Department of Cardiology, Akershus University Hospital, Lorenskog, Norway.
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
Open Heart. 2021 Dec;8(2). doi: 10.1136/openhrt-2021-001884.
Soluble ST2 (sST2) reflects inflammation, endothelial dysfunction and myocardial fibrosis, is produced in the lungs and is an established biomarker in heart failure. We sought to determine the role of sST2 in COVID-19 by assessing pathophysiological correlates and its association to in-hospital outcomes.
We enrolled 123 consecutive, hospitalised patients with COVID-19 in the prospective, observational COVID-19 MECH study. Biobank samples were collected at baseline, day 3 and day 9. The key exposure variable was sST2, and the outcome was ICU treatment with mechanical ventilation or in-hospital death.
Concentrations of sST2 at baseline was median 48 (IQR 37-67) ng/mL, and 74% had elevated concentrations (>37.9 ng/mL). Higher baseline sST2 concentrations were associated with older age, male sex, white race, smoking, diabetes, hypertension and chronic kidney disease. Baseline sST2 also associated with the presence of SARS-CoV-2 viraemia, lower oxygen saturation, higher respiratory rate and increasing concentrations of biomarkers reflecting inflammation, thrombosis and cardiovascular disease. During the hospitalisation, 8 (7%) patients died and 27 (22%) survivors received intensive care unit (ICU) treatment. Baseline sST2 concentrations demonstrated a graded association with disease severity (median, IQR): medical ward 43 (36-59) ng/mL; ICU 67 (39-104) ng/mL and non-survivors 107 (72-116) ng/mL (p<0.001 for all comparisons). These associations persisted at day 3 and day 9 .
sST2 concentrations associate with SARS-CoV-2 viraemia, hypoxaemia and concentrations of inflammatory and cardiovascular biomarkers. There was a robust association between baseline sST2 and disease severity that was independent of, and superior to, established risk factors. sST2 reflects key pathophysiology and may be a promising biomarker in COVID-19.
NCT04314232.
可溶性 ST2（sST2）反映炎症、内皮功能障碍和心肌纤维化，在肺部产生，是心力衰竭的既定生物标志物。我们通过评估病理生理学相关性及其与住院期间结局的关系，旨在确定 sST2 在 COVID-19 中的作用。
我们在前瞻性观察性 COVID-19 MECH 研究中纳入了 123 例连续住院的 COVID-19 患者。在基线、第 3 天和第 9 天采集生物样本。关键暴露变量为 sST2，结局为 ICU 治疗（机械通气）或住院期间死亡。
基线时 sST2 浓度中位数为 48（IQR 37-67）ng/ml，74%的患者浓度升高（>37.9ng/ml）。较高的基线 sST2 浓度与年龄较大、男性、白种人、吸烟、糖尿病、高血压和慢性肾脏病有关。基线 sST2 还与 SARS-CoV-2 病毒血症、低氧饱和度、呼吸频率升高以及反映炎症、血栓形成和心血管疾病的生物标志物浓度升高有关。住院期间，8 例（7%）患者死亡，27 例（22%）幸存者接受 ICU 治疗。基线 sST2 浓度与疾病严重程度呈梯度相关（中位数，IQR）：内科病房 43（36-59）ng/ml；ICU 67（39-104）ng/ml，非幸存者 107（72-116）ng/ml（所有比较均<0.001）。这些关联在第 3 天和第 9 天仍存在。
sST2 浓度与 SARS-CoV-2 病毒血症、低氧血症和炎症及心血管生物标志物浓度相关。基线 sST2 与疾病严重程度之间存在着与现有风险因素无关且优于后者的强关联。sST2 反映了关键的病理生理学，可能是 COVID-19 的一种有前途的生物标志物。
NCT04314232。
