University of South Florida 13201 Bruce B. Downs Blvd, Tampa, Florida 33612-3805, USA
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Pino R, Izurieta AC, Ríos-Barnés M, Ricart S, De Sevilla MF, Monfort L, Launes C, Cano I, Lecina L, Sánchez Manubens J, Mosquera JM, Jordan I, Sánchez de Toledo J, Monsonís M, Esteva C, Muñoz-Almagro C, Fumadó V, Fortuny C, Garcia Garcia JJ, Noguera-Julian A, Anton J. Correspondence on: 'Paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 mimicking Kawasaki disease (Kawa-COVID-19): a multicentre cohort' by Pouletty et al. Ann Rheum Dis 2022; 81:e159. [PMID: 32759264 DOI: 10.1136/annrheumdis-2020-218538] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 07/11/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Rosa Pino
- Hospital Medicine Unit, Pediatrics Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Ana Carolina Izurieta
- Hospital Medicine Unit, Pediatrics Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - María Ríos-Barnés
- Infectious Diseases and Systemic Inflammatory Response in Pediatrics, Infectious Diseases Unit, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Sílvia Ricart
- Hospital Medicine Unit, Pediatrics Department, Hospital Sant Joan de Déu, Barcelona, Spain
- Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Mariona F De Sevilla
- Hospital Medicine Unit, Pediatrics Department, Hospital Sant Joan de Déu, Barcelona, Spain
- CIBERESP, Madrid, Spain
| | - Laura Monfort
- Hospital Medicine Unit, Pediatrics Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Cristian Launes
- Hospital Medicine Unit, Pediatrics Department, Hospital Sant Joan de Déu, Barcelona, Spain
- CIBERESP, Madrid, Spain
| | - Iván Cano
- Hospital Medicine Unit, Pediatrics Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Laura Lecina
- Hospital Medicine Unit, Pediatrics Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Judith Sánchez Manubens
- Pediatric Rheumatology Unit, Hospital Sant Joan de Déu, Barcelona, Spain
- Pediatric Rheumatology, Consorcio Corporación Sanitaria Parc Taulí, Sabadell, Barcelona, Spain
| | | | - Iolanda Jordan
- CIBERESP, Madrid, Spain
- Pediatric Intensive Care Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Joan Sánchez de Toledo
- Pediatric Cardiology Department, Hospital Sant Joan de Déu, Barcelona, Spain
- Department of Critical Care Medicine, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Manuel Monsonís
- Department of Microbiology, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Cristina Esteva
- CIBERESP, Madrid, Spain
- Department of Molecular Microbiology, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Carmen Muñoz-Almagro
- CIBERESP, Madrid, Spain
- Department of Molecular Microbiology, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Victòria Fumadó
- Infectious Diseases and Systemic Inflammatory Response in Pediatrics, Infectious Diseases Unit, Hospital Sant Joan de Déu, Barcelona, Spain
- Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Clàudia Fortuny
- Infectious Diseases and Systemic Inflammatory Response in Pediatrics, Infectious Diseases Unit, Hospital Sant Joan de Déu, Barcelona, Spain
- CIBERESP, Madrid, Spain
| | - Juan José Garcia Garcia
- Infectious Diseases and Systemic Inflammatory Response in Pediatrics, Infectious Diseases Unit, Hospital Sant Joan de Déu, Barcelona, Spain
- CIBERESP, Madrid, Spain
| | - Antoni Noguera-Julian
- Infectious Diseases and Systemic Inflammatory Response in Pediatrics, Infectious Diseases Unit, Hospital Sant Joan de Déu, Barcelona, Spain
- CIBERESP, Madrid, Spain
| | - Jordi Anton
- Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain
- Pediatric Rheumatology Unit, Hospital Sant Joan de Déu, Barcelona, Spain
