Indian Journal of Medical Biochemistry

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VOLUME 24 , ISSUE 2 ( May-August, 2020 ) > List of Articles

Original\\Research Article

Cardiac Biomarkers in Patients with COVID-19

Barnali Das, Seema Y Bhatia, Rashmi Patil

Citation Information : Das B, Bhatia SY, Patil R. Cardiac Biomarkers in Patients with COVID-19. Indian J Med Biochem 2020; 24 (2):43-49.

DOI: 10.5005/jp-journals-10054-0157

License: CC BY-NC 4.0

Published Online: 01-08-2020

Copyright Statement:  Copyright © 2020; The Author(s).


Abstract

Objectives: The primary aim of the study is to evaluate the role of cardiac biomarkers like high-sensitive troponin I (hs troponin I), N terminal-pro B-type natriuretic peptide (NT-proBNP) in coronavirus disease 2019 (COVID-19) patients who were admitted to the intensive care unit (ICU) with positive test results of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by real-time reverse transcriptase-polymerase chain reaction (rRT-PCR) in Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India. This study comprises two main objectives: • To evaluate the significance of cardiac markers in COVID-19 patients by test and receiver operating characteristic (ROC) analysis in 85 patients presented with complaints of chest pain and tested positive for SARS-CoV-2 by rRT-PCR. To represent the data considered in case and control groups for hs troponin I and NT-proBNP graphically in a box plot. Box plots may also have lines extending from the boxes (whiskers) indicating variability outside the upper and lower quartiles. • To determine the percentage positivity and mortality rate of COVID-19 patients with cardiac injury in 1 month period (August 1, 2020 to August 31, 2020) data of 261 individuals. Materials and methods: In the first part of the study, a total of 125 individuals (13–95 years) were considered for this study. Among the total number of patients considered, 85 individuals considered in the case group in the age group of 13–95 years (median age 65 years) had complaints of chest pain. The case group consisted of 22 females and 63 males. Forty healthy adults without any history and clinical evidence suggestive of COVID-19 and without any comorbidities, like diabetes, hypertension, chronic lung disease, cardiac disease, cancer, and immunocompromised status, were considered as a control group for the study. The control group comprises 8 females and 32 males in the age group of 13–86 years (median age 57 years). Cardiac biomarkers (hs troponin I and NT-proBNP) of these 85 patients were used to evaluate the cardiac injury found in COVID-19 patients. Statistical analysis was carried out on the data after determining whether the data had a normal/log-normal distribution and their significance was determined by calculating the p value. The accuracy of the biomarkers (NT-proBNP and hs troponin I) was checked using ROC analysis. The percentage of patients showing abnormal cardiac markers was also calculated. In the second part of the study, we have analyzed 1-month data (August 1, 2020 to August 31, 2020) of 261 individuals to evaluate the percentage positivity and mortality rate of COVID-19 patients with a cardiac injury. Results: The data were found to have normal/log-normal distribution. We found a significant increase in mean values of both hs troponin I and NT-proBNP in COVID-19 patients with chest pain than the control group. We applied the ROC curve to discriminate case population more precisely than the control population. Receiver operating characteristic analysis for NT-proBNP and hs troponin I showed that the area under the curve (AUC) of NT-proBNP is 1.0 and the AUC of hs troponin I is 0.91. The percentage of patients tested positive for SARS-CoV-2 with cardiac injury within 1 month time period (August 1, 2020 to August 31, 2020) was found to be 10%. The percentage recovery and death among the number of patients tested positive for SARS-CoV-2 with cardiac injury was found to be 88 and 12%, respectively. Conclusion: Both the cardiac markers (NT-proBNP and hs troponin I) have an excellent accuracy in patients with COVID-19 with chest pain, suggestive of cardiac injury. Clinical significance: Understanding the cardiac biomarkers in COVID-19 patients with chest pain appears to be beneficial to triage, risk-stratify, and prognosticate patients with COVID-19 based on the evidence of cardiac injury and the presence of underlying cardiovascular disease.


