Inflammatory and Tissue Damage Biomarkers Progression as Mortality Prognosis in Patients with Covid-19 Disease

Document Type : Original Article

Authors

1 Science Research Doctor, Biomedical Research Department, CMN 20 de Noviembre ISSSTE, México City.

2 Cardiothoracic Surgeon, Cardiovascular Department, CMN 20 de Noviembre ISSSTE, México City.

3 Endocrinologist, Endocrinology Department, CMN 20 de Noviembre ISSSTE, México City.

4 Intensive Care Physician, Intensive Therapy Department, CMN 20 de Noviembre ISSSTE, México City.

5 Bio-medical Engineer, Research Coordination, CMN 20 de Noviembre ISSSTE, México City.

Abstract

Introduction: Metabolic and inflammatory disorders are widely described in COVID-19 disease by SARS-CoV-2, especially in advanced gravity stages, nevertheless, the increase in inflammatory and tissue damage biomarkers could identify patients with higher mortality risk since early disease stages.
Material and Method: A retrospective Cohort study was performed to evaluate the progression pattern and mortality risk of proinflammatory (Ferritin and IL-6) and damage tissue biomarkers seric levels (LDH, CPK, CPK-MB and TnIc) since the beginning of the disease to end outcome considered, in this study, as death or recovery
Results: We evaluated 120 patients with mean age 51±10 years. The CAT study showed in all patients bilateral polished glass lung lesions. The inflammatory and seric tissue injured biomarkers were significantly higher since the beginning of the hospitalization in patients who died compared with patients that survived (p = 0.01). The myocardial injury biomarkers (CPK-MB and TnIc) were significantly higher in severe gravity stages of deceased patients compared to patients who survived (p = 0.001 and 0.003 respectively) with a global mortality of 38.3% (n = 48). The mortality risk was extremely elevated (RR> 10) when inflammatory and tissue injury biomarkers showed seric levels 2 folds above normal values, showing survival of  < 60% after tenth day since the beginning disease.
Conclusion: Since the beginning of COVID-19 disease by SARS CoV2 virus, patients show serum elevation in ferritin, LDH and CPK. This seric values were associated with higher mortality risk, when elevated 2 folds above normal values.

Keywords

References

  1. Li B, Yang J, Zhao F, Zhi L, Wang X, Liu L, et al. Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China. Clinical Research in Cardiology. 2020 May; 109(5):531-8.
  2. Zheng YY, Ma YT, Zhang JY, Xie X. COVID-19 and the cardiovascular system. Nature Reviews Cardiology. 2020 May; 17(5):259-60.
  3. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The lancet. 2020 Feb 15; 395(10223):497-506.
  4. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, e. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. The lancet. 2020 Feb 15; 395(10223):507-13.
  5. Badawi A, Ryoo SG. Prevalence of comorbidities in the Middle East respiratory syndrome coronavirus (MERS-CoV): a systematic review and meta-analysis. International Journal of Infectious Diseases. 2016 Aug 1; 49:129-33.
  6. Clerkin KJ, Fried JA, Raikhelkar J, Sayer G, Griffin JM, Masoumi A, et al. COVID-19 and cardiovascular disease. Circulation. 2020 May 19; 141(20):1648-55.
  7. Booth CM, Matukas LM, Tomlinson GA, Rachlis AR, Rose DB, Dwosh HA, et al. Clinical features and short-term outcomes of 144 patients with SARS in the greater Toronto area. Jama. 2003 Jun 4; 289(21):2801-9.
  8. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of coronavirus disease 2019 in China. New England journal of medicine. 2020 Apr 30; 382(18):1708-20.
  9. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. Jama. 2020 Mar 17; 323(11):1061-9.
  10. Zheng YY, Ma YT, Zhang JY, Xie X. COVID-19 and the cardiovascular system. Nature Reviews Cardiology. 2020 May; 17(5):259-60.
  11. Zhang H, Penninger JM, Li Y, Zhong N, Slutsky AS. Angiotensin-converting enzyme 2 (ACE2) as a SARS-CoV-2 receptor: molecular mechanisms and potential therapeutic target. Intensive care medicine. 2020 Apr; 46(4):586-90.
  12. McPherson RA, Msc MD, Pincus MR. Henry's clinical diagnosis and management by laboratory methods E-book. Elsevier Health Sciences; 2021 Jul 16.
  13. Fantin VR, St-Pierre J, Leder P. Attenuation of LDH-A expression uncovers a link between glycolysis, mitochondrial physiology, and tumor maintenance. Cancer cell. 2006 Jun 13; 9(6):425-34.
  14. Hinkle J, Brunner CK. Suddarth's Handbook of Laboratory and Diagnostic Tests. Kindle. Philadelphia: Wolters Kluwer Health, Lippincott Williams & Wilkins; c2014. Lactate Dehydrogenase; p. 354
  15. Totura AL, Baric RS. SARS coronavirus pathogenesis: host innate immune responses and viral antagonism of interferon. Current opinion in virology. 2012 Jun 1; 2(3):264-75.
  16. Mahajan S, Decker CE, Yang Z, Veis D, Mellins ED, Faccio R. Plcγ2/Tmem178 dependent pathway in myeloid cells modulates the pathogenesis of cytokine storm syndrome. Journal of autoimmunity. 2019 Jun 1; 100:62-74.
  17. Mahallawi WH, Khabour OF, Zhang Q, Makhdoum HM, Suliman BA. MERS-CoV infection in humans is associated with a pro-inflammatory Th1 and Th17 cytokine profile. Cytokine. 2018 Apr 1; 104:8-13.
  18. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. The lancet. 2020 Feb 15; 395(10223):507-13.
  19. Han Y, Zhang H, Mu S, Wei W, Jin C, Tong C, et al. Lactate dehydrogenase, an independent risk factor of severe COVID-19 patients: a retrospective and observational study. Aging (Albany NY). 2020 Jun 30; 12(12):11245.
  20. Ferrari D, Motta A, Strollo M, Banfi G, Locatelli M. Routine blood tests as a potential diagnostic tool for COVID-19. Clinical chemistry and laboratory medicine (CCLM). 2020 Jul 1; 58(7):1095-9.
  21. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of coronavirus disease 2019 in China. New England journal of medicine. 2020 Apr 30; 382(18):1708-20.
  22. Xiong Y, Sun D, Liu Y, Fan Y, Zhao L, Li X, et al. Clinical and high-resolution CT features of the COVID-19 infection: comparison of the initial and follow-up changes. Investigative radiology. 2020.
  23. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The lancet. 2020 Mar 28; 395(10229):1054-62.
  24. Oudit GY, Kassiri Z, Jiang C, Liu PP, Poutanen SM, Penninger JM, et al. SARS‐coronavirus modulation of myocardial ACE2 expression and inflammation in patients with SARS. European journal of clinical investigation. 2009 Jul; 39(7):618-25.
  25. Xu Z, Shi L, Wang Y, Zhang J, Huang L, Zhang C, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. The Lancet respiratory medicine. 2020 Apr 1; 8(4):420-2.
  26. Dong M, Liu T, Li G. Association between acute infections and risk of acute coronary syndrome: a meta-analysis. International journal of cardiology. 2011 Mar 17; 147(3):479-82.
  27. Pesaresi M, Pirani F, Tagliabracci A, Valsecchi M, Procopio AD, Busardò FP, et al. SARS-CoV-2 identification in lungs, heart and kidney specimens by transmission and scanning electron microscopy. European review for medical and pharmacological sciences. 2020 May; 24(9):5186-8.
Journal of Cardio-Thoracic Medicine
Volume 9, Issue 4
December 2021
Pages 878-883

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