Increasing cardiac troponin-I level as a cardiac injury index correlates with in-hospital mortality and biofactors in severe hospitalised COVID-19 patients.

BACKGROUND: Severe acute respiratory syndrome coronavirus-2 raised in 2019 (COVID-19) affects the lung tissue and other organs, specifically the heart. METHODS: The current study evaluated 120 hospitalised patients with severe COVID-19 between March 2021 and February 2022. Patients' demographics, vital signs, electrocardiogram abnormalities, clinical laboratory tests, including troponin I (TPI), mortality, and discharge type, were recorded. RESULTS: Among the 120 hospitalised patients with severe COVID-19, 54 (45.0%) patients were male, with an average age of 63.2 ± 1.4. Many patients have chronic comorbidities, including hypertension (51.6%), diabetes mellitus (34.1%), and ischemic heart disease (17.5%). The in-hospital and six months after the discharge mortality were 45.8% and 21.5%, respectively. Cardiac injury was observed in 14 (11.7%) patients with a mean TPI level of 8.386 ± 17.89 µg/L, and patients with cardiac injury had higher mortality than those without cardiac injury (P < 0.001). Furthermore, the cardiac injury was meaningfully correlated with age (ρ = 0.182, P = 0.019), history of ischemic heart disease (ρ = 0.176, P = 0.05), hospitalisation result and mortality (ρ = 0.261, P = 0.004), inpatient in ICU (ρ = 0.219, P = 0.016), and serum levels of urea (ρ = 0.244, P = 0.008) and creatinine (ρ = 0.197, P = 0.033). Additionally, the discharge results were significantly correlated with oxygen saturation with (ρ = -0.23, P = 0.02) and without (ρ = -0.3, P = 0.001) oxygen therapy, D-dimer (ρ = 0.328, P = 0.019), LDH (ρ = 0.308, P = 0.003), urea (ρ = 0.2, P = 0.03), and creatinine (ρ = 0.17, P = 0.06) levels. CONCLUSION: Elevated TPI levels are associated with increased mortality in severe COVID-19 patients. Therefore, TPI may be a beneficial biofactor for early diagnosis of cardiac injury and preventing a high mortality rate.

Chapter 26 - Immunotherapy as an emerging and promising tool against viral infections

Immunotherapies, as a strategy for disease management, manipulate or object to the ingredients of the immune system. Viral infections illustrate a significant threat to human health that was proven via documents in many countries. Nowadays, several immunotherapeutic approaches, as an alternative therapy, are increasingly investigated to treat infectious diseases that caused intense advances toward discovering pathogen-host immunity interactions. Novel therapeutic approaches certainly are essential to eliminate the challenges confronted by existing viral infection diseases’ prevention and treatment methods (lack of adequate efficacy, drug side-effect, and the apparition of drug resistance). As proven by evidences in the latest developments of pharmaceuticals, such as vaccines and monoclonal antibodies (mAbs), immunotherapy strategies display plentiful promise to manage the limitation. In this chapter, we explain some of the unique existing approaches to prevent and treat viral infectious disease via immunotherapies such as mAb-based therapies, vaccines, T-cell-based therapies, utilizing cytokine levels, and checkpoint inhibition as well as defensins. At the same time, its general performance has been displayed in cancer and many viral disease treatments [human immunodeficiency virus, malaria, tuberculosis, Zika virus, and coronavirus disease (COVID-19)]. Finally, immunotherapeutics’ unique features, cost, and safety will be affected by its general administration.