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  1. Cao Z, Jia Y, Zhu B. BNP and NT-proBNP as diagnostic biomarkers for cardiac dysfunction in both clinical and forensic medicine. Int J Mol Sci 2019;20(8):1820. DOI: 10.3390/ijms20081820.
  2. Lippi G, Simundic AM, Plebani M. Potential preanalytical and analytical vulnerabilities in the laboratory diagnosis of coronavirus disease 2019 (COVID-19). Clin Chem Lab Med 2020;58(7):1070–1076. DOI: 10.1515/cclm-2020-0285.
  3. Geng YJ, Wei ZY, Qian HY, et al. Pathophysiological characteristics and therapeutic approaches for pulmonary injury and cardiovascular complications of coronavirus disease 2019. Cardiovasc Pathol 2020;47:107228. DOI: 10.1016/j.carpath.2020.107228.
  4. Akhmerov A, Marbán E. COVID-19 and the heart. Circ Res 2020;126(10):1443–1455. DOI: 10.1161/CIRCRESAHA.120.317055.
  5. Guo T, Fan Y, Chen M, et al. Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19). JAMA Cardiol 2020;5(7):811–818. DOI: 10.1001/jamacardio.2020.1017.
  6. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72314 cases from the Chinese Center for Disease Control and Prevention. JAMA 2020;323(13):1239–1242. DOI: 10.1001/jama.2020.2648.
  7. Clerkin KJ, Fried JA, Raikhelkar J, et al. COVID-19 and cardiovascular disease. Circulation 2020;141(20):1648–1655. DOI: 10.1161/CIRCULATIONAHA.120.046941.
  8. Gao L, Jiang D, Wen X, et al. Prognostic value of NT-proBNP in patients with severe COVID-19. medRxiv 2020. DOI: 10.1101/2020.03.07.20031575.
  9. Gao Y, Li T, Han M, et al. Diagnostic utility of clinical laboratory data determinations for patients with the severe COVID-19. J Med Virol 2020;92(7):791–796. DOI: 10.1002/jmv.25770.
  10. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult in patients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020;395(10229):1054–1062. DOI: 10.1016/S0140-6736 (20)30566-3.
  11. Lala A, Johnson KW, Januzzi JL, et al. Prevalence and impact of myocardial injury in patients hospitalized with COVID-19 infection. J Am Coll Cardiol 2020;76(5):533–546. DOI: 10.1016/j.jacc.2020.06.007.
  12. Mahajan K, Negi PC, Ganju N, et al. Cardiac biomarker-based risk stratification algorithm in patients with severe COVID-19. Diabetes Metab Syndr 2020;14(5):929–931. DOI: 10.1016/j.dsx.2020.06.027.
  13. Dimiati H, Wahab AS, Juffrie M, et al. Study of NT-proBNP and Hs-Troponin I biomarkers for early detection of children's heart function of protein energy malnutrition. Pediatr Rep 2019;11(2):7997. DOI: 10.4081/pr.2019.7997.
  14. Lang JP, Wang X, Moura FA, et al. A current review of COVID-19 for the cardiovascular specialist. Am Heart J 2020;226:29–44. DOI: 10.1016/j.ahj.2020.04.025.
  15. World Health Organization. Novel Coronavirus (2019-nCoV) situation reports. Available from: https://covid19.who.int/. Accessed: 16th September 2020.
  16. Shereen MA, Khan S, Kazmi A, et al. COVID-19 infection: Origin, transmission, and characteristics of human coronaviruses. J Adv Res 2020;24:91–98. DOI: 10.1016/j.jare.2020.03.005.
  17. Sohrabi C, Alsafi Z, O’Neill N, et al. World Health Organization declares global emergency: A review of the 2019 novel coronavirus (COVID-19). Int J Surg 2020;76:71–76. DOI: 10.1016/j.ijsu.2020.02.034.
  18. Lippi G, Plebani M. The critical role of laboratory medicine during coronavirus disease 2019 (COVID-19) and other viral outbreaks. Clin Chem Lab Med 2020;58(7):1063–1069. DOI: 10.1515/cclm-2020-0240.
  19. Paul S, Harshaw-Ellis K. Evolving use of biomarkers in the management of heart failure. Cardiol Rev 2019;27(3):153–159. DOI: 10.1097/CRD.0000000000000224.
  20. Fransworth CW. BNP or NT-proBNP Are these tests interchangeable? Scientific Shorts 2019.
  21. Kerkela R, Ulvila J, Magga J. Natriuretic peptides in the regulation of cardiovascular physiology and metabolic events. J Am Heart Assoc 2015;4(10):e002423. DOI: 10.1161/JAHA.115.002423.
  22. Xu RY, Zhu XF, Yang Y, et al. High-sensitive cardiac troponin T. J Geriatr Cardiol 2013;10(1):102–109. DOI: 10.3969/j.issn.1671-5411.2013.01.015.
  23. Clerico A, Ripoli A, Masotti S, et al. Evaluation of 99th percentile and reference change values of a high-sensitivity cTnI method: A multicenter study. Clin Chim Acta 2019;493:156–161. DOI: 10.1016/j.cca.2019.02.029.
  24. Gore MO, Seliger SL, Defilippi CR, et al. Age- and sex-dependent upper reference limits for the high-sensitivity cardiac troponin T assay. J Am Coll Cardiol 2014;63(14):1441–1448. DOI: 10.1016/j.jacc.2013.12.032.
  25. Roffi M, Patrono C, Collet JP, et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2016;37(3):267–315. DOI: 10.1093/eurheartj/ehv320.
  26. Wu AHB, Christenson RH, Greene DN, et al. Clinical laboratory practice recommendations for the use of cardiac troponin in acute coronary syndrome: expert opinion from the Academy of the American Association for Clinical Chemistry and the Task Force on Clinical Applications of Cardiac Bio-Markers of the International Federation of Clinical Chemistry and Laboratory Medicine. Clin Chem 2018;64(4):645–655. DOI: 10.1373/clinchem.2017.277186.
  27. Thygesen K, Alpert JS, Jaffe AS, et al. Fourth universal definition of myocardial infarction. J Am Coll Cardiol 2018;72(18):2231–2264. DOI: 10.1016/j.jacc.2018.08.1038.
  28. Iqbal N, Wentworth B, Choudhary R, et al. Cardiacbiomarkers: New tools for heart failure management. Cardiovasc Diagn Ther 2012;2(2):147–164. DOI: 10.3978/j.issn.2223-3652.2012.06.03.
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