Serum sST2: key biomarkers in COVID-19 patients with implications for coronary artery disease

As the coronavirus disease-2019 (COVID-19) pandemic persists, post-COVID-19 syndrome (PS), characterized by symptoms like chest pain, fatigue, and palpitations, is becoming a significant medical and social issue. COVID-19 patients with existing coronary artery disease (CAD) may face higher risks of complications. It is crucial to assess if PS patients also have CAD, though data is limited.

We studied 75 COVID-19 patients and 68 non-COVID-19 patients admitted to our hospital between 2022/12/20 to 2023/01/20. Demographic, laboratory, and clinical data were collected upon admission. The Gensini score (GS) was used to assess coronary atherosclerosis severity. Patients were categorized by GS and clinical traits to identify potential independent risks linked to CAD and COVID-19 severity.

COVID-19 patients with existing CAD had higher levels of serum soluble growth stimulation expression of gene 2 protein (sST2), myeloperoxidase, ALT, AST, PT, B-type natriuretic peptide (BNP), and hypersensitive troponin-I (hs-cTnI), along with longer hospital stays, more ICU admissions, and increased heart failure and ACS morbidity compared to those without CAD. Univariate and multivariate analysis identified sST2 as an independent risk factor for COVID-19 patients with coexisting CAD (odds ratio 1.122). sST2 levels were positively correlated with coronary angiography GS (r = 0.474, p < 0.001) in COVID-19 patients and were significantly higher in cases with GS ≥ 32, regardless of COVID-19 status (p < 0.001) and specifically in COVID-19 patients (p = 0.006). ROC analysis showed sST2 predicted ICU admission, hospital stay duration, and morbidity of HF and ACS similarly to GS.

Admission serum sST2 levels should be considered in COVID-19 patients with CAD-like symptoms for treatment planning and could serve as a prognostic biomarker for COVID-19 with co-existing CAD in clinical practice.