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Clerbaux LA, Albertini MC, Amigó N, Beronius A, Bezemer GFG, Coecke S, Daskalopoulos EP, del Giudice G, Greco D, Grenga L, Mantovani A, Muñoz A, Omeragic E, Parissis N, Petrillo M, Saarimäki LA, Soares H, Sullivan K, Landesmann B. Factors Modulating COVID-19: A Mechanistic Understanding Based on the Adverse Outcome Pathway Framework. J Clin Med 2022; 11:4464. [PMID: 35956081 PMCID: PMC9369763 DOI: 10.3390/jcm11154464] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/05/2022] [Accepted: 07/06/2022] [Indexed: 12/10/2022] Open
Abstract
Addressing factors modulating COVID-19 is crucial since abundant clinical evidence shows that outcomes are markedly heterogeneous between patients. This requires identifying the factors and understanding how they mechanistically influence COVID-19. Here, we describe how eleven selected factors (age, sex, genetic factors, lipid disorders, heart failure, gut dysbiosis, diet, vitamin D deficiency, air pollution and exposure to chemicals) influence COVID-19 by applying the Adverse Outcome Pathway (AOP), which is well-established in regulatory toxicology. This framework aims to model the sequence of events leading to an adverse health outcome. Several linear AOPs depicting pathways from the binding of the virus to ACE2 up to clinical outcomes observed in COVID-19 have been developed and integrated into a network offering a unique overview of the mechanisms underlying the disease. As SARS-CoV-2 infectibility and ACE2 activity are the major starting points and inflammatory response is central in the development of COVID-19, we evaluated how those eleven intrinsic and extrinsic factors modulate those processes impacting clinical outcomes. Applying this AOP-aligned approach enables the identification of current knowledge gaps orientating for further research and allows to propose biomarkers to identify of high-risk patients. This approach also facilitates expertise synergy from different disciplines to address public health issues.
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Affiliation(s)
- Laure-Alix Clerbaux
- European Commission, Joint Research Centre (JRC), 21027 Ispra, Italy; (S.C.); (E.P.D.); (N.P.); (M.P.); (B.L.)
| | | | - Núria Amigó
- Biosfer Teslab SL., 43204 Reus, Spain;
- Department of Basic Medical Sciences, Universitat Rovira i Virgili (URV), 23204 Reus, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
| | - Anna Beronius
- Institute of Environmental Medicine, Karolinska Institutet, 17177 Stockholm, Sweden;
| | - Gillina F. G. Bezemer
- Impact Station, 1223 JR Hilversum, The Netherlands;
- Department of Pharmaceutical Sciences, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3584 CG Utrecht, The Netherlands
| | - Sandra Coecke
- European Commission, Joint Research Centre (JRC), 21027 Ispra, Italy; (S.C.); (E.P.D.); (N.P.); (M.P.); (B.L.)
| | - Evangelos P. Daskalopoulos
- European Commission, Joint Research Centre (JRC), 21027 Ispra, Italy; (S.C.); (E.P.D.); (N.P.); (M.P.); (B.L.)
| | - Giusy del Giudice
- Finnish Hub for Development and Validation of Integrated Approaches (FHAIVE), Faculty of Medicine and Health Technology, Tampere University, 33100 Tampere, Finland; (G.d.G.); (D.G.); (L.A.S.)
| | - Dario Greco
- Finnish Hub for Development and Validation of Integrated Approaches (FHAIVE), Faculty of Medicine and Health Technology, Tampere University, 33100 Tampere, Finland; (G.d.G.); (D.G.); (L.A.S.)
| | - Lucia Grenga
- Département Médicaments et Technologies pour la Santé (DMTS), Université Paris-Saclay, CEA, INRAE, SPI, F-30200 Bagnols-sur-Ceze, France;
| | - Alberto Mantovani
- Department of Food Safety, Nutrition and Veterinary Public Health, Istituto Superiore di Sanità, 00161 Rome, Italy;
| | - Amalia Muñoz
- European Commission, Joint Research Centre (JRC), 2440 Geel, Belgium;
| | - Elma Omeragic
- Faculty of Pharmacy, University of Sarajevo, 71000 Sarajevo, Bosnia and Herzegovina;
| | - Nikolaos Parissis
- European Commission, Joint Research Centre (JRC), 21027 Ispra, Italy; (S.C.); (E.P.D.); (N.P.); (M.P.); (B.L.)
| | - Mauro Petrillo
- European Commission, Joint Research Centre (JRC), 21027 Ispra, Italy; (S.C.); (E.P.D.); (N.P.); (M.P.); (B.L.)
