Long-term predictive value of cardiac biomarkers in patients with COVID-19 infection.

OBJECTIVE: Several studies have investigated the association between cardiac biomarkers and short-term prognosis in the COVID-19 infection. However, the data on the predictive value of cardiac biomarkers to predict long-term prognosis in COVID-19 infection are limited. We aimed at determining the relationship between N-terminal brain-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin I (hs-TnI) as cardiac biomarkers and in-hospital/long-term outcomes in COVID-19 infection. PATIENTS AND METHODS: The study included a total of 916 patients with confirmed COVID-19 infection. The primary outcome was in-hospital and 1-year mortality. The secondary outcome was intensive care need at admission or the need to be transferred to the intensive care unit later on. RESULTS: The study included 498 (54.4%) males and 418 (45.6%) females with a mean age of 55.1±18.5 years. The patients with known heart failure (HF), COVID-19-related HF, acute renal failure (ARF), chronic kidney disease (CKD), diabetes mellitus, hypertension, coronary artery disease (CAD), chronic obstructive pulmonary disease (COPD)/asthma, high CO-RADS score (≥ 4), lower EF, higher hs-TnI, and NT-proBNP levels had increased in-hospital and 1-year mortality. After multivariate analysis, NT-proBNP, hs-TnI, CKD, ARF, diabetes mellitus, and CAD were independent predictors of in-hospital and 1-year mortality. After ROC analysis, NT-proBNP cut-off levels of 1022.50 (sensitivity 87.5%, specificity 87.1%) and 1008 (sensitivity 88.6%, specificity 88.0%) were found to predict in-hospital and 1-year mortality, respectively. Hs-TnI cut-off levels of 49.6 (sensitivity 88.6%, specificity 88.9%) and 34.10 (sensitivity 83.8%, specificity 84.1%) were found to predict in-hospital and 1-year mortality, respectively. CONCLUSIONS: The current study suggests that NT-proBNP and hs-TnI can be used as valuable cardiac biomarkers to predict short-term and long-term parameters in COVID-19 infection.

Autonomic dysfunction and metabolic disorders as the possible sequelae of COVID-19 infection.

OBJECTIVE: The Coronavirus disease 2019 (COVID-19) infection is associated with autonomic dysfunction. Data on the long-term relationship between COVID-19 infection, heart rate recovery (HRR), and exaggerated blood pressure response to exercise (EBPR) are very limited. In our study, we aimed at investigating the long-term association between COVID-19, HRR, EBPR, metabolic, and echocardiographic parameters. PATIENTS AND METHODS: The study included 65 patients in the study group (33 female, median age 46) and 57 in the control group (30 female, 39 median age) between 1 April 2020 and 1 January 2021. Office blood pressure measurement, 24-hour ambulatory blood pressure monitoring, treadmill test, echocardiography, and metabolic parameters were evaluated. RESULTS: The frequency of blunted HRR (25 subjects, 38.5%, p < 0.001) and EBPR (7 subjects, 10.8%, p = 0.014) were significantly higher in study group. The study group had higher levels of white blood cell (p = 0.002), neutrophil, c-reactive protein, and uric acid (p < 0.001). Diameters of left atrium, aortic root, and ascending aorta were significantly higher in study group (p < 0.05). Age adjusted multiple logistic regression analysis showed that neutrophil levels (odds ratio (OR), 9.21; 95% confidence interval (CI), 1.52-55.75, p = 0.016), glomerular filtration rate (OR, 1.34; 95% CI, 1.13-1.59, p = 0.001), basal heart rate (OR, 1.58; 95% CI, 1.17-2.12, p = 0.003), and mean heart rate (OR, 1.22; 95% CI, 1.03-1.45, p = 0.0021) were independently associated with COVID-19 infection. CONCLUSIONS: The frequency of blunted HRR and EBPR, and uric acid levels were significantly higher in the study group compared to the control group, suggesting autonomic dysfunction as the possible sequelae of the COVID-19 infection and increased risk of cardiovascular events in the future.

Association among CO-RADS score, co-morbid diseases, and short-term prognosis in COVID-19 infection.

OBJECTIVE: CO-RADS scoring system is used as a diagnostic tool. However, the data about its association with co-morbid diseases and effectiveness in predicting intensive care need and short-term mortality are lacking. In our study, we aimed to investigate the association among CO-RADS score, co-morbid diseases, intensive care need, and 28-day-mortality. PATIENTS AND METHODS: The study included 665 patients with COVID-19 infection suspicion between 30 May 2020 and 30 October 2020. RESULTS: The sensitivity of CT was 77%, and specificity was 52%. A higher CT score was associated with the rate of positive PCR test results (p<0.001), and older patients had higher CO-RADS scores than younger patients (p<0.001). Hypertension (OR: 7.956; p=0.005) and diabetes mellitus (OR: 5.902; p=0.015) were associated with significantly higher CO-RADS scores. Most patients treated in the intensive care unit (ICU) had a CO-RADS score of 5. The CO-RADS score was 4 and above in 115 (89.2%) patients who were transferred to the intensive care unit due to worsening of clinical condition (p<0.001). The 28-day mortality was significantly higher in patients with a CO-RADS score of 4 and above than in patients with a score of 3 and below (97.3% vs. 2.7%) (p<0.001). CONCLUSIONS: Irrespective of PCR results, a higher CO-RADS score gives us useful information about ICU need or mortality risk and alerts us for early treatment to reduce the risk of further transmission, intensive care need, and mortality particularly in patients with co-morbid diseases.