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Gajula SNR, Khairnar AS, Jock P, Kumari N, Pratima K, Munjal V, Kalan P, Sonti R. LC-MS/MS: A sensitive and selective analytical technique to detect COVID-19 protein biomarkers in the early disease stage. Expert Rev Proteomics 2023; 20:5-18. [PMID: 36919634 DOI: 10.1080/14789450.2023.2191845] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
INTRODUCTION The COVID-19 outbreak has put enormous pressure on the scientific community to detect infection rapidly, identify the status of disease severity, and provide an immediate vaccine/drug for the treatment. Relying on immunoassay and a real-time reverse transcription polymerase chain reaction (rRT-PCR) led to many false-negative and false-positive reports. Therefore, detecting biomarkers is an alternative and reliable approach for determining the infection, its severity, and disease progression. Recent advances in liquid chromatography and mass spectrometry (LC-MS/MS) enable the protein biomarkers even at low concentrations, thus facilitating clinicians to monitor the treatment in hospitals. AREAS COVERED This review highlights the role of LC-MS/MS in identifying protein biomarkers and discusses the clinically significant protein biomarkers such as Serum amyloid A, Interleukin-6, C-Reactive Protein, Lactate dehydrogenase, D-dimer, cardiac troponin, ferritin, Alanine transaminase, Aspartate transaminase, gelsolin and galectin-3-binding protein in COVID-19, and their analysis by LC-MS/MS in the early stage. EXPERT OPINION Clinical doctors monitor significant biomarkers to understand, stratify, and treat patients according to disease severity. Knowledge of clinically significant COVID-19 protein biomarkers is critical not only for COVID-19 caused by the coronavirus but also to prepare us for future pandemics of other diseases in detecting by LC-MS/MS at the early stages.
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Affiliation(s)
- Siva Nageswara Rao Gajula
- Department of Pharmaceutical Analysis, National Institute of Pharmaceutical Education and Research (NIPER), Hyderabad, Balanagar, India
| | - Ankita Sahebrao Khairnar
- Department of Pharmaceutical Analysis, National Institute of Pharmaceutical Education and Research (NIPER), Hyderabad, Balanagar, India
| | - Pallavi Jock
- Department of Pharmaceutical Analysis, National Institute of Pharmaceutical Education and Research (NIPER), Hyderabad, Balanagar, India
| | - Nikita Kumari
- Department of Pharmaceutical Analysis, National Institute of Pharmaceutical Education and Research (NIPER), Hyderabad, Balanagar, India
| | - Kendre Pratima
- Department of Pharmaceutical Analysis, National Institute of Pharmaceutical Education and Research (NIPER), Hyderabad, Balanagar, India
| | - Vijay Munjal
- Department of Pharmaceutical Analysis, National Institute of Pharmaceutical Education and Research (NIPER), Hyderabad, Balanagar, India
| | - Pavan Kalan
- Department of Pharmaceutical Analysis, National Institute of Pharmaceutical Education and Research (NIPER), Hyderabad, Balanagar, India
| | - Rajesh Sonti
- Department of Pharmaceutical Analysis, National Institute of Pharmaceutical Education and Research (NIPER), Hyderabad, Balanagar, India
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Naeem A, Tabassum S, Gill S, Khan MZ, Mumtaz N, Qaiser Q, Karamat M, Arif M, Naeem F, Afifi A, Basit J, Nashwan AJ. COVID-19 and Cardiovascular Diseases: A Literature Review From Pathogenesis to Diagnosis. Cureus 2023; 15:e35658. [PMID: 37009373 PMCID: PMC10065369 DOI: 10.7759/cureus.35658] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2023] [Indexed: 03/05/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) took the world by storm after the first case of COVID-19 emerged in China on December 8, 2019. The disease is generally considered as an infection of the respiratory system, but serious life-threatening myocardial injuries have been reported with this infection. Coronavirus can damage cardiac myocytes by entering the cell through angiotensin-converting enzyme 2 (ACE-2) receptor binding. Myocardial infarction, myocarditis, heart failure, cardiac arrhythmias, and Takotsubo cardiomyopathy are cardiac clinical manifestations commonly seen among patients affected by COVID-19. These cardiac pathologies are seen both during ongoing infection and post-infection. Elevated levels of myoglobin, troponin, creatine kinase-MB, plasma interleukin-6, lactate dehydrogenase (LDH), and N-terminal pro-b-type natriuretic peptide (NT-proBNP) have been found in COVID-19-associated myocardial injuries. The diagnostic modalities used in myocardial injuries due to COVID-19 include electrocardiography (ECG), cardiac magnetic resonance imaging (CMR), endomyocardial biopsy, echocardiography (Echo), and computerized tomography (CT-Scan). This literature review will discuss, in detail, the pathogenesis, clinical manifestations, and diagnosis of myocardial injuries due to COVID-19.