| | - Laura A. Saarimäki
- Finnish Hub for Development and Validation of Integrated Approaches (FHAIVE), Faculty of Medicine and Health Technology, Tampere University, 33100 Tampere, Finland; (G.d.G.); (D.G.); (L.A.S.)
| | - Helena Soares
- Laboratory of Immunobiology and Pathogenesis, Chronic Diseases Research Centre, Faculdade de Ciências Médicas Medical School, University of Lisbon, 1649-004 Lisbon, Portugal;
| | - Kristie Sullivan
- Physicians Committee for Responsible Medicine, Washington, DC 20016, USA;
| | - Brigitte Landesmann
- European Commission, Joint Research Centre (JRC), 21027 Ispra, Italy; (S.C.); (E.P.D.); (N.P.); (M.P.); (B.L.)
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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: 06/24/2022] [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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Niraula A, Baral N, Lamsal M, Bataju M, Thapa S. Potential role of biochemical markers in the prognosis of COVID-19 patients. SAGE Open Med 2022; 10:20503121221108613. [PMID: 35832258 PMCID: PMC9272200 DOI: 10.1177/20503121221108613] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 06/01/2022] [Indexed: 01/08/2023] Open
Abstract
The global pandemic due to coronavirus disease 2019 (COVID-19) has posed an overall threat to modern medicine. The course of the disease is uncertain with varying forms of presentation that cannot be managed solely with clinical skills and vigor. Since its inception, laboratory medicine forms a backbone for the proper diagnosis, treatment, monitoring, and prediction of the severity of the disease. Clinical biochemistry, an integral component of laboratory medicine, has been an unsung hero in the disease prognosis and severity assessment in COVID-19. This review attempts to highlight the biomarkers which have shown a significant role and can be used in the identification, stratification, and prediction of disease severity in COVID-19 patients. It also highlights the basis of the use of these biomarkers in the disease course and their implications.
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Affiliation(s)
- Apeksha Niraula
- Department of Clinical Biochemistry, Institute of Medicine, Tribhuvan University Teaching Hospital, Maharajgunj, Nepal
| | - Nirmal Baral
- Department of Biochemistry, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Madhab Lamsal
- Department of Biochemistry, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Mahima Bataju
- Department of Biochemistry, KIST Medical College and Teaching Hospital, Lalitpur, Nepal
| | - Saroj Thapa
- Department of Biochemistry, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
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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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Cersosimo A, Cimino G, Amore L, Calvi E, Pascariello G, Inciardi RM, Lombardi CM, Vizzardi E, Metra M. Cardiac biomarkers and mortality in COVID-19 infection: A review. Monaldi Arch Chest Dis 2022; 93. [PMID: 35736404 DOI: 10.4081/monaldi.2022.2276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 06/16/2022] [Indexed: 12/15/2022] Open
Abstract
Lots of meta-analysis emphasize that a great number of hospitalized patients with moderate and severe forms of COVID-19 developed acute myocardial damage, defined as an increase of cardiac biomarkers, such N-terminal pro-B-type natriuretic peptide (NT-pro-BNP), creatine kinase-myocardial band (CK-MB) and of all type of troponins. The highest mortality rate is related with progressively increasing biomarkers levels and with a history of cardiovascular disease. In fact, the biomarkers dosage should be considered as a prognostic marker in all patients with COVID-19 disease at admission, during hospitalization and in the case of clinical deterioration. The purpose of this review is to evaluate cardiovascular prognostic factors in COVID-19 disease throughout the analysis of cardiac biomarkers to early identify the most serious patients and to optimize their outcomes.
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Affiliation(s)
- Angelica Cersosimo
- Department of Medical and Surgical Specialties, Institute of Cardiology, University of Brescia.
| | - Giuliana Cimino
- Department of Medical and Surgical Specialties, Institute of Cardiology, University of Brescia.
| | - Ludovica Amore
- Department of Medical and Surgical Specialties, Institute of Cardiology, University of Brescia.
| | - Emiliano Calvi
- Department of Medical and Surgical Specialties, Institute of Cardiology, University of Brescia.
| | - Greta Pascariello
- Department of Medical and Surgical Specialties, Institute of Cardiology, University of Brescia.
| | - Riccardo Maria Inciardi
- Department of Medical and Surgical Specialties, Institute of Cardiology, University of Brescia.
| | - Carlo Mario Lombardi
- Department of Medical and Surgical Specialties, Institute of Cardiology, University of Brescia.
| | - Enrico Vizzardi
- Department of Medical and Surgical Specialties, Institute of Cardiology, University of Brescia.
| | - Marco Metra
- Department of Medical and Surgical Specialties, Institute of Cardiology, University of Brescia.
