SARS-CoV-2 Viremia is Associated With Inflammatory, But Not Cardiovascular Biomarkers, in Patients Hospitalized for COVID-19

Abstract

Background COVID-19 may present with a variety of cardiovascular manifestations, and elevations of biomarkers reflecting myocardial injury and stress are prevalent. SARS-CoV-2 has been found in cardiac tissue, and myocardial dysfunction post-COVID-19 may occur. However, the association between SARS-CoV-2 RNA in plasma and cardiovascular biomarkers remains unknown. Methods and Results COVID MECH (COVID-19 Mechanisms) was a prospective, observational study enrolling consecutive, hospitalized patients with laboratory-confirmed infection with SARS-CoV-2 and symptoms of COVID-19. Biobank plasma samples used to measure SARS-CoV-2 RNA and cardiovascular and inflammatory biomarkers were collected in 123 patients at baseline, and in 96 patients (78%) at day 3. Patients were aged 60±15 (mean ± SD) years, 71 (58%) were men, 68 (55%) were White, and 31 (25%) received mechanical ventilation during hospitalization. SARS-CoV-2 RNA was detected in plasma from 48 (39%) patients at baseline. Patients with viremia were more frequently men, had more diabetes mellitus, and lower oxygen saturation. Patients with viremia had higher concentrations of interleukin-6, C-reactive protein, procalcitonin, and ferritin (all <0.001), but comparable levels of cTnT (cardiac troponin T; P=0.09), NT-proBNP (N-terminal pro-B-type natriuretic peptide; P=0.27) and D-dimer (P=0.67) to patients without viremia. SARS-CoV-2 RNA was present in plasma at either baseline or day 3 in 50 (52%) patients, and these patients experienced increase from baseline to day 3 in NT-proBNP and D-dimer concentrations, while there was no change in cTnT. Conclusions SARS-CoV-2 viremia was associated with increased concentrations of inflammatory, but not cardiovascular biomarkers. NT-proBNP and D-dimer, but not cTnT, increased from baseline to day 3 in patients with viremia. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04314232.

Keywords: COVID‐19; RNA; SARS‐CoV‐2; biomarkers; cardiovascular; viremia.

Conflict of interest statement

Dr Myhre has served on advisory boards for Novartis and Novo Nordisk, and has received consulting honoraria from Novartis, AmGen, and Novo Nordisk. Dr Omland has served on advisory boards for Abbott Diagnostics, Roche Diagnostics, and Bayer and has received research support from Abbott Diagnostics, Novartis, Roche Diagnostics, Singulex, and SomaLogic via Akershus University Hospital, and speaker's or consulting honoraria from Roche Diagnostics, Siemens Healthineers, and CardiNor. The remaining authors have no disclosures to report.

Figures

Figure 1. Concentrations of NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide), cTnT (cardiac troponin T) and D‐dimer at baseline and day 3, in patients with (n=50) and without (n=46) severe acute respiratory syndrome coronavirus 2 viremia at either time point.

P values are for paired sample analysis within each group, and for analyses comparing log‐transformed delta values between the groups. cTnT indicates cardiac troponin T; and NT‐proBNP, N‐terminal pro‐B‐type natriuretic peptide.