SARS‐CoV‐2 viremia is associated with inflammatory, but not cardiovascular biomarkers, in patients hospitalized for COVID‐19

Abstract Background COVID‐19 may present with a variety of cardiovascular manifestations, and elevations of biomarkers reflecting myocardial injury and stress are prevalent. SARS‐CoV‐2 has been found in cardiac tissue, and myocardial dysfunction post‐COVID‐19 may occur. However, the association between SARS‐CoV‐2 RNA in plasma and cardiovascular biomarkers remains unknown. Methods and Results COVID MECH was a prospective, observational study enrolling consecutive, hospitalized patients with laboratory‐confirmed infection with SARS‐CoV‐2 and symptoms of COVID‐19. Biobank plasma samples used to measure SARS‐CoV‐2 RNA and cardiovascular and inflammatory biomarkers were collected in 123 patients at baseline, and in 96 (78%) at day 3. Patients were aged 60±15 years, 71 (58%) male, 68 (55%) Caucasian and 31 (25%) received mechanical ventilation during hospitalization. SARS‐CoV‐2 RNA was detected in plasma from 48 (39%) patients at baseline. Patients with viremia were more frequently male, had more diabetes mellitus and lower oxygen saturation. Patients with viremia had higher concentrations of interleukin‐6, C‐reactive protein, procalcitonin and ferritin (all <0.001), but comparable levels of cardiac troponin T (cTnT; p=0.09), N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP; p=0.27) and D‐dimer (p=0.67) to patients without viremia. SARS‐CoV‐2 RNA was present in plasma at either baseline or day 3 in 50 (52%) patients, and these patients experienced increase from baseline to day 3 in NT‐proBNP and D‐dimer concentrations, while there was no change in cTnT. Conclusions SARS‐CoV‐2 viremia was associated with increased concentrations of inflammatory, but not cardiovascular biomarkers. NT‐proBNP and D‐dimer, but not cTnT, increased from baseline to day 3 in patients with viremia.

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Relationship between ECG Findings and Serum Biomarkers in COVID-19 Patients

Journal Of Cardiovascular Emergencies ◽

10.2478/jce-2021-0013 ◽

2021 ◽

Vol 7 (3) ◽

pp. 64-69

Author(s):

Gökhan Perincek ◽

Muammer Karakayalı ◽

Sema Avcı

Keyword(s):

Lymphocyte Count ◽

Myocardial Injury ◽

Troponin T ◽

P Wave ◽

Rt Pcr ◽

C Reactive Protein ◽

Premature Ventricular Contractions ◽

Reactive Protein ◽

Fragmented Qrs ◽

D Dimer

Abstract Background and aim: The aim of this study was to evaluate the relationship between ECG findings and blood parameters indicative of inflammation and myocardial injury in COVID-19 patients. Methods: The study included 159 females and 194 males. Demographics, ECG findings (axis, rhythm, branch block, ST- and T-wave changes, premature ventricular contractions, early repolarization, S1Q3T3, fragmented QRS [fQRS], rate, PR, QRS, QT interval, QTc, P-wave dispersion) and albumin, D-dimer, ferritin, pro-BNP, procalcitonin, protein, troponin T, neutrophil-to-lymphocyte ratio (NLR), C-reactive protein/albumin ratio (CAR) were recorded. Results: In the study, 45% of the cases were female and 55% were male. The mean age of the included patients was 45.7 ± 24.4 years. The most frequent comorbidities were chronic obstructive pulmonary disease (COPD) and hypertension (HT) in both groups. The incidence of fQRS on the 1st day was significantly higher in patients with negative COVID-19 test (23% for positive RT-PCR versus 35.6% for negative RT-PCR, p = 0.016). QTc values on the 3rd and 5th day were significantly higher in patients with negative RT-PCR (p = 0.045 and p = 0.042, respectively). Albumin and procalcitonin were significantly higher in patients with positive COVID-19 test results (p = 0.018 and p <0.001, respectively). Patients with fragmented QRS presented significantly lower serum albumin (40.62 ± 4.73 g/L vs. 42.92 ± 3.72 g/L, p = 0.01), and protein levels (p = 0.02), as well as lower lymphocyte count, and significantly higher levels of C-reactive protein (47.01 ± 65.01 mg/L vs. 24.55 ± 44.17 mg/L, p = 0.001), D-dimer (p = 0.009), neutrophil count, pro-BNP (p = 0.004), troponin T (p <0.001), NRL and CAR (1.28 ± 1.83 versus 0.6 ± 1.11, p <0.001). Conclusion: Patients with COVID-19 infection presented significantly higher levels of C-reactive protein, D-dimer, neutrophil, pro-BNP, procalcitonin, troponin T, NLR, and CAR, and significantly lower levels of albumin, lymphocyte count, and serum proteins, indicating the level of inflammation and its relationship with myocardial injury. Further follow-up studies are required, on larger patient sets, for the development of risk prediction tools in COVID-19 patients.