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Ogungbe O, Kumbe B, Fadodun OA, Latha T, Meyer D, Asala AF, 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. IJC 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] [Journal Information] [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
- Johns Hopkins University Bloomberg School of Public Health, 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 Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Wendy S. Post
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yvonne Commodore-Mensah
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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B-Type Natriuretic Peptide at Admission Is a Predictor of All-Cause Mortality at One Year after the First Acute Episode of New-Onset Heart Failure with Preserved Ejection Fraction. J Pers Med 2022; 12:jpm12060890. [PMID: 35743676 PMCID: PMC9225135 DOI: 10.3390/jpm12060890] [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: 04/29/2022] [Revised: 05/11/2022] [Accepted: 05/23/2022] [Indexed: 11/21/2022] Open
Abstract
Background: Heart failure with preserved ejection fraction (HFpEF) has been assessed extensively, but few studies analysed the predictive value of the NT-proBNP in patients with de novo and acute HFpEF. We sought to identify NT-proBNP at admission as a predictor for all-cause mortality and rehospitalisation at 12 months in patients with new-onset HFpEF. Methods: We analysed 91 patients (73 ± 11 years, 68% females) admitted for de novo and acute HFpEF, using the Cox proportional hazard risk model. Results: An admission NT-proBNP level above the threshold of 2910 pg/mL identified increased all-cause mortality at 12 months (AUC = 0.72, sensitivity = 92%, specificity = 53%, p < 0.001). All-cause mortality adjusted for age, gender, medical history, and medication in the augmented NT-proBNP group was 16-fold higher (p = 0.018), but with no difference in rehospitalisation rates (p = 0.391). The predictors of increased NT-proBNP ≥ 2910 pg/mL were: age (p = 0.016), estimated glomerular filtration rate (p = 0.006), left atrial volume index (p = 0.001), history of atrial fibrillation (p = 0.006), and TAPSE (p = 0.009). Conclusions: NT-proBNP above 2910 pg/mL at admission for de novo and acute HFpEF predicted a 16-fold increased mortality at 12 months, whereas values less than 2910 pg/mL forecast a high likelihood of survival (99.3%) in the next 12 months, and should be considered as a useful prognostic tool, in addition to its utility in diagnosing heart failure.
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Long-term cardio-vascular risk assessment in chronic kidney disease and kidney transplanted patients following SARS-COV-2 disease: protocol for multi-center observational match controlled trial. BMC Nephrol 2022; 23:176. [PMID: 35524223 PMCID: PMC9077937 DOI: 10.1186/s12882-022-02809-4] [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: 04/05/2022] [Accepted: 04/29/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The coronavirus disease (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) produced a pandemic since March 2020 by affecting more than 243 million people with more than 5 million deaths globally. SARS-CoV-2 infection is produced by binding to angiotensin-converting enzyme, which among other sites is highly expressed in the endothelial cells of the blood vessels, pericytes and the heart, as well as in renal podocytes and proximal tubular epithelial cells. SARS-CoV-2 and cardiovascular disease (CVD) are interconnected by risk factors association with an increased incidence of the disease and by determining de novo cardiac complications. At the same time, COVID-19 disease can lead to acute kidney injury directly, or due to sepsis, multi-organ failure and shock. Therefore, the pre-existence of both CVD and chronic kidney disease (CKD) is linked with a higher risk of severe disease and worse prognosis. METHODS The main aim of this study is to assess the CV risk in a CKD (stage 3 to 5), dialysis and kidney transplanted population, following SARS-CoV-2 infection, with focus on the endothelial dysfunction as compared to a control group of matched patients. By using clinical evaluation, flow-mediated dilatation, carotid-femoral pulse wave velocity, intima-media thickness, echocardiographic parameters, lung ultrasound, bioimpedance spectroscopy and a series of novel biomarkers, the investigators will determine the long-term impact of this disease on CV and renal outcomes. DISCUSSION This study will address the challenges and implications in long-term CV sequeale of COVID-19 and focus on a better understanding of the underlying mechanisms and possible therapeutic options. TRIAL REGISTRATION Patient enrolment in the trial started in January 2021 and is expected to finish at the end of 2022. The study can be found on ClinicalTrials.gov database with NCT05125913 identifier. Registered on 18 November 2021 - Retrospectively registered.
