Elevated cardiac biomarkers may be effective prognostic predictors for patients with COVID-19: A multicenter, observational study

Yang, Jie; Liao, Xuelian; Yin, Wei Hsian; Wang, Bo; Yue, Jirong; Bai, Lan; Liu, Dan; Zhu, Ting; Huang, Zhixin; Kang, Yan

doi:10.1016/j.ajem.2020.10.013

Cited by 25 publications

(19 citation statements)

References 37 publications

(38 reference statements)

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“…A previous study including 288 severe and non-severe COVID-19 patients found myoglobin higher than 106 μg/L, WBC higher than 10 × 109/L, and CRP higher than 10 mg/L as risk factors for severe cases 59 . Similarly, another study of 357 deceased and recovered cases reported elevated levels of myoglobin along with CK-MB in patients resulting in in-hospital death 60 . However, an elevated level of myoglobin (≥ 306.5 μg/L) was found to be a risk factor for in-hospital death, independent of Troponin and CK-MB levels 61 .…”

Section: Discussionmentioning

confidence: 87%

Myoglobin and C-reactive protein are efficient and reliable early predictors of COVID-19 associated mortality

Ali

Noman

Guo

et al. 2021

Sci Rep

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Since the emergence of SARS-CoV-2, numerous studies have been attempting to determine biomarkers, which could rapidly and efficiently predict COVID-19 severity, however there is lack of consensus on a specific one. This retrospective cohort study is a comprehensive analysis of the initial symptoms, comorbidities and laboratory evaluation of patients, diagnosed with COVID-19 in Huoshenshan Hospital, Wuhan, from 4th February to 12th March, 2020. Based on the data collected from 63 severely ill patients from the onset of symptoms till the full recovery or demise, we found not only age (average 70) but also blood indicators as significant risk factors associated with multiple organ failure. The blood indices of all patients showed hepatic, renal, cardiac and hematopoietic dysfunction with imbalanced coagulatory biomarkers. We noticed that the levels of LDH (85%, P < .001), HBDH (76%, P < .001) and CRP (65%, P < .001) were significantly elevated in deceased patients, indicating hepatic impairment. Similarly, increased CK (15%, P = .002), Cre (37%, P = 0.102) and CysC (74%, P = 0.384) indicated renal damage. Cardiac injury was obvious from the significantly elevated level of Myoglobin (52%, P < .01), Troponin-I (65%, P = 0.273) and BNP (50%, P = .787). SARS-CoV-2 disturbs the hemolymphatic system as WBC# (73%, P = .002) and NEUT# (78%, P < .001) were significantly elevated in deceased patients. Likewise, the level of D-dimer (80%, P < .171), PT (87%, P = .031) and TT (57%, P = .053) was elevated, indicating coagulatory imbalances. We identified myoglobin and CRP as specific risk factors related to mortality and highly correlated to organ failure in COVID-19 disease.

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Section: Discussionmentioning

confidence: 87%

Myoglobin and C-reactive protein are efficient and reliable early predictors of COVID-19 associated mortality

Ali

Noman

Guo

et al. 2021

Sci Rep

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“…Two studies were conducted in Turkey [ 34 , 58 ], 1 in the USA [ 57 ], 1 in Korea [ 52 ], and the remaining 51 in China [ 14 , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [53] , [54] , [55] , [56] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] , [71] , [72] , [73] , [74] , [75] , [76] , [77] , [78] , [79] , [80] , [81] , [82] , [83] , [84] , [85] , [86] , [87] ]. Three studies were prospective [ 42 , 53 , 68 ], 47 retrospective [ [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] ...…”

Section: Resultsmentioning

confidence: 99%

“…Three studies were prospective [ 42 , 53 , 68 ], 47 retrospective [ [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [43] , [44] , [45] , [46] , [47] , [48] , [50] , [51] , [52] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , 67 , [69] , [70] , [71] , [72] , [73] , [74] , [75] , [76] , [77] , [78] , [79] , [80] , [81] , [82] , [83] , [84] , [85] , 87 ], whereas the remaining 5 did not report information regarding the study design [ 14 , 49 , 66 , 71 , 86 ]. Clinical endpoints included disease severity based on current clinical guidelines in 21 studies [ 38 , 43 , 45 , [48] , [49] , [50] , [51] , [52] , 54 ...…”

Section: Resultsmentioning

confidence: 99%

“…While the exact mechanisms involved in the pathogenesis of cardiac complications in COVID-19 remain to be established, the presence of myocardial necrosis has been shown to be independently associated with more severe disease, transfer to the intensive care unit (ICU) and mortality [ [11] , [12] , [13] ]. Biomarkers of myocardial damage, particularly creatine kinase-MB (CK-MB) and troponin, have been increasingly investigated in COVID-19 patients in terms of their predictive capacity and potential to assist with clinical decisions [ 14 ]. A number of systematic reviews and meta-analyses on troponin and COVID-19 have been published [ [15] , [16] , [17] , [18] ].…”