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Affiliation(s)
- Aroma Naeem
- Internal Medicine, Mayo Hospital, Lahore, Lahore, PAK
| | | | - Saima Gill
- Internal Medicine, Mayo Hospital, Lahore, Lahore, PAK
| | | | - Nimra Mumtaz
- Internal Medicine, Mayo Hospital, Lahore, Lahore, PAK
| | - Qamoos Qaiser
- Medicine and Surgery, Lahore General Hospital, Lahore, PAK
| | | | - Mashhood Arif
- Internal Medicine, Aziz Fatimah Medical and Dental College, Faisalabad, PAK
| | - Farhan Naeem
- Internal Medicine, Mayo Hospital, Lahore, Lahore, PAK
| | | | - Jawad Basit
- Medicine, Holy Family Hospital, Rawalpindi, PAK
- Cardiology, Rawalpindi Medical University, Rawalpindi, PAK
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Keefe JA, Avadhanula V, Nicholson EG, Devaraj S, Piedra PA, Bozkurt B, Wehrens XH. Abnormalities in cardiac and inflammatory biomarkers in ambulatory subjects after COVID-19 infection. IJC HEART & VASCULATURE 2022; 43:101144. [PMID: 36321063 PMCID: PMC9613792 DOI: 10.1016/j.ijcha.2022.101144] [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: 10/17/2022] [Revised: 10/22/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022]
Abstract
Background Coronavirus-2019 (COVID-19) is known to affect the heart and is associated with a pro-inflammatory state. Most studies to date have focused on clinically sick subjects. Here, we report cardiac and proinflammatory biomarkers levels in ambulatory young adults with asymptomatic or mild COVID-19 infection compared to those without infection 4-8 weeks after severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) testing. Methods 131 asymptomatic or mildly symptomatic subjects were enrolled following testing for SARS-COV-2. Fifty subjects tested negative, and 81 subjects tested positive. Serum samples were collected for measurement of C-reactive protein, ferritin, interleukin-6, NT-pro-B-type natriuretic peptide, and cardiac troponin 28-55 days after SARS-COV-2 RT-PCR testing. Results Biomarker levels trended higher in SARS-COV-2-positive vs negative subjects, but differences in biomarker levels or proportion of subjects with elevated biomarkers were not statistically significant with respect to SARS-COV-2 status. Among individuals with ≥ 1 comorbidity, odds of elevated CRP were greater compared to individuals without any comorbidities (odds ratio [OR] = 2.90); this effect size was increased 1.4-fold among SARS-COV-2-positive subjects (OR = 4.03). Similarly, NT-pro-BNP was associated with CVD, with the strongest association in COVID-positive individuals (OR = 16.9). Conclusions In a relatively young, healthy adult population, mild COVID-19 infection was associated with mild elevations in cardiac and proinflammatory biomarkers within 4-8 weeks of mild or asymptomatic COVID-19 infection in individuals with preexisting comorbidities, but not among individuals without comorbidities. For the general population of young adults, we did not find evidence of elevation of cardiac or proinflammatory biomarkers 4-8 weeks after COVID-19 infection.Clinical Perspective: This is a characterization of cardiac and proinflammatory biomarkers in ambulatory subjects following asymptomatic or mild COVID-19 infection. Young, ambulatory individuals did not have cardiac and proinflammatory biomarker elevation 4-8 weeks after mild COVID-19 infection. However, COVID-19 infection was associated with biomarker elevations in select individuals with comorbidities.Clinical study number: H-47423.
