CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 1, January–April 2023 18 AFRICA Tables 5 and 6 show ROC curve analysis with daily cut-off values of troponin I and D-dimer values. Compared to the other parameters, a significant statistical relationship between troponin I values ≥ 16.05 pg/ml on the seventh day and the need for intensive care was detected (AUC 0.896, sensitivity 78.6%, specificity 78.3%, p < 0.001). Troponin I values ≥ 30.25 pg/ ml on the ninth day were also related to higher mortality rates (AUC 0.920, sensitivity 89.5%, specificity 89.3%, p < 0.001). A significant statistical relationship between D-dimer values ≥ 878 hg/ml on the second day and the need for intensive care was detected (AUC 0.896, sensitivity 78.6%, specificity 78.3%, p < 0.001). Furthermore D-dimer values ≥ 1 106 hg/ml on the 10th day was related to mortality rates (AUC 0.817, sensitivity 68.4%, specificity 65.2%, p < 0.001). Cut-off values of serum CRP, ferritin, LDH and CK for the patients included in the study were also calculated (Table 6). It was observed that hospitalisation periods of ≥ 9.5 days were associated with mortality (AUC 0.738, sensitivity 68.4%, specificity 65.9%, p < 0.001). Discussion It was found that ACE-2 receptors in human cells have a strong binding affinity to the spike protein of SARS-CoV-2.6 It is assumed that the cardiac injury associated with SARS-CoV-2 is caused by the high number of ACE-2 receptors in the heart.6 It is reasonable to assume that the heart damage caused by COVIDTable 2. Relationship between laboratory values and mortality rate Laboratory values Mortality Discharge p-value CK (U/l) 122 ± 305 375 ± 524 0.03 CK-MB (U/l) 10 ± 12 9 ± 5 1.19 Pro-BNP (ng/l) 1719 ± 1658 4420 ± 8967 0.935 CRP (mg/l) 102 ± 84 105 ± 580 0.01 Ferritin (ng/ml) 302 ± 328 697 ± 590 < 0.001 Urea (ng/dl) 42 ± 33 76 ± 62 0.01 Creatinine (mg/dl) 09 ± 0.5 1.3 ± 0.8 0.01 AST (U/l) 33 ± 35 45 ± 27 0.02 ALT (U/l) 35 ± 42 45 ± 75 0.082 LDH (U/l) 273 ± 130 528 ± 310 < 0.001 Sodium (mmol/l) 137 ± 4 141 ± 8 0.013 Potassium (mmol/l) 4 ± 0.5 4.2 ± 1.1 0.199 CK: creatine kinase; CK-MB: creatine kinase myocardial band; Pro-BNP: probrain natriuretic peptide; CRP: C-reactive protein; AST: aspartate aminotransferase; ALT: alanine aminotransferase; LDH: lactate dehydrogenase. Table 3. Relationship between daily troponin I values and need for intensive care and mortality rate Daily troponin I (pg/ml) Mortality Discharge p-value Intensive care General ward p-value Troponin I 1 115 ± 703 744 ± 3211 < 0.001 50 ± 293 696 ± 2585 < 0.001 Troponin I 2 999 ± 4665 2315 ± 5660 0.001 1143 ± 565 1655 ± 4556 < 0.001 Troponin I 3 560 ± 2268 1600 ± 4165 0.006 496 ± 2515 1217 ± 3317 < 0.001 Troponin I 4 181 ± 935 666±1760 < 0.001 180 ± 1046 481±1419 < 0.001 Troponin I 5 194 ± 745 484 ± 1017 < 0.001 99 ± 559 499 ± 1053 < 0.001 Troponin I 6 37 ± 103 420 ± 888 < 0.001 21 ± 58 288 ± 719 < 0.001 Troponin I 7 31 ± 103 458 ± 1146 < 0.001 10 ± 14 369 ± 1004 < 0.001 Troponin I 8 43 ± 124 649 ± 1823 < 0.001 40 ± 134 455 ± 1517 < 0.001 Troponin I 9 20 ± 51 227 ± 322 < 0.001 14 ± 24 165 ± 283 < 0.001 Troponin I 10 13 ± 16 162 ± 226 < 0.001 16 ± 18 135 ± 213 0.006 Table 4. Relationship between daily D-dimer values and need for intensive care and mortality rate Daily D-dimer (ng/ml) Mortality Discharge p-value Intensive care General ward p-value D-dimer 1 1178 ± 1834 3082 ± 3470 0.008 897 ± 1394 2941 ± 3186 < 0.001 D-dimer 2 1265 ± 1415 4401 ±3512 < 0.001 835 ± 832 3456 ± 3145 < 0.001 D-dimer 3 1272 ± 1626 2761 ± 2552 0.002 1034 ± 1588 2448 ± 2191 < 0.001 D-dimer 4 1050 ± 1140 2749 ± 2363 < 0.001 964 ± 1044 2100 ± 2092 0.002 D-dimer 5 940 ± 1023 2261 ± 1822 0.001 861 ± 1009 1982 ± 1668 < 0.001 D-dimer 6 1119 ± 1048 2114 ± 1556 0.004 898 ± 849 2005 ± 1475 < 0.001 D-dimer 7 999 ± 875 2118 ± 1712 0.008 873 ± 788 1910 ± 1575 0.001 D-dimer 8 1033 ± 918 2311 ± 2465 0.01 904 ± 932 2031 ± 2168 0.02 D-dimer 9 1106 ± 1048 2084 ± 2030 0.005 1014 ± 1083 1825 ± 1759 0.02 D-dimer 10 1038 ± 8220 2599 ± 2082 < 0.001 938 ± 848 2411 ± 1938 < 0.001 Table 5. Sensitivity, specificity, AUC, cut-off values of daily troponin I and D-dimer and need for intensive care Markers Sensitivity (%) Specificity (%) AUC Cut-off value p-value Troponin I 1 (pg/ml) 75.9 73.9 0.843 9.1 < 0.001 Troponin I 2 (pg/ml) 78.9 78.6 0.832 20 < 0.001 Troponin I 3 (pg/ml) 77.1 76.50 0.819 14 < 0.001 Troponin I 4 (pg/ml) 73.5 73.2 0.827 18.8 < 0.001 Troponin I 5 (pg/ml) 78.8 76.9 0.863 19.5 < 0.001 Troponin I 6 (pg/ml) 70.6 70 0.798 17.30 < 0.001 Troponin I 7 (pg/ml) 78.6 78.3 0.896 16.05 < 0.001 Troponin I 8 (pg/ml) 80.6 77.8 0.846 13.45 < 0.001 Troponin I 9 (pg/ml) 78.6 78.9 0.837 13.15 < 0.001 Troponin I