COVID-19 Cytokine Storm Biomarkers. Comorbidities and Outcomes in Hemodyalisis Patients

Biomarkers of inflammation and thrombosis have been well documented in patients with Covid-19. Recent publications point to studies of the muscle markers Troponin and Creatine Kinase in Covid-19 patients and find out the associations among them as well as with all the available laboratory data that can interfere with them.

Evaluation of the association of inflammatory, thrombogenic and cardiac muscle injury parameters in patients with severe Covid-19 and comorbities evolution hospitalized in Intensive Care Units (ICU) of a tertiary hospital in São Paulo, being a significant proportion of them on hemodyalisis [1-5].

From February 20, 2020 to September 20 of the same year, 536 COVID-positive patients were admitted to the ICU of a tertiary hospital in a private public system. All identification data, clinical, anthropometric, laboratory, therapeutic procedures and discharge conditions were recorded by the Tasy system. A database was assembled from it, and 63 parameters were recorded for their correlation and association, and in the present study the highlight focused on the inflammatory marker C Reactive Protein (CRP), thrombogenic and its associates D Dimer, Lactic Dehydrogenase (LD) and Fibrinogen, as well as those of general and cardiac muscle injury Creatin Kinase (CK), MB Creatin Kinase (MBCK) and Troponin. Due to the size of the database and the hypotheses to be searched, the R System was used for statistical calculations, using both the data tree and the classifications in bar charts.

Their mean age was 63,4 years, being 61 percent male and on hemodyalisis. Their clinical, anthropometric, laboratory values and therapies were the basis for the construction of a data bank with 16700 informations. Statistical analysis was performed on the R system, due to the large size of data and for the sake of correlations being done among all the measurements. Having Creatin Kinase as reference variable, in descending order, the associations were with MB Creatin Kinase, C Reactive Protein, Creatinine, D Dimer, Lactic Dehydrogenase, Diabetes, Body Mass Index, Fibrinogen and Hypertension. When the marked variable was Troponin associations were MB Creatin Kinase, Lactic Dehydrogenase, D Dimer, Creatin Kinase, Diabetes, Fibrinogen, Creatinine, Dyslipidemia, C Reactive Protein, Body Mass Index, Race, Hypertension and Statin use. Associations of muscle markers as Troponin and Creatin Kinase were found with all inflammation and thrombosis markers as well as factors such as Race, Diabetes, Hypertension, Dyslipidemia, Body Mass Index and Statins are interrelated in Covid-19 infection. It is noteworthy that besides the associations already expected among inflammatory and thrombotic markers, classic muscle markers behaved in the same way. The main results are also presented in tables and figures. Table 1 and Figures 1-5

Table 1: Average demographics - first five months*.

*Both groups studied until July 20 and until September 20 were homogeneous.

Figure 1: LD-Lactic Dehydrogenase; SH-Systolic Hypertension. Results in Tree Format: Reference Parameter C Reactive Protein.

Figure 2: Cytokine Storm-Creatin Kinase parameter reference.

Figure 3: Cytokine Storm-Troponin parameter reference.

Figure 4: Cytokine Storm-Lactic Dehydrogenase parameter reference.

Figure 5: Cytokine Storm-D Dimer Parameter reference.

Table 2: Degree of pulmonary area affected and hemodyalisis patients.

Table 3: Degree of pulmonary area affected and number of hemodyalisis patients in each subgroup.

Table 4: Destiny of acute kidney disease patients on hemodialysis after discharges from Intensive Care Unit.

Table 5: Destiny of renal patients not on hemodialysis after discharges from Intensive Care Unit.

Tables 2 & 3 demonstrate that the outcome raises the hypothesis of association of the pulmonary area affected with pulmonary congestion and not linearly correlated to the area, despite some authors having observed the contrary [6]. It is important to note that although hipertension comorbidity was the more prevalent, diabetes comorbidity that came next had the worst death rate than hypertension surpassing it in the range of 30%. Although there were no means of estimating by laboratory methods it must be mentioned that the interrelations of alteration of biomarkers induced by the Covid-19 infection is possibly mediated by Covid-19 repression of the anti-aging gene that is critical to programmed cell death [7]. All parameters researched in positive Covid-19 hemodyalitic patients [8-11] admitted to the ICU present concomitance of laboratory evaluators of inflammation, thrombotic risk and skeletal and tissue muscle injury, which indicates the need for anti-inflammatory and anti-thrombotic therapies among all others.

Associations of muscle markers as Troponin and CK were found with all inflammation and thrombosis markers as well as factors such as, Diabetes, Hypertension, Dyslipidemia, BMI and Race mainly are found in Covid-19 infection. Considering the demographic distribution of severe Covid-19 patients special attention has to be given to the diabetics mortality rate in spite of hypertension being the more prevalent comorbidity in all reports.

The large spectrum of concomitant alterations caused by the same disease demonstrates that these factors are not altered independently but by one and the same infectious agent. Patients on dialysis demonstrated similar patterns of laboratory biomarkers of inflammation, thrombosis and muscle injury as the overall of Covid-19 patients admitted to the Intensive Care Unit.

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