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Impacto de la fragilidad en la enfermedad por COVID-19 en una cohorte de gente mayor de la ciudad de Barcelona. Aten Primaria 2022; 54:102393. [PMID: 35779366 PMCID: PMC9125044 DOI: 10.1016/j.aprim.2022.102393] [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: 02/23/2022] [Revised: 05/06/2022] [Accepted: 05/14/2022] [Indexed: 12/02/2022] Open
Abstract
Objetivo Describir la incidencia y mortalidad de COVID-19, durante la primera ola, en la población de personas mayores de Barcelona, según sus niveles previos de fragilidad. Diseño Estudio de cohortes retrospectivo. Emplazamiento y participantes Población de 65 o más años asignada a los centros de Atención Primaria de Barcelona del Institut Català de la Salut, seguidos entre marzo y junio de 2020. Mediciones principales Fragilidad calculada al inicio a partir de la historia clínica informatizada. Resultados durante el seguimiento: diagnóstico de COVID-19, posible o confirmado con PCR y mortalidad por todas las causas. Resultados Se analizaron 251788 mayores de 64 años. Un 61,3% tenían algún nivel de fragilidad, 27,8% moderada o grave. La incidencia de COVID-19 fue de 3,13 casos por 100 habitantes (N = 7883) y la mortalidad por COVID-19 fue del 21,5% (N =1 691). Tanto la incidencia como la mortalidad por COVID-19 fueron superiores a mayor edad, en hombres, a mayor privación y a mayor nivel de fragilidad. Los individuos con fragilidad leve, moderada y grave tuvieron un hazard ratio ajustado de enfermedad por COVID-19 de 1,47, 2,08 y 3,50 respectivamente. Entre los sujetos con COVID-19, aquéllos con fragilidad leve, moderada y grave tuvieron un hazard ratio ajustado de mortalidad por COVID-19 de 1,44, 1,69 y 2,47 respectivamente. Conclusiones Consideramos necesario el abordaje de la fragilidad también en situación de pandemia, dado que es una condición tratable y a su vez factor de riesgo de COVID-19 más grave, donde el papel de la Atención Primaria es primordial, por su accesibilidad y longitudinalidad.
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Implications of microvascular dysfunction and nitric oxide mediated inflammation in severe COVID-19 infection. Am J Med Sci 2022; 364:251-256. [PMID: 35469768 PMCID: PMC9027037 DOI: 10.1016/j.amjms.2022.04.015] [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: 01/26/2021] [Revised: 03/01/2022] [Accepted: 04/14/2022] [Indexed: 12/12/2022]
Abstract
Infection with COVID-19 has resulted in over 276,000 deaths in the United States and over 1.5 million deaths globally, with upwards of 15% of patients requiring hospitalization. Severe COVID-19 infection is, in essence, a microvascular disease. This contention has been emphasized throughout the course of the pandemic, particularly due to the clinical manifestation of severe infection. In fact, it has been hypothesized and shown in particular instances that microvascular function is a significant prognosticator for morbidity and mortality. Initially thought to be isolated to the pulmonary system and resulting in ARDS, patients with COVID-19 have been observed to have acute cardiac, renal, and thrombolytic complications. Therefore, severe COVID-19 is a vascular disease that has systemic implications. The objective of this review is to provide a mechanistic background for the microvascular nature of severe COVID-19 infection, with a particular emphasis on dysfunction of the endothelial glycocalyx and nitric oxide mediated pathogenesis.
