COVID-19 pneumonia and disease severity in patients hospitalized during the first pandemic wave at University Hospital Centre Split: cardiovascular biomarkers strongly correlate with risk of poor outcomes

    Authors

    Abstract

    **Introduction**: Acute elevations of biomarkers reflecting myocardial injury, thrombosis, systemic inflammation, and heart dysfunction are associated with poor prognosis among hospitalized patients with COVID-19. (1-3) In this study, we aimed to determine levels of these biomarkers in patients that were hospitalized with COVID-19 pneumonia at our institution during the first pandemic wave. Secondly, we aimed to determine if these biomarkers correlate with risk assessment tools such as MEWS (Modified Early Warning Score) and SOFA (Sequential Organ Failure Assessment) scores that reflect disease severity and clinical deterioration of patients. **Patients and Methods**: Data of 40 consecutive hospitalized patients with PCR-confirmed SARS-CoV-2 infection and pneumonia verified by imaging methods were considered for the analysis. **Results**: The mean age was 80.5 ± 9.9 years and 25 (78.1%) were women. Of these patients, 9 (22.5%) had a significant renal insufficiency (eGFR 14 pg/mL) while 10 patients (32.3%) satisfied acute heart failure rule-in criteria according to natriuretic peptide cut-off values adjusted for age. The mean hs-cTnT value was 28.9 ± 42.7 pg/mL while mean NT-proBNP value was 2481 ± 4662 pg/mL. One-third of patients (32.3%) had C-reactive protein values >41.1 mg/L (mean 33.7 ± 39.1 mg/L), highly predictive of severe disease. Nearly two-thirds of patients (N=19, 61.3%) had D-dimer levels >2.1 mg/L that was highly predictive of in-hospital death in previous studies (**Figure 1**). The mean MEWS and SOFA scores were 2.5 ± 1.6 and 3.1 ± 2.3 points, respectively. In decreasing order of relationship, CRP, D-dimer, and NT-proBNP values significantly correlated with both MEWS and SOFA scores as shown in **Table 1**. Troponin values had a borderline association with both risk scores. FIGURE 1. Prevalence of abnormal cardiovascular biomarkers reflecting myocardial injury, ventricular overload, systemic inflammation and thrombotic risk among patients hospitalized with COVID-19 pneumonia. CRP - C-reactive protein; hs-cTnT - high-sensitivity cardiac troponin T; NT-proBNP - N-terminal of proBrain Natriuretic Peptide ### TABLE 1: Correlation of cardiovascular laboratory parameters with the risk of clinical deterioration (MEWS score) and estimated rate of organ failure (SOFA score). | **Laboratory parameter** | **MEWS score** | **MEWS score** | **SOFA score** | **SOFA score** | | --- | --- | --- | --- | --- | | | **r-value** | **p-value** | **r-value** | **p-value** | | NT-proBNP | 0.360 | 0.047* | 0.360 | 0.047* | | hs-cTnT | 0.304 | 0.096 | 0.306 | 0.094 | | CRP | 0.802 | <0.001* | 0.710 | <0.001* | | D-dimer | 0.449 | 0.011* | 0.439 | 0.013* | [†] CRP-C-reactive protein; hs-cTnT-high-sensitivity cardiac troponin T; MEWS-Modified Early Warning Score for Clinical Deterioration; NT-proBNP-N-terminal of proBrain Natriuretic Peptide; SOFA-sequential organ failure assessment score *denotes significant result at p<0.05; r-Pearson’s correlation coefficient; p-statistical significance **Conclusions**: Our data show that a significant number of patients hospitalized due to COVID-19 were elderly and with a high risk of thrombotic events and cardiac insufficiency. Likewise, a high inflammatory burden was observed in one-third of patients. CRP correlated the most with MEWS and SOFA score, followed by D-dimer levels and NT-proBNP while no significant interaction was observed with cardiac troponin values.

    Keywords

    cardiovascular biomarkers, COVID-19, pneumonia

    DOI

    https://doi.org/10.15836/ccar2021.76

    Literature

    1. Yao Y, Cao J, Wang Q, Shi Q, Liu K, Luo Z, et al. D-dimer as a biomarker for disease severity and mortality in COVID-19 patients: a case control study. J Intensive Care. 2020 July 10;8:49. https://doi.org/10.1186/s40560-020-00466-z
    2. Luo X, Zhou W, Yan X, Guo T, Wang B, Xia H, et al. Prognostic value of C-reactive protein in patients with COVID-19. Clin Infect Dis. 2020;71(16):2174. https://doi.org/10.1101/2020.03.21.20040360
    3. Sandoval Y, Januzzi JL, Jaffe AS. Cardiac Troponin for Assessment of Myocardial Injury in COVID-19: JACC Review Topic of the Week. J Am Coll Cardiol. 2020 September 8;76(10):1244–58. https://doi.org/10.1016/j.jacc.2020.06.068
    Cardiologia Croatica
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    COVID-19 pneumonia and disease severity in patients hospitalized during the first pandemic wave at University Hospital Centre Split: cardiovascular biomarkers strongly correlate with risk of poor outcomes

