A Potent Predictor of Poor COVID-19 Outcomes: Troponin/ Creatine Kinase-MB Ratio

Yıl 2024, Cilt: 8 Sayı: 3, 266 - 273, 17.12.2024

Avsar Zerman , Cihan Aydin , Nermin Zerman

https://doi.org/10.46332/aemj.1359197

Öz

Purpose: In this study, we aimed to derive significant implications by evaluating the predictive value of the troponin/CK-MB ratio, which has not been studied in previous research.

Materials and Methods: We screened all COVID-19 patients admitted to the intensive care unit(ICU) between April 2020 and September 2022. All medical records, laboratory results, and in-hospital mortality were recorded.

Results: We included 182 patients in this study. The overall correct classification rate of the proposed model was 83.0%. The Nagelkerke R² value explained 55.8% of the variance in mortality. The most predictive variable was the troponin/CK-MB ratio. An increase of 1 unit in the troponin/CK-MB ratio elevated the mortality risk by 108.90 times. A cut-off value for the troponin/CK-MB ratio, identified as the most predictive laboratory parameter, was determined to be 0.00745.

Conclusion: The Troponin/CK-MB ratio has the potential to predict in-hospital mortality in COVID-19 patients. In the management of COVID-19 in the ICU, this ratio should be used to predict poor outcomes, assisting physicians in determining the optimal follow-up care for these patients

Anahtar Kelimeler

cardiovascular abnormalities, innate inflammatory response, mortality rate, SARS-CoV-2

Kötü COVID-19 Sonuçlarının Güçlü Bir Öngörücüsü: Troponin/Kreatin Kinaz-MB Oranı

Öz

Amaç: Bu çalışmada daha önce yapılan çalışmalarda çalışılmayan troponin/CK-MB oranının öngörüsünü değerlendirerek belirleyici çıkarımlar elde etmeyi amaçladık.

Araçlar ve Yöntem: Nisan 2020 ile Eylül 2022 tarihleri arasında yoğun bakım ünitesine (YBÜ) kabul edilen tüm COVID-19 hastalarını taradık. Tüm tıbbi kayıtlar, laboratuvar sonuçları ve hastane içi ölüm kaydedildi.

Bulgular: Bu çalışmaya 182 hastayı dahil ettik. Amaçlanan modelin genel doğru sınıflandırma oranı %83.0'dır. Nagelkerke R2 değeri incelendiğinde mortalitedeki varyansın %55.8'ini açıklamaktadır. En belirleyici değişken troponin/CK-MB oranıydı. Troponin/CK-MB oranındaki 1 birimlik artış ölüm riskini 108.90 kat artırdı. Troponin/CK-MB oranı için en belirleyici laboratuvar parametresi olan kesme değeri 0.00745 olarak belirlendi.

Sonuç: Troponin/CK-MB oranının hastane içi COVID-19 mortalitesini öngörmede potansiyel bir etkisi vardır. Yoğun bakımda COVİD-19 yönetiminde kötü sonuçları tahmin etmek için Troponin/CK-MB oranı kullanılmalıdır. Dolayısıyla hekimlerin COVID-19'un optimal takibini yönetmelerine yardımcı olabilir.

Anahtar Kelimeler

doğuştan gelen inflamatuar yanıt, kardiyovasküler anormallikler, ölüm oranı, SARS-CoV-2