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Zuin M, Rigatelli G, Bilato C, Zuliani G, Roncon L. Heart failure as a complication of COVID-19 infection: systematic review and meta-analysis. Acta Cardiol 2022; 77:107-113. [PMID: 34080948 DOI: 10.1080/00015385.2021.1890925] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND/OBJECTIVES The prevalence and prognostic implications of heart failure (HF), as a complication of COVID-19 infection remains unclear. We performed a systematic review and metanalysis aimed to evaluate the pooled incidence of acute HF as a cardiac complication of COVID-19 disease and to estimate the related mortality risk in these patients. METHODS Data were obtained searching MEDLINE, Scopus and Web of Science for all investigations published any time to 26 December 2020. If statistical heterogeneity was 50%, the results were derived from the fixed-effects model otherwise the random-effects model. RESULTS Overall, 1064 patients [mean age 66 years, 618 males] were included in the final analysis reviewing six investigations. The cumulative in-hospital rate of COVID-19 patients complicated by acute HF ranged between 6.9 and 63.4% among the studies reviewed. A random effect model revealed a pooled incidence of COVID-19 patients complicated by acute HF in 20.2% of cases (95% CI: 11.1-33.9%, p < 0.0001 I2 = 94.4%). A second pooled analysis, based on a random-effect model, confirmed a significant increased risk of death in COVID-19 patients complicated by acute HF during the infection (OR 9.36, 95% CI 4.76-18.4, p < 0.0001, I2 = 56.6%). Meta-regression analysis, using age as moderator variable, failed in founding a statistically significant relationship with the incidence of acute HF onset as a complication of COVID-19 disease (p = 0.062) or the mortality risk among the same subjects (p = 0.053). CONCLUSIONS Acute HF represents a frequent complication of COVID-19 infection associated with a higher risk of mortality in the short-term period.
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Affiliation(s)
- Marco Zuin
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Gianluca Rigatelli
- Department of Cardiology, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Claudio Bilato
- Division of Cardiology, West Vicenza General Hospitals, Arzignano, Italy
| | - Giovanni Zuliani
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Loris Roncon
- Department of Cardiology, Santa Maria della Misericordia Hospital, Rovigo, Italy
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Zhao Y, Lyu N, Zhang W, Tan H, Jin Q, Dang A. Prognosis Implication of N-Terminal Pro-B-Type Natriuretic Peptide in Adult Patients With Acute Myocarditis. Front Cardiovasc Med 2022; 9:839763. [PMID: 35433855 PMCID: PMC9009355 DOI: 10.3389/fcvm.2022.839763] [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: 12/20/2021] [Accepted: 03/10/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe aim of this study is to investigate the role of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in assessing the poor outcomes of adult patients with acute myocarditis.MethodsA total of 170 adult patients with available NT-proBNP information were included in the study. They were grouped according to quartiles of NT-proBNP concentrations at admission. Baseline and follow-up information was collected. Thirty-day major adverse cardiac events (MACE) were death and heart transplantation. Long-term MACE included all-cause death, heart transplantation, re-hospitalization due to heart failure, sustained ventricular arrhythmia, and myocarditis relapse.ResultsDuring a median follow-up of 3.8 years, patients in the highest NT-proBNP quartile suffered from the highest risk both of 30-day and long-term MACE (P < 0.001 by log-rank test). Multivariate analysis showed that apart from left ventricular ejection fraction (LVEF), an increased baseline NT-proBNP > 3,549 pg/mL (hazard ratio 3.535, 95% CI 1.316–9.499, P = 0.012) and NT-proBNP > 7,204 pg/mL (hazard ratio 22.261, 95% CI 1.976–250.723, P = 0.012) was independent predictor of long-term and 30-day MACE, respectively.ConclusionsHigher baseline NT-proBNP level was an independent predictor of poor outcomes in adult patients with acute myocarditis. Therefore, NT-proBNP may serve as a useful biomarker for risk stratification in acute myocarditis patients.
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Affiliation(s)
- Yan Zhao
- State Key Laboratory of Cardiovascular Disease, Department of Special Care Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Naqiang Lyu
- State Key Laboratory of Cardiovascular Disease, Department of Special Care Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Zhang
- State Key Laboratory of Cardiovascular Disease, Department of Special Care Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Huiqiong Tan
- Emergency and Critical Care Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qi Jin
- Center for Pulmonary Vascular Diseases, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China
| | - Aimin Dang
- State Key Laboratory of Cardiovascular Disease, Department of Special Care Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Aimin Dang
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