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Affiliation(s)
- Joshua A. Keefe
- Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX 77030, USA
- Department of Integrative Physiology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Vasanthi Avadhanula
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Erin G. Nicholson
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Sridevi Devaraj
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Pedro A. Piedra
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Biykem Bozkurt
- Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX 77030, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Xander H.T. Wehrens
- Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX 77030, USA
- Department of Integrative Physiology, Baylor College of Medicine, Houston, TX 77030, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
- Department of Neuroscience, Baylor College of Medicine, Houston, TX 77030, USA
- Center for Space Medicine, Baylor College of Medicine, Houston, TX 77030, USA
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Muthyala A, Sasidharan S, John KJ, Lal A, Mishra AK. Utility of cardiac bioenzymes in predicting cardiovascular outcomes in SARS-CoV-2. World J Virol 2022; 11:375-390. [PMID: 36188743 PMCID: PMC9523328 DOI: 10.5501/wjv.v11.i5.375] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/12/2022] [Accepted: 08/10/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Cardiovascular complications have been increasingly recognized in the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) associated coronavirus disease 2019 (COVID-19). Cardiac biomarkers are released because of this ongoing cardiovascular injury and can act as surrogate markers to assess the disease severity. AIM To review the variation and utility of these biomarkers in COVID-19 to ascertain their role in diagnosis, prognosis and clinical outcomes of the disease. METHODS We performed a literature search in PubMed, Medline and the Reference Citation Analysis (RCA), using the search terms "COVID-19" and "cardiac bioenzymes" or "cardiac biomarkers". Additionally, we also used the latest reference citation analysis tool to identify more articles. RESULTS Cardiac troponin has been consistently elevated in patients with COVID-19 associated myocarditis, and strongly correlated with adverse prognosis. Natri-uretic peptides including brain natriuretic peptide (BNP) and pro-BNP is elevated in patients with COVID-19 associated cardiac injury, irrespective of their prior heart failure status, and independently correlated with worst outcomes. Alongside these traditional biomarkers, novel cardiac bioenzymes including presepsin, soluble ST2 and copeptin, are also increasingly recognized as markers of cardiovascular injury in COVID-19 and can be associated with poor outcomes. CONCLUSION Assessment of cardiac bioenzymes at admission and their serial monitoring can help assess the severity of disease and predict mortality in patients with SARS-CoV-2 infection. Future studies are needed to elude the critical importance of novel biomarkers.
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Affiliation(s)
- Anjani Muthyala
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Sandeep Sasidharan
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Kevin John John
- Department of Critical Care, Belivers Church Medical College Hospital, Thiruvalla 689103, Kerela, India
| | - Amos Lal
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN 55905, United States
| | - Ajay K Mishra
- Department of Cardiology, Saint Vincent Hospital, Worcester, MA 01608, United States
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Wollborn J, Karamnov S, Fields KG, Yeh T, Muehlschlegel JD. COVID-19 increases the risk for the onset of atrial fibrillation in hospitalized patients. Sci Rep 2022; 12:12014. [PMID: 35835807 PMCID: PMC9281233 DOI: 10.1038/s41598-022-16113-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 07/05/2022] [Indexed: 11/27/2022] Open
Abstract
COVID-19 is associated with significant extrapulmonary symptoms. Myocardial involvement has been described for infections with SARS-CoV-2 which may lead to an increase in morbidity and mortality. The objective of our study was to investigate the association of COVID-19 and atrial fibrillation (AF) or atrial flutter (AFl) in hospitalized patients. This retrospective study used electronic medical records to detect patients with COVID-19 and their comorbidities within the Mass General Brigham hospital system. All patients ≥ 18 years who were hospitalized and received a PCR test for SARS-CoV-2 were screened for inclusion as well as patients from a pre-pandemic cohort. We matched on common risk factors for AF and then used multivariable logistic regression to estimate the odds for AF or AFl. Of 78,725 patients eligible for analysis, 11,004 COVID-19 negative patients were matched to 3,090 COVID-19 positive patients and 5005 pre-pandemic patients were matched to 2283 COVID-19 positive patients. After adjusting for demographics and comorbidities, COVID-19 positive patients had 1.19 times the odds (95% CI 1.00, 1.41) of developing AF compared to COVID-19 negative patients and 1.57 times the odds (95% CI 1.23, 2.00) of developing AF compared to pre-pandemic patients. Our study demonstrated an increased risk for AF, directing the attention for improved screening and treatment regimens for the sequelae of COVID-19. While COVID-19 continues to affect many people around the world, AF may be a significant cause for morbidity and mortality. Adequate detection and treatment of AF is essential to reduce the burden of disease.
