Characteristics of individual biomarkers and their prognostic role in various variants of acute coronary syndrome development in patients with a new coronavirus infection

Aim. Based on the study of individual biomarkers in patients with a coronavirus disease 2019 (COVID-19) in combination with acute coronary syndrome (ACS), to develop a method for predicting the course type.

Material and methods. The study included patients with severe COVID-19 and ACS (n=104) of three variants: subgroup 1 (n=35) — unstable angina (UA); subgroup 2 (n=34) — non-ST-elevation myocardial infarction (NSTEMI); subgroup 3 (n=35) — ST-elevation MI (STEMI).

Results. In patients with COVID-19 and ACS, the following was observed: a significant lung damage according to computed tomography (%) — 45,00 (35,00; 55,00), high scores on intensive care severity scales: SOFA — 16,00 (14,00; 18,00) and SAPS II — 21,00 (17,00; 24,00), as well as elevated values of C-reactive protein (mg/l) — 129,60 (74,55; 198,68), creatine phosphokinase (CPK) (U/l) — 1986,50 (1204,50; 2163,00), lactate dehydrogenase (U/l) — 1117,50 (711,25; 1458,00), troponin (ng/l) — 82,50 (63,00; 119,50) and ferritin (ng/lm) — 965,50 (757,25; 1222,50). Among the cytokine profile parameters, both increased (interleukin (IL)-1β (pg/ml) — 8,94 (8,48; 9,50)) and decreased (IL-4 (pg/ml) — 10,52 (10,01; 10,91); IL-10 (pg/ml) — 85,11 (83,02; 87,98); interferon-γ (pg/ml) — 9,27 (8,58; 9,85)) values were recorded. In the subgroup with STEMI, the highest SOFA (Me=18,00; p_1-3=0,003 and p_2-3<0,001) and SAPS II (Me=25,00; all p<0,001) scores were found. In patients with UA, the blood total protein content was higher (p_1-2<0,001 and p_1-3=0,003), and the level of C-reactive protein and CPK was lower (p<0,001 for all) than in the comparison subgroups. In addition, these patients had highest values of IL-4 (Me=10,91 pg/m; p<0,001), IL-10 (Me=86,60; p=0,002), interferon-γ (Me=9,75; pg/ml, p_1-2=0,002 and p_1-3<0,001) and the lowest levels of IL-1β (Me=8,51 pg/ml; p<0,001), IL-6 (Me=14,90 pg/ml; p<0,001), tumor necrosis factor-α (Me=22,21 pg/ml, p_1-3=0,009).

Conclusion. The main contribution to divided prediction of UA and MI was made by the SAPS II score and IL-1β, and to a lesser extent by CPK and IL-6. To clarify the MI variant (with and without ST-segment elevation) — the SOFA scale and IL-6 contribution was significant. The obtained discriminant models have a sensitivity of 97% and 91%, and a specificity of 97% and 85%, respectively.

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