FREQUENCY OF RAISED CARDIAC BIOMARKERS IN PATIENTS WITH COVID-19 INFECTION AND ITS ASSOCIATION WITH MORTALITY

Abstract

Background: Myocardial injury with raised Troponin levels and other cardiac biomarkers has been reported in COVID-19 and is associated with increased mortality. Data regarding clinical presentation and associated risk factors in patients with raised cardiac biomarkers in COVID-19 are limited. This study aimed to assess the frequency of myocardial injury as evidenced by raised cardiac markers in COVID-19 patients along with its association with mortality.

Material and Methods: This retrospective cohort study was conducted at Sindh Infectious Diseases Hospital and Research Centre. Data for different clinical variables were collected on a structured pro forma from the medical records and clinical outcomes were seen for hospital discharge or in-hospital mortality. SPSS software (version 25.0) was used for data analysis. Categorical variables were analyzed using frequencies and percentages and compared using the x² test or Fisher’s exact test. Continuous variables were analyzed using the mean, and median. A p-value less than 0.05 was considered statistically significant. The multivariate logistic regression model was used to see the association of mortality with independent risk factors.

Results: A total of 384 patients were studied; 243 (63.3%) were males. The mean age was 64.46 years. There were 373 (97.1%) individuals with raised pro-BNP levels, and 167(43.5%) had raised troponin-I values. Also, 156(40.62%) patients had increased both troponin-I and pro-BNP levels. The most common clinical presentation was shortness of breath seen in 321 (83.6%) patients. Cytokine Release Syndrome (CRS) was seen in 169 (44%). A low ejection fraction was present in 31 (8.1%). The average mean hospital stay was 8.97 days. Two hundred and thirteen (55.46%) patients were in ICU. Mortality was seen in 159 (41.4%). Survival was significantly associated with normal troponin-I (OR: 4.8, 95%CI: 3.0-7.5, P=0.00), normal ejection fraction EF>45% (OR: 2.3, 95%CI: 1.0-5.33, P=0.034) and age more than 60 years (OR: 0.6, 95%CI: 0.38-0.94 P=0.027) while raised pro-BNP has no association with mortality (P-value <0.129).

Conclusion: COVID-19 infection associated with myocardial injury as evidenced by raised cardiac enzymes and decreased ejection fraction is associated with high mortality in patients less than 60 years of age.

Keywords: COVID-19, Cardiac biomarkers, Troponin I, pro-BNP, Myocardial injury