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Affiliation(s)
- Jakob Wollborn
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA
| | - Sergey Karamnov
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA
| | - Kara G Fields
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA
| | - Tiffany Yeh
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA
| | - Jochen D Muehlschlegel
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA.
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Levi Y, Yamin D, Brandes T, Shmueli E, Patalon T, Peretz A, Gazit S, Nahir B. Early Oxygen Treatment Measurements Can Predict COVID-19 Mortality: A Preliminary Study. Healthcare (Basel) 2022; 10:1146. [PMID: 35742198 PMCID: PMC9222284 DOI: 10.3390/healthcare10061146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/08/2022] [Accepted: 06/14/2022] [Indexed: 01/08/2023] Open
Abstract
Halting the rapid clinical deterioration, marked by arterial hypoxemia, is among the greatest challenges clinicians face when treating COVID-19 patients in hospitals. While it is clear that oxygen measures and treatment procedures describe a patient's clinical condition at a given time point, the potential predictive strength of the duration and extent of oxygen supplementation methods over the entire course of hospitalization for a patient death from COVID-19 has yet to be assessed. In this study, we aim to develop a prediction model for COVID-19 mortality in hospitals by utilizing data on oxygen supplementation modalities of patients. We analyzed the data of 545 patients hospitalized with COVID-19 complications admitted to Assuta Ashdod Medical Center, Israel, between 7 March 2020, and 16 March 2021. By solely analyzing the daily data on oxygen supplementation modalities in 182 random patients, we could identify that 75% (9 out of 12) of individuals supported by reservoir oxygen masks during the first two days died 3-30 days following hospital admission. By contrast, the mortality rate was 4% (4 out of 98) among those who did not require any oxygenation supplementation. Then, we combined this data with daily blood test results and clinical information of 545 patients to predict COVID-19 mortality. Our Random Forest model yielded an area under the receiver operating characteristic curve (AUC) score on the test set of 82.5%, 81.3%, and 83.0% at admission, two days post-admission, and seven days post-admission, respectively. Overall, our results could essentially assist clinical decision-making and optimized treatment and management for COVID-19 hospitalized patients with an elevated risk of mortality.
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Affiliation(s)
- Yosi Levi
- Department of Industrial Engineering, Tel Aviv University, Tel Aviv 69978, Israel; (Y.L.); (T.B.); (E.S.)
| | - Dan Yamin
- Department of Industrial Engineering, Tel Aviv University, Tel Aviv 69978, Israel; (Y.L.); (T.B.); (E.S.)