Section: Introductionmentioning

confidence: 99%

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Serum CK-MB, COVID-19 severity and mortality: An updated systematic review and meta-analysis with meta-regression

Zinellu

Sotgia

Fois

et al. 2021

Advances in Medical Sciences

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Objectives We conducted a systematic review and meta-analysis with meta-regression of creatine kinase-MB (CK-MB), a biomarker of myocardial injury, in COVID-19 patients. Methods We searched PubMed, Web of Science and Scopus, for studies published between January 2020 and January 2021 that reported CK-MB, COVID-19 severity and mortality (PROSPERO registration number: CRD42021239657). Results Fifty-five studies in 11,791 COVID-19 patients were included in the meta-analysis. The pooled results showed that CK-MB concentrations were significantly higher in patients with high disease severity or non-survivor status than patients with low severity or survivor status (standardized mean difference, SMD, 0.81, 95% CI 0.61 to 1.01, p<0.001). The rate of patients with CK-MB values above the normal range was also significantly higher in the former than the latter (60/350 vs 98/1,780; RR=2.84, 95%CI 1.89 to 4.27, p<0.001; I 2 =19.9, p=0.254). Extreme between-study heterogeneity was observed (I 2 =93.4%, p<0.001). Sensitivity analysis, performed by sequentially removing each study and re-assessing the pooled estimates, showed that the magnitude and direction of the effect size was not modified (effect size range, 0.77 to 0.84). Begg's (p=0.50) and Egger's (p=0.86) t-tests did not show publication bias. In meta-regression analysis, the SMD was significantly and positively associated with the white blood count, aspartate aminotransferase, myoglobin, troponin, brain natriuretic peptide, lactate dehydrogenase, and D-dimer. Conclusions Higher CK-MB concentrations were significantly associated with severe disease and mortality in COVID-19 patients. This biomarker of myocardial injury might be useful for risk stratification in this group.

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“…Meta-analysis reveals that elevated CK-MB levels suggest cardiac damage and are significantly associated with disease severity and an increased risk of mortality in COVID-19 patients. 119 , 120 …”

Section: Search Strategymentioning

confidence: 99%

Attenuating the Effects of Novel COVID-19 (SARS-CoV-2) Infection-Induced Cytokine Storm and the Implications

Rowaiye¹,

Okpalefe²,

Adejoke³

et al. 2021

JIR

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The COVID-19 pandemic constitutes an arduous global health challenge, and the increasing number of fatalities calls for the speedy pursuit of a remedy. This review emphasizes the changing aspects of the COVID-19 disease, featuring the cytokine storm’s pathological processes. Furthermore, we briefly reviewed potential therapeutic agents that may modulate and alleviate cytokine storms. The literature exploration was made using PubMed, Embase, MEDLINE, Google scholar, and China National Knowledge Infrastructure databases to retrieve the most recent literature on the etiology, diagnostic markers, and the possible prophylactic and therapeutic options for the management of cytokine storm in patients hospitalized with COVID-19 disease. The causative agent, severe acute respiratory coronavirus-2 (SARS-CoV-2), continually threatens the efficiency of the immune system of the infected individuals. As the first responder, the innate immune system provides primary protection against COVID-19, affecting the disease’s progression, clinical outcome, and prognosis. Evidence suggests that the fatalities associated with COVID-19 are primarily due to hyper-inflammation and an aberrant immune function. Accordingly, the magnitude of the release of pro-inflammatory cytokines such as interleukin (IL)-1, (IL-6), and tumor necrosis alpha (TNF-α) significantly differentiate between mild and severe cases of COVID-19. The early prediction of a cytokine storm is made possible by several serum chemistry and hematological markers. The prompt use of these markers for diagnosis and the aggressive prevention and management of a cytokine release syndrome is critical in determining the level of morbidity and fatality associated with COVID-19. The prophylaxis and the rapid treatment of cytokine storm by clinicians will significantly enhance the fight against the dreaded COVID-19 disease.

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Elevated cardiac biomarkers may be effective prognostic predictors for patients with COVID-19: A multicenter, observational study

Cited by 25 publications

References 37 publications

Myoglobin and C-reactive protein are efficient and reliable early predictors of COVID-19 associated mortality

Myoglobin and C-reactive protein are efficient and reliable early predictors of COVID-19 associated mortality

Serum CK-MB, COVID-19 severity and mortality: An updated systematic review and meta-analysis with meta-regression

Attenuating the Effects of Novel COVID-19 (SARS-CoV-2) Infection-Induced Cytokine Storm and the Implications

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