    Extended Abstract
    Issue1-2
    Published
    Pages76-77
    PDF via DOIhttps://doi.org/10.15836/ccar2021.76
    cardiovascular biomarkers
    COVID-19
    pneumonia

    Authors

    Ivan JerkovićORCIDUniversity Hospital Centre Split, Split, Croatia
    Maja MizdrakORCIDUniversity Hospital Centre Split, Split, Croatia
    Josip Anđelo Borovac*ORCIDUniversity of Split School of Medicine, Split, Croatia
    Joško BožićORCIDUniversity of Split School of Medicine, Split, Croatia
    Vedran KovačićORCIDUniversity Hospital Centre Split, Split, Croatia
    Tina Tičinović KurirORCIDUniversity of Split School of Medicine, Split, Croatia

    *Correspondence email: jborovac@mefst.hr

    Abstract

    **Introduction**: Acute elevations of biomarkers reflecting myocardial injury, thrombosis, systemic inflammation, and heart dysfunction are associated with poor prognosis among hospitalized patients with COVID-19. (1-3) In this study, we aimed to determine levels of these biomarkers in patients that were hospitalized with COVID-19 pneumonia at our institution during the first pandemic wave. Secondly, we aimed to determine if these biomarkers correlate with risk assessment tools such as MEWS (Modified Early Warning Score) and SOFA (Sequential Organ Failure Assessment) scores that reflect disease severity and clinical deterioration of patients. **Patients and Methods**: Data of 40 consecutive hospitalized patients with PCR-confirmed SARS-CoV-2 infection and pneumonia verified by imaging methods were considered for the analysis. **Results**: The mean age was 80.5 ± 9.9 years and 25 (78.1%) were women. Of these patients, 9 (22.5%) had a significant renal insufficiency (eGFR 14 pg/mL) while 10 patients (32.3%) satisfied acute heart failure rule-in criteria according to natriuretic peptide cut-off values adjusted for age. The mean hs-cTnT value was 28.9 ± 42.7 pg/mL while mean NT-proBNP value was 2481 ± 4662 pg/mL. One-third of patients (32.3%) had C-reactive protein values >41.1 mg/L (mean 33.7 ± 39.1 mg/L), highly predictive of severe disease. Nearly two-thirds of patients (N=19, 61.3%) had D-dimer levels >2.1 mg/L that was highly predictive of in-hospital death in previous studies (**Figure 1**). The mean MEWS and SOFA scores were 2.5 ± 1.6 and 3.1 ± 2.3 points, respectively. In decreasing order of relationship, CRP, D-dimer, and NT-proBNP values significantly correlated with both MEWS and SOFA scores as shown in **Table 1**. Troponin values had a borderline association with both risk scores. FIGURE 1. Prevalence of abnormal cardiovascular biomarkers reflecting myocardial injury, ventricular overload, systemic inflammation and thrombotic risk among patients hospitalized with COVID-19 pneumonia. CRP - C-reactive protein; hs-cTnT - high-sensitivity cardiac troponin T; NT-proBNP - N-terminal of proBrain Natriuretic Peptide ### TABLE 1: Correlation of cardiovascular laboratory parameters with the risk of clinical deterioration (MEWS score) and estimated rate of organ failure (SOFA score). | **Laboratory parameter** | **MEWS score** | **MEWS score** | **SOFA score** | **SOFA score** | | --- | --- | --- | --- | --- | | | **r-value** | **p-value** | **r-value** | **p-value** | | NT-proBNP | 0.360 | 0.047* | 0.360 | 0.047* | | hs-cTnT | 0.304 | 0.096 | 0.306 | 0.094 | | CRP | 0.802 | <0.001* | 0.710 | <0.001* | | D-dimer | 0.449 | 0.011* | 0.439 | 0.013* | [†] CRP-C-reactive protein; hs-cTnT-high-sensitivity cardiac troponin T; MEWS-Modified Early Warning Score for Clinical Deterioration; NT-proBNP-N-terminal of proBrain Natriuretic Peptide; SOFA-sequential organ failure assessment score *denotes significant result at p<0.05; r-Pearson’s correlation coefficient; p-statistical significance **Conclusions**: Our data show that a significant number of patients hospitalized due to COVID-19 were elderly and with a high risk of thrombotic events and cardiac insufficiency. Likewise, a high inflammatory burden was observed in one-third of patients. CRP correlated the most with MEWS and SOFA score, followed by D-dimer levels and NT-proBNP while no significant interaction was observed with cardiac troponin values.

    Literature

    1. 1.
      Yao Y, Cao J, Wang Q, Shi Q, Liu K, Luo Z, et al. D-dimer as a biomarker for disease severity and mortality in COVID-19 patients: a case control study. J Intensive Care. 2020 July 10;8:49.DOI
    2. 2.
      Luo X, Zhou W, Yan X, Guo T, Wang B, Xia H, et al. Prognostic value of C-reactive protein in patients with COVID-19. Clin Infect Dis. 2020;71(16):2174.DOI
    3. 3.
      Sandoval Y, Januzzi JL, Jaffe AS. Cardiac Troponin for Assessment of Myocardial Injury in COVID-19: JACC Review Topic of the Week. J Am Coll Cardiol. 2020 September 8;76(10):1244–58.DOI