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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