- Center for Combatting Pandemics, Tel Aviv University, Tel Aviv 69978, Israel
| | - Tomer Brandes
- Department of Industrial Engineering, Tel Aviv University, Tel Aviv 69978, Israel; (Y.L.); (T.B.); (E.S.)
| | - Erez Shmueli
- Department of Industrial Engineering, Tel Aviv University, Tel Aviv 69978, Israel; (Y.L.); (T.B.); (E.S.)
| | - Tal Patalon
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv 68125, Israel; (T.P.); (S.G.); (B.N.)
| | - Asaf Peretz
- Internal Medicine COVID-19 Ward, Samson Assuta Ashdod University Hospital, Ashdod 7747629, Israel;
| | - Sivan Gazit
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv 68125, Israel; (T.P.); (S.G.); (B.N.)
| | - Barak Nahir
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv 68125, Israel; (T.P.); (S.G.); (B.N.)
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de Falco R, Vargas M, Palma D, Savoia M, Miscioscia A, Pinchera B, Vano M, Servillo G, Gentile I, Fortunato G. B-Type Natriuretic Peptides and High-Sensitive Troponin I as COVID-19 Survival Factors: Which One Is the Best Performer? J Clin Med 2021; 10:2726. [PMID: 34205536 PMCID: PMC8235158 DOI: 10.3390/jcm10122726] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/04/2021] [Accepted: 06/18/2021] [Indexed: 02/06/2023] Open
Abstract
Increased concentrations of B-type natriuretic peptide (BNP), N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity troponin I (HsTnI) in COVID-19 patients have already been reported. The aim of this study is to evaluate which of these common markers of cardiac disease is the most useful predictor of fatal outcome in COVID-19 patients. One hundred and seventy-four patients affected with COVID-19 were recruited, and markers of cardiac disease and the clinical history of the patients were collected at admission in the infectious disease unit or intensive care unit. NT-proBNP, BNP and HsTnI values were higher in in-hospital non-surviving patients. Receiver operating characteristic (ROC) curve analysis of NT-proBNP, BNP and HsTnI was performed, with NT-proBNP (AUC = 0.951) and HsTnI (AUC = 0.947) being better performers (p = 0.01) than BNP (AUC = 0.777). Logistic regression was performed assessing the relation of HsTnI and NT-proBNP to fatal outcome adjusting for age and gender, with only NT-proBNP being significant. The population was then divided into two groups, one with higher NT-proBNP values at admission than the cut-off resulted from the ROC curve (511 ng/L) and a second one with lower values. The Kaplan-Meier analysis showed an absence of fatal outcome in the group of patients with NT-proBNP values lower than the cut-off (p < 0.001). NT-proBNP proved to be the best prognostic tool for fatal outcome among markers of cardiac disease in COVID-19 patients.
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Affiliation(s)
- Renato de Falco
- Department of Biochemistry and Medical Biotechnology, University of Naples “Federico II”, Via Sergio Pansini 5, 80131 Naples, Italy; (R.d.F.); (D.P.); (M.S.); (A.M.); (M.V.)
| | - Maria Vargas
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Via Sergio Pansini 5, 80131 Naples, Italy; (M.V.); (G.S.)
| | - Daniela Palma
- Department of Biochemistry and Medical Biotechnology, University of Naples “Federico II”, Via Sergio Pansini 5, 80131 Naples, Italy; (R.d.F.); (D.P.); (M.S.); (A.M.); (M.V.)
- CEINGE Biotecnologie Avanzate s.c. a r.l., Via Gaetano Salvatore 486, 80145 Naples, Italy
| | - Marcella Savoia
- Department of Biochemistry and Medical Biotechnology, University of Naples “Federico II”, Via Sergio Pansini 5, 80131 Naples, Italy; (R.d.F.); (D.P.); (M.S.); (A.M.); (M.V.)
| | - Anna Miscioscia
- Department of Biochemistry and Medical Biotechnology, University of Naples “Federico II”, Via Sergio Pansini 5, 80131 Naples, Italy; (R.d.F.); (D.P.); (M.S.); (A.M.); (M.V.)
| | - Biagio Pinchera
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples “Federico II”, Via Sergio Pansini 5, 80131 Naples, Italy; (B.P.); (I.G.)
| | - Martina Vano
- Department of Biochemistry and Medical Biotechnology, University of Naples “Federico II”, Via Sergio Pansini 5, 80131 Naples, Italy; (R.d.F.); (D.P.); (M.S.); (A.M.); (M.V.)
| | - Giuseppe Servillo
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Via Sergio Pansini 5, 80131 Naples, Italy; (M.V.); (G.S.)
| | - Ivan Gentile
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples “Federico II”, Via Sergio Pansini 5, 80131 Naples, Italy; (B.P.); (I.G.)
