Biomarkers Associated with Cardiovascular Morbidity and Mortality in COVID-19 Patients

Abstract

Background: Severe acute respiratory syndrome coronavirus 2 (COVID-19) is linked to adverse cardiovascular outcomes in hospitalized patients but predicting the clinical course remains challenging. The purpose of this study was to examine the association between two biomarkers, troponin-I (TN) and interleukin-6 (IL-6), and cardiovascular morbidity and mortality in patients hospitalized with COVID-19. Methods: This is a retrospective single-center study of patients hospitalized with COVID-19 from March 2020 to May 2020. Elevated TN and IL-6 were defined as >0.02 ng/ml and >65.9 ng/mL respectively. The primary outcome was mortality with secondary outcomes including intensive care unit (ICU) admission and adverse cardiovascular outcomes (heart failure (HF), arrhythmia, myocardial infarction (MI), and pericarditis). Chi-squared tests and student t-tests were used for statistical analyses to examine the relationship between the presence of positive biomarkers and outcomes;p<0.05 significant. Results: In total, 150 patients were identified with the majority being African American (70%), males (55%) and an average age of 63.7 years. Patients with elevated TN had significantly increased mortality rates (36.1% vs. 19.2%, OR 2.4, p=0.021), incidence of arrhythmias (15.3% vs. 1.3%, OR 13.9, p=0.002), incidence of HF (13.9% vs. 1.3%, OR 12.4, p=0.003), and incidence of MI (13.9% vs. 1.3%, OR 12.4, p=0.003). Patients with elevated IL-6 had significantly higher mortality rates (42.7% vs. 12.0%, OR 5.5, p=<0.001), ICU admissions (50.7% vs. 18.7%, OR 4.5, p=<0.0001), incidence of arrhythmias (13.3% vs. 2.7%, OR 5.6, p=0.016), incidence of HF (12.0% vs. 2.7%, OR 5.0, p=0.028), and incidence of MI (13.3% vs. 1.3%, OR 11.4, p= 0.0048). Conclusion: Myocardial injury evidenced by elevated TN and elevated IL-6 are predictive of severe COVID-19 infections and cardiovascular complications, irrespective of race as seen in this cohort. Early detection at hospital admission and perhaps subsequent monitoring of TN and IL-6 could be beneficial in triage and to identify potential early escalation of care.