Kaynakça

• 1. Ho JPTF, Donders HCM, Zhou N, Schipper K, Su N, de Lange J. Association between the degree of obstructive sleep apnea and the severity of COVID-19: an explorative retrospective cross-sectional study. PLoS One. 2021;16(9):e0257483.
• 2. WHO Director-General's opening remarks at the media briefing on COVID-19 – 3 March 2020. Geneva: World Health Organization; 2020. Available at: https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarksat-the-media-briefing-on-covid-19---3-march-2020 Accessed September 10, 2023.
• 3. Ciceri F, Beretta L, Scandroglio AM, et al. Microvascular COVID-19 lung vessels obstructive thromboinflammatory syndrome (MicroCLOTS): an atypical acute respiratory distress syndrome working hypothesis. Crit Care Resusc. 2020;22(2):95-97.
• 4. Henry BM, Vikse J, Benoit S, Favaloro EJ, Lippi G. Hyperinflammation and derangement of renin-angiotensin-aldosterone system in COVID-19: A novel hypothesis for clinically suspected hypercoagulopathy and microvascular immunothrombosis. Clin Chim Acta. 2020;507:167-173.
• 5. Menga LS, Berardi C, Ruggiero E, Grieco DL, Antonelli M. Noninvasive respiratory support for acute respiratory failure due to COVID-19. Curr Opin Crit Care. 2022;28(1):25-50.
• 6. Babapoor-Farrokhran S, Gill D, Walker J, Rasekhi RT, Bozorgnia B, Amanullah A. Myocardial injury and COVID-19: Possible mechanisms. Life Sci. 2020;253: 117723.
• 7. Devaux CA, Rolain JM, Raoult D. ACE2 receptor polymorphism: Susceptibility to SARS-CoV-2, hypertension, multi-organ failure, and COVID-19 disease outcome. J Microbiol Immunol Infect. 2020;53(3):425-435.
• 8. Imazio M, Klingel K, Kindermann I, et al. COVID-19 pandemic and troponin: indirect myocardial injury, myocardial inflammation or myocarditis? Heart. 2020;106 (15):1127-1131.
• 9. Shi L, Wang Y, Wang Y, Duan G, Yang H. Meta-Analysis of Relation of Creatine kinase-MB to Risk of Mortality in Coronavirus Disease 2019 Patients. Am J Cardiol. 2020;130:163-165.
• 10. Zhu Z, Wang M, Lin W, et al. Cardiac biomarkers, cardiac injury, and comorbidities associated with severe illness and mortality in coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis. Immun Inflamm Dis. 2021;9(4):1071-1100.
• 11. Stark M, Kerndt CC, Sharma S. Troponin. [Updated 2023 Apr 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available at: https://www.ncbi.nlm.nih.gov/books/NBK507805/ Accessed September 10, 2023.
• 12. WHO Global Health Estimates. Available at: https://www.who. int/news-room/fact-sheets/detail/the-top-10-causes-of-death Accessed September 10, 2023.
• 13. Battaglini D, Lopes-Pacheco M, Castro-Faria-Neto HC, Pelosi P, Rocco PRM. Laboratory Biomarkers for Diagnosis and Prognosis in COVID-19. Front Immunol. 2022;13:857573.
• 14. Gaze DC. Clinical utility of cardiac troponin measurement in COVID-19 infection. Ann Clin Biochem. 2020;57(3):202-205.
• 15. Maloberti A, Biolcati M, Giannattasio C. Troponin elevation in COVID-19 patients: An important stratification biomarker with still some open questions. Int J Cardiol. 2021;341:107-109.
• 16. Schnaubelt S, Oppenauer J, Tihanyi D, et al. Arterial stiffness in acute COVID-19 and potential associations with clinical outcome. J Intern Med. 2021;290(2):437-443.
• 17. Puntmann VO, Carerj ML, Wieters I, et al. Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered From Coronavirus Disease 2019 (COVID-19). JAMA Cardiol. 2020;5(11):1265-1273.
• 18. Tersalvi G, Vicenzi M, Calabretta D, Biasco L, Pedrazzini G, Winterton D. Elevated Troponin in Patients With Coronavirus Disease 2019: Possible Mechanisms. J Card Fail. 2020;26(6):470-475.
• 19. Baykara N; PREGCOVID-ICU study group. Clinical Characteristics, Outcomes, and Risk Factors for Mortality in Pregnant/Puerperal Women with COVID-19 Admitted to ICU in Turkey: A Multicenter, Retrospective Study from a Middle-Income Country. J Intensive Care Med. 2024;39(6):577-594.
• 20. Sarı Küçük R, Uluç K, Merve Çolakoğlu Ş, Kılınç Berktaş C, Mutlu S, Turgut N. The effect of using iloprost on prognosis in COVID-19 patients with ARDS: a retrospective clinical study. Eur Rev Med Pharmacol Sci. 2023;27(9):4269-4279.
• 21. Güngör S, Ediboğlu Ö, Yazıcıoğlu Moçin Ö, et al. Evaluation of Patients with COVID-19 Followed Up in Intensive Care Units in the Second Year of the Pandemic: A Multicenter Point Prevalence Study. Thorac Res Pract. 2023;25(1):11-16.
• 22. Xiong TY, Redwood S, Prendergast B, Chen M. Coronaviruses and the cardiovascular system: acute and long-term implications. Eur Heart J. 2020;41(19):1798-1800.
• 23. García de Guadiana-Romualdo L, Morell-García D, Rodríguez-Fraga O, et al. Cardiac troponin and COVID-19 severity: Results from BIOCOVID study. Eur J Clin Invest. 2021;51(6):e13532.
• 24. Papageorgiou N, Sohrabi C, Prieto Merino D, et al. High sensitivity troponin and COVID-19 outcomes. Acta Cardiol. 2022;77(1):81-88.
• 25. Majure DT, Gruberg L, Saba SG, Kvasnovsky C, Hirsch JS, Jauhar R. Northwell Health COVID-19 Research Consortium. Usefulness of Elevated Troponin to Predict Death in Patients With COVID-19 and Myocardial Injury. Am J Cardiol. 2021;138:100-106.
• 26. Wibowo A, Pranata R, Akbar MR, Purnomowati A, Martha JW. Prognostic performance of troponin in COVID-19: A diagnostic meta-analysis and meta-regression. Int J Infect Dis. 2021;105:312-318.
• 27. Hu Q, Cheng C, Li Y, Duan G, Chen S. Elevated Creatine Kinase-MB Is an Independent Risk Factor for Mortality of COVID-19: Based on Adjusted Data. Arch Iran Med. 2022;25(2):124-125.