- Staff UNESCO Chair for Health Education and Sustainable Development, University of Naples Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Giuliana Fortunato
- Department of Biochemistry and Medical Biotechnology, University of Naples “Federico II”, Via Sergio Pansini 5, 80131 Naples, Italy; (R.d.F.); (D.P.); (M.S.); (A.M.); (M.V.)
- CEINGE Biotecnologie Avanzate s.c. a r.l., Via Gaetano Salvatore 486, 80145 Naples, Italy
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Abstract
Pre-existing heart failure (HF) in diagnosed patients with coronavirus disease 2019 (COVID-19) is associated with a close to two-fold increased mortality rate compared to COVID-19 patients without prior HF history. Moreover, based both on biomarker as well as imaging findings, widespread endothelial and cardiac injury seems to be present in many patients presenting with COVID-19, associated with adverse outcomes including new onset HF. Systematic echocardiographic studies in patients with COVID-19 indicate that the most common cardiac pathology is right ventricular (RV) dilatation (39%) over and above both left ventricular (LV) diastolic dysfunction (16%) and LV systolic dysfunction (10%). In addition, myocardial injury, assessed by magnetic resonance imaging (MRI), is observed in some 55% to 70% of patients recently recovered from COVID-19 even in those who didn't get very sick during the acute illness. These observations seem to indicate a potentially rather high risk of clinical HF emerging in patients post-COVID-19, warranting close long-term monitoring of patients during recovery. On the other hand, given the established adverse prognostic role that pre-existing HF plays as a comorbidity in the context of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, it not only seems important in the still ongoing COVID-19 pandemic that all patients with known HF should proactively be well controlled and treated according to current guidelines, but also additionally be considered for priority vaccination against the SARS-CoV-2 infection if not yet vaccinated.
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Affiliation(s)
- Eberhard Standl
- Forschergruppe Diabetes e.V. at Helmholtz Centre, Munich, Germany.
| | - Oliver Schnell
- Forschergruppe Diabetes e.V. at Helmholtz Centre, Munich, Germany
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Selçuk M, Keskin M, Çınar T, Günay N, Doğan S, Çiçek V, Kılıç Ş, Asal S, Yavuz S, Keser N, Orhan AL. Prognostic significance of N-Terminal Pro-BNP in patients with COVID-19 pneumonia without previous history of heart failure. J Cardiovasc Thorac Res 2021; 13:141-145. [PMID: 34326968 PMCID: PMC8302897 DOI: 10.34172/jcvtr.2021.26] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/11/2021] [Indexed: 12/17/2022] Open
Abstract
Introduction: The objective of the present research was to evaluate the possible association between the N-terminal pro-brain type natriuretic peptide (NT-proBNP) levels and in-hospital mortality in coronavirus disease 2019 (COVID-19) pneumonia patients who did not have pre-existing heart failure (HF). Methods: A total of 137 consecutive patients without pre-existing HF and hospitalized due to COVID-19 pneumonia were enrolled into the current research. The main outcome of the research was the in-hospital death. The independent parameters linked with the in-hospital death were determined by multivariable analysis. Results: A total of 26 deaths with an in-hospital mortality rate of 18.9% was noted. Those who died were older with an increased frequency of co-morbidities such as hypertension, chronic kidney disease, coronary artery disease, stroke and dementia. They had also increased white blood cell (WBC) counts and had elevated glucose, creatinine, troponin I, and NT-pro-BNP levels but had decreased levels of hemoglobin. By multivariable analysis; age, NT-pro-BNP, WBC, troponin I, and creatinine levels were independently linked with the in-hospital mortality. After ROC evaluation, the ideal value of the NT-pro-BNP to predict the in-hospital mortality was found as 260 ng/L reflecting a sensitivity of 82% and a specificity of 93% (AUC:0.86; 95%CI:0.76-0.97). Conclusion: The current research clearly shows that the NT-proBNP levels are independently linked with the in-hospital mortality rates in subjects with COVID-19 pneumonia and without HF. Thus, we believe that this biomarker can be used as a valuable prognostic parameter in such cases.
