Kozak Kateryna, Pavlyshyn Halyna, Vari Sandor George
Department of Pediatrics, No.2, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine.
International Research and Innovation in Medicine Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
J Multidiscip Healthc. 2025 May 30;18:3009-3019. doi: 10.2147/JMDH.S514776. eCollection 2025.
The studies of COVID-19-related cardiovascular events in children are not widespread. Criteria for cardiovascular dysfunction have been explicitly proposed for multisystem inflammatory syndrome in children (MIS-C), while for other COVID-19 manifestations, it remains unclear. Although instrumental confirmation of cardiovascular injury is well-known, laboratory markers for such injuries have not been thoroughly studied. Our study aimed to identify prognostic cut-off values for caspase-3 and cardiac troponin I (cTI) to define cardiovascular injury in pediatric COVID-19 patients during acute infection and MIS-C.
A cross-sectional study was conducted in Ternopil, Ukraine, involving two hundred sixty children aged one month to 17 years who had not previously been vaccinated against SARS-CoV-2. The research focused on different severities of COVID-19: mild (n=87); moderate (n=66); severe COVID-19 (n=22); MIS-C (n=40) and 45 non-SARS-CoV-2 infected persons. ELISA tests were used to measure caspase-3 and cardiac troponin I levels.
Caspase-3 and cTI levels were significantly higher in patients with severe COVID-19 and MIS-C compared to non-infected individuals. Furthermore, COVID-19 and MIS-C patients with cardiac abnormalities had substantially higher levels of caspase-3 and cTI compared to those without structural changes. The study also revealed a positive correlation between caspase-3 and cardiac troponin I levels in both the COVID-19 group (r = 0.41; p < 0.05) and the MIS-C group (r = 0.55; p < 0.05). The study has identified specific cut-off values for caspase-3 and cTI that can be used to predict cardiovascular structural changes in pediatric patients with COVID-19 and MIS-C. These values are caspase-3 ≥ 5.22 ng/mL, cTI≥ 1.34 ng/mL for COVID-19, and caspase-3 ≥ 6.52 ng/mL and cTI ≥ 0.39 ng/mL for MIS-C.
Current research has demonstrated that children with severe COVID-19, as well as patients with MIS-C, must undergo careful screening for cardiovascular events that could include biomarkers.
关于儿童新冠病毒相关心血管事件的研究并不广泛。儿童多系统炎症综合征（MIS-C）的心血管功能障碍标准已明确提出，但对于其他新冠病毒表现，仍不清楚。尽管心血管损伤的仪器确认众所周知，但此类损伤的实验室标志物尚未得到充分研究。我们的研究旨在确定半胱天冬酶 - 3和心肌肌钙蛋白I（cTI）的预后临界值，以界定急性感染期和MIS-C期儿科新冠病毒患者的心血管损伤。
在乌克兰捷尔诺波尔进行了一项横断面研究，纳入260名年龄在1个月至17岁之间、此前未接种过新冠病毒疫苗的儿童。该研究聚焦于不同严重程度的新冠病毒感染：轻症（n = 87）；中症（n = 66）；重症新冠病毒感染（n = 22）；MIS-C（n = 40）以及45名未感染新冠病毒的个体。采用酶联免疫吸附测定（ELISA）试验测量半胱天冬酶 - 3和心肌肌钙蛋白I水平。
与未感染个体相比，重症新冠病毒感染和MIS-C患者的半胱天冬酶 - 3和cTI水平显著更高。此外，有心脏异常的新冠病毒感染和MIS-C患者的半胱天冬酶 - 3和cTI水平明显高于无结构变化的患者。该研究还揭示，在新冠病毒感染组（r = 0.41；p < 0.05）和MIS-C组（r = 0.55；p < 0.05）中，半胱天冬酶 - 3和心肌肌钙蛋白I水平呈正相关。该研究确定了半胱天冬酶 - 3和cTI的特定临界值可用于预测儿科新冠病毒感染和MIS-C患者的心血管结构变化。这些值对于新冠病毒感染而言，半胱天冬酶 - 3≥5.22 ng/mL，cTI≥1.34 ng/mL；对于MIS-C而言，半胱天冬酶 - 3≥6.52 ng/mL且cTI≥0.39 ng/mL。
当前研究表明，重症新冠病毒感染儿童以及MIS-C患者必须接受仔细筛查，以检测可能包括生物标志物在内的心血管事件。
