Association Between COVID-19 Infection and Cardiac Biomarkers in Hospitalized Patients at a Tertiary Care Center

Mahmoud W Bader; Abdulqader M Alaa Adeen; Omar E Hetta; Alwaleed K Aloufi; Muhannad H Fallata; Abdulaziz A Alsiraihi; Mohamed E Ahmed; Abdulhalim J Kinsara

doi:10.7759/cureus.41527

Association Between COVID-19 Infection and Cardiac Biomarkers in Hospitalized Patients at a Tertiary Care Center

Cureus. 2023 Jul 7;15(7):e41527. doi: 10.7759/cureus.41527. eCollection 2023 Jul.

Authors

Mahmoud W Bader¹, Abdulqader M Alaa Adeen¹, Omar E Hetta¹, Alwaleed K Aloufi¹, Muhannad H Fallata¹, Abdulaziz A Alsiraihi¹, Mohamed E Ahmed², Abdulhalim J Kinsara^{3

1

4}

Affiliations

¹ College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU.
² College of Sciences & Health Professions, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU.
³ Cardiology, Ministry of National Guard - Health Affairs, Jeddah, SAU.
⁴ King Abdullah International Medical Research Center, Ministry of National Guard - Health Affairs, Jeddah, SAU.

Abstract

Background The effects of coronavirus disease 2019 (COVID-19) on the cardiovascular system are well established. However, knowledge gaps in the clinical implications of cardiac involvement in COVID-19 patients are yet to be addressed. This study aimed to investigate acute cardiac injury (ACI) risk factors and outcomes associated with COVID-19 infection with cardiac involvement. Methodology In this retrospective study, we included hospitalized patients between March 2020 and May 2022 with confirmed COVID-19 infection and evidence of cardiac involvement. Results In total, 501 patients were included, of whom 396 (79%) had evidence of ACI. The median troponin level was 25.8 (interquartile range (IQR) = 10.8-71). Patients with evidence of ACI were significantly more likely to have diabetes mellitus (75% vs. 60%), cardiovascular disease (48% vs. 37%), chronic lung disease (22.2% vs. 12.4%), and chronic kidney disease (32.3% vs. 16.2%). Additionally, patients with ACI were significantly more likely to have cardiomegaly (60.6% vs. 44.8%) and bilateral lobe infiltrates (77.8% vs. 60%) on X-ray. Patients with ACI were significantly more likely to suffer from complications such as cardiogenic shock (5.3% vs. 0%), pneumonia (80.1% vs. 65.7%), sepsis (24.2% vs. 9.5%), and acute respiratory distress syndrome (33.1% vs. 8.6%). Patients with ACI were also significantly more likely to be admitted to the intensive care unit (ICU) (57% vs. 26.7%) and significantly more likely to die (38.1% vs. 11.4%). The results of the multivariate regression analysis indicated that mortality was significantly higher in patients with elevated troponin levels (adjusted odds ratio = 4.73; 95% confidence interval = 2.49-8.98). Conclusions In COVID-19-infected patients, old age, diabetes mellitus, cardiovascular disease, chronic lung disease, and chronic kidney disease were associated with an increased risk of ACI. The presence of ACI in the context of COVID-19 infection was noted to increase the risk for severe complications, such as cardiogenic shock, ICU admission, sepsis, and death.

Keywords: acute cardiac injury; beta natriuretic peptides (bnp); cardiac troponin; covid-19; risk factors.