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Affiliation(s)
- Murat Selçuk
- Cardiology, Health Sciences University, Sultan II. Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Muhammed Keskin
- Cardiology, Health Sciences University, Sultan II. Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Tufan Çınar
- Cardiology, Health Sciences University, Sultan II. Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Nuran Günay
- Cardiology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Selami Doğan
- Cardiology, Health Sciences University, Sultan II. Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Vedat Çiçek
- Cardiology, Health Sciences University, Sultan II. Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Şahhan Kılıç
- Cardiology, Health Sciences University, Sultan II. Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Süha Asal
- Cardiology, Health Sciences University, Sultan II. Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Samet Yavuz
- Cardiology, Health Sciences University, Sultan II. Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Nurgül Keser
- Cardiology, Health Sciences University, Sultan II. Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Ahmet L. Orhan
- Cardiology, Health Sciences University, Sultan II. Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
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10
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Anker MS, Landmesser U, von Haehling S, Butler J, Coats AJS, Anker SD. Weight loss, malnutrition, and cachexia in COVID-19: facts and numbers. J Cachexia Sarcopenia Muscle 2021; 12:9-13. [PMID: 33382211 PMCID: PMC7890265 DOI: 10.1002/jcsm.12674] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Patients with COVID-19 disease are prone to develop significant weight loss and clinical cachexia. Three reports with altogether 589 patients that reported on weight loss and cachexia in COVID-19 were identified. Disease severity of patients and the timing of the assessment during the disease course in these patients were variable-65 patients (11%) were intensive care treated at the time of assessment, and 183 (31%) were cared for in sub-intensive or intermediate care structures. The frequency of weight loss ≥5% (that defines cachexia) was 37% (range 29-52%). Correlates of weight loss occurrence were reported to be raised C-reactive protein levels, impaired renal function status, and longer duration of COVID-19 disease. Underweight status by WHO criteria (BMI < 18.5 kg/m2 ) was only observed in 4% of patients analysing data from seven studies with 6661 patients. Cachexia assessment in COVID-19 needs assessment of weight loss. COVID-19 associated cachexia is understood to affect muscle and fat tissue as is also seen in many other chronic illness-associated forms of cachexia. There are many factors that can contribute to body wasting in COVID-19, and they include loss of appetite and taste, fever and inflammation, immobilization, as well as general malnutrition, catabolic-anabolic imbalance, endocrine dysfunction, and organ-specific complications of COVID-19 disease such as cardiac and renal dysfunction. Treatment of COVID-19 patients should include a focus on nutritional support and rehabilitative exercise whenever possible. Specific anti-cachectic therapies for COVID-19 do not exist, but constitute a high medical need to prevent long-term disability due to acute COVID-19 disease.
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Affiliation(s)
- Markus S Anker
- Department of Cardiology, Universitätsmedizin Berlin, Charité-Campus Benjamin-Franklin, Hindenburgdamm 30, 12200, Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
| | - Ulf Landmesser
- Department of Cardiology, Universitätsmedizin Berlin, Charité-Campus Benjamin-Franklin, Hindenburgdamm 30, 12200, Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Javed Butler
- Department of Medicine, University of Mississippi, Jackson, MS, USA
| | | | - Stefan D Anker
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany.,Department of Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
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Varmani S, Chowhan R, Sharma I, Narang R. COVID-19 and cardiovascular disease: Clinical implications of biochemical pathways. JOURNAL OF THE PRACTICE OF CARDIOVASCULAR SCIENCES 2021. [DOI: 10.4103/jpcs.jpcs_21_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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