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Clinical characteristics of COVID-19 patients (Latvia, Spring 2020)

10.25143/fk2/hnmlhh ◽

2020 ◽

Author(s):

Ludmila Viksna ◽

◽

Oksana Kolesova ◽

Aleksandrs Kolesovs ◽

Ieva Vanaga ◽

...

Keyword(s):

Blood Cells ◽

Troponin T ◽

Sodium Concentration ◽

C Reactive Protein ◽

Reactive Protein ◽

Erythrocyte Sedimentation ◽

Coagulation Tests ◽

Damage Indicators ◽

Prothrombin Index ◽

D Dimer

Data include following variables: Demographics, epidemiological history, comorbidities, diagnosis, complications, and symptoms on admission to the hospital. Also, body’s temperature and SpO2. Blood cells: white cells count (WBC), neutrophils (Neu), lymphocytes (Ly), eosinophils (Eo) and monocytes (Mo), percentages of segmented and banded neutrophils, erythrocytes (RBC), platelet count (PLT), hemoglobin (Hb), and hematocrit (HCT); Inflammatory indicators: erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP); Tissue damage indicators: alanine aminotransferase (ALT), lactate dehydrogenase (LDH), and troponin T (TnT); Electrolytes: potassium and sodium concentration; Renal function indicators: creatinine and glomerular filtration rate (GFR); Coagulation tests: D-dimer, prothrombin time, and prothrombin index on admission to the hospital.

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Widespread Parenchymal Abnormalities and Pulmonary Embolism on Contrast-Enhanced CT Predict Disease Severity and Mortality in Hospitalized COVID-19 Patients

Frontiers in Medicine ◽

10.3389/fmed.2021.666723 ◽

2021 ◽

Vol 8 ◽

Author(s):

Francesca Campoccia Jalde ◽

Mats O. Beckman ◽

Ann Mari Svensson ◽

Max Bell ◽

Magnus Sköld ◽

...

Keyword(s):

Computed Tomography ◽

Pulmonary Embolism ◽

Pulmonary Artery ◽

Troponin T ◽

Main Pulmonary Artery ◽

C Reactive Protein ◽

Reactive Protein ◽

Parenchymal Abnormalities ◽

Pulmonary Artery Diameter ◽

D Dimer

Purpose: Severe COVID-19 is associated with inflammation, thromboembolic disease, and high mortality. We studied factors associated with fatal outcomes in consecutive COVID-19 patients examined by computed tomography pulmonary angiogram (CTPA).Methods: This retrospective, single-center cohort analysis included 130 PCR-positive patients hospitalized for COVID-19 [35 women and 95 men, median age 57 years (interquartile range 51–64)] with suspected pulmonary embolism based on clinical suspicion. The presence and extent of embolism and parenchymal abnormalities on CTPA were recorded. The severity of pulmonary parenchymal involvement was stratified by two experienced radiologists into two groups: lesions affecting ≤50% or >50% of the parenchyma. Patient characteristics, radiological aspects, laboratory parameters, and 60-day mortality data were collected.Results: Pulmonary embolism was present in 26% of the patients. Most emboli were small and peripheral. Patients with widespread parenchymal abnormalities, with or without pulmonary embolism, had increased main pulmonary artery diameter (p < 0.05) and higher C-reactive protein (p < 0.01), D-dimer (p < 0.01), and troponin T (p < 0.001) and lower hemoglobin (p < 0.001). A wider main pulmonary artery diameter correlated positively with C-reactive protein (r = 0.28, p = 0.001, and n = 130) and procalcitonin. In a multivariant analysis, D-dimer >7.2 mg/L [odds ratio (±95% confidence interval) 4.1 (1.4–12.0)] and ICU stay were significantly associated with embolism (p < 0.001). The highest 60-day mortality was found in patients with widespread parenchymal abnormalities combined with pulmonary embolism (36%), followed by patients with widespread parenchymal abnormalities without pulmonary embolism (26%). In multivariate analysis, high troponin T, D-dimer, and plasma creatinine and widespread parenchymal abnormalities on CT were associated with 60-day mortality.Conclusions: Pulmonary embolism combined with widespread parenchymal abnormalities contributed to mortality risk in COVID-19. Elevated C-reactive protein, D-dimer, troponin-T, P-creatinine, and enlarged pulmonary artery were associated with a worse outcome and may mirror a more severe systemic disease. A liberal approach to radiological investigation should be recommended at clinical deterioration, when the situation allows it. Computed tomography imaging, even without intravenous contrast to assess the severity of pulmonary infiltrates, are of value to predict outcome in COVID-19. Better radiological techniques with higher resolution could potentially improve the detection of microthromboses. This could influence anticoagulant treatment strategies, preventing clinical detoriation.

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The role and efficacy of routine high-sensitivity troponin T screening in paediatric COVID-19

Cardiology in the Young ◽

10.1017/s1047951121005199 ◽

2022 ◽

pp. 1-5

Author(s):

Mehmet G. Ramoğlu ◽

Selen Karagözlü ◽

Özlem Bayram ◽

Jeyhun Bakhtiyarzada ◽

Alperen Aydın ◽

...

Keyword(s):

Troponin T ◽

Myocardial Dysfunction ◽

High Sensitivity ◽

Common Symptom ◽

C Reactive Protein ◽

Protein Levels ◽

Reactive Protein ◽

High Sensitivity Troponin ◽

High Sensitivity Troponin T ◽

Echocardiographic Findings

Abstract Objective: We aimed to evaluate the efficacy and role of high-sensitivity troponin T in children with a confirmed SARS-CoV-2 infection and also the correlation of troponin T levels with symptoms, and echocardiographic findings were analysed. Methods: Two hundred and fourteen patients with a confirmed SARS-CoV-2 infection between the dates of 28 March and 15 August 12020 were enrolled in this retrospective single-centre study. Patients with comorbidities and diagnosed as multisystem inflammatory syndrome in children were excluded. Demographic data, clinical and laboratory parameters were evaluated. The patients were classified and compared according to the troponin positivity. The correlation of troponin T with symptoms and echocardiographic findings was analysed. Results: The most common symptoms in the whole study group were fever (53.3%) and cough (24.8%). Troponin T levels were elevated in 15 (7%) patients. The most common symptom in patients with troponin positivity was also fever (73.3%). Troponin T positivity was significantly higher in patients under the age of 12 months and troponin T levels were negatively correlated with age. C-reactive protein levels were elevated in 77 (36%) of the patients in the whole group and 7 (46.7%) of 15 patients with troponin positivity. C-reactive protein levels were similar between groups. Conclusion: Routine troponin screening does not yield much information in previously healthy paediatric COVID-19 patients without any sign of myocardial dysfunction. Elevated troponin levels may be observed but it is mostly a sign of myocardial injury without detectable myocardial dysfunction in this group of patients.

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Challenges of Diagnosing Viral Myocarditis in Adolescents in the Era of COVID-19 and MIS-C

Case Reports in Pediatrics ◽

10.1155/2021/4797498 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Hemali P. Shah ◽

Richard Frye ◽

Sunny Chang ◽

Erin Faherty ◽

Jeremy Steele ◽

...

Keyword(s):

Myocardial Injury ◽

Viral Myocarditis ◽

Shortness Of Breath ◽

Chest Tightness ◽

C Reactive Protein ◽

Reactive Protein ◽

Erythrocyte Sedimentation ◽

Clinical Presentations ◽

Inflammatory Syndrome ◽

D Dimer

Myocarditis has a wide array of clinical presentations ranging from asymptomatic to sudden cardiac death. Pediatric myocarditis is a rare disease, with an estimated annual incidence of 1 to 2 per 100,000 children though its true prevalence remains unknown due to its variable and often subclinical presentation. The diagnosis of myocarditis is challenging in the era of COVID-19 and Multisystem Inflammatory Syndrome in Children (MIS-C), which can have overlapping clinical conundrum. Here, we present a case of a 17-year-old male presenting with chest tightness, shortness of breath, and electrocardiogram (EKG) findings concerning for myocardial injury along with elevated inflammatory markers such as D-dimer, ESR (Erythrocyte Sedimentation Rate), and CRP (C-Reactive Protein). We discuss the key elements of our clinical experience with this case and review the literature for pediatric myocarditis, with a focus on differentiating it from MIS-C in the current COVID-19 pandemic era.

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Increased preoperative C-reactive protein contributes to perioperative myocardial injury

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0030-1269361 ◽

2011 ◽

Vol 59 (S 01) ◽

Author(s):

G Goerlach ◽

C Wassmann ◽

P Roth ◽

A Böning

Keyword(s):

Myocardial Injury ◽

C Reactive Protein ◽

Reactive Protein

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Efficacy of Tocilizumab Therapy in Different Subtypes of COVID-19 Cytokine Storm Syndrome

Viruses ◽

10.3390/v13061067 ◽

2021 ◽

Vol 13 (6) ◽

pp. 1067

Author(s):

Oleksandr Oliynyk ◽

Wojciech Barg ◽

Anna Slifirczyk ◽

Yanina Oliynyk ◽

Vitaliy Gurianov ◽

...

Keyword(s):

Macrophage Activation Syndrome ◽

Macrophage Activation ◽

Cytokine Storm ◽

Cytokine Release ◽

Cytokine Release Syndrome ◽

C Reactive Protein ◽

Treatment Results ◽

Reactive Protein ◽

Median Serum ◽

D Dimer

Background: Cytokine storm in COVID-19 is heterogenous. There are at least three subtypes: cytokine release syndrome (CRS), macrophage activation syndrome (MAS), and sepsis. Methods: A retrospective study comprising 276 patients with SARS-CoV-2 pneumonia. All patients were tested for ferritin, interleukin-6, D-Dimer, fibrinogen, calcitonin, and C-reactive protein. According to the diagnostic criteria, three groups of patients with different subtypes of cytokine storm syndrome were identified: MAS, CRS or sepsis. In the MAS and CRS groups, treatment results were assessed depending on whether or not tocilizumab was used. Results: MAS was diagnosed in 9.1% of the patients examined, CRS in 81.8%, and sepsis in 9.1%. Median serum ferritin in patients with MAS was significantly higher (5894 vs. 984 vs. 957 ng/mL, p < 0.001) than in those with CRS or sepsis. Hypofibrinogenemia and pancytopenia were also observed in MAS patients. In CRS patients, a higher mortality rate was observed among those who received tocilizumab, 21 vs. 10 patients (p = 0.043), RR = 2.1 (95% CI 1.0–4.3). In MAS patients, tocilizumab decreased the mortality, 13 vs. 6 patients (p = 0.013), RR = 0.50 (95% CI 0.25–0.99). Сonclusions: Tocilizumab therapy in patients with COVID-19 and CRS was associated with increased mortality, while in MAS patients, it contributed to reduced mortality.

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Comparison of Effects of Statin Use on Mortality in Patients With Peripheral Arterial Disease With Versus Without Elevated C-Reactive Protein and D-Dimer Levels

The American Journal of Cardiology ◽

10.1016/j.amjcard.2009.12.054 ◽

2010 ◽

Vol 105 (9) ◽

pp. 1348-1352 ◽

Cited By ~ 12

Author(s):

Himabindu Vidula ◽

Lu Tian ◽

Kiang Liu ◽

Michael H. Criqui ◽

Luigi Ferrucci ◽

...

Keyword(s):

Peripheral Arterial Disease ◽

Arterial Disease ◽

C Reactive Protein ◽

Reactive Protein ◽

Peripheral Arterial ◽

D Dimer ◽

Statin Use

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Kinetics of Procalcitonin in Pediatric Patients on Extracorporeal Membrane Oxygenation

Biomarker Insights ◽

10.1177/1177271917751900 ◽

2018 ◽

Vol 13 ◽

pp. 117727191775190 ◽

Cited By ~ 5

Author(s):

Sara Bobillo ◽

Javier Rodríguez-Fanjul ◽

Anna Solé ◽

Julio Moreno ◽

Mònica Balaguer ◽

...

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Prospective Observational Study ◽

Pediatric Patients ◽

Clinical Situation ◽

Multiple Organ ◽

C Reactive Protein ◽

Reactive Protein ◽

Membrane Oxygenation ◽

Neurologic Sequelae ◽

Kinetics Of

Objectives: To assess the kinetics of procalcitonin (PCT) and C-reactive protein (CRP) in pediatric patients who required extracorporeal membrane oxygenation (ECMO) and to analyze its relationship with morbidity and mortality. Patients and methods: Prospective observational study including pediatric patients who required ECMO. Both PCT and CRP were sequentially drawn before ECMO (P0) and until 72 hours after ECMO. Results: A total of 40 patients were recruited. Two cohorts were established based on the value of the P0 PCT (>10 ng/mL). Comparing the kinetics of PCT and CRP in these cohorts, the described curves were the expected for each clinical situation. The cutoff for P0 PCT to predict multiple organ dysfunction syndrome was 2.55 ng/mL (sensibility 83%, specificity 100%). Both PCT and CRP did not predict risk of neurologic sequelae or mortality in any group. Conclusions: Procalcitonin does not seem to be modified by ECMO and could be a good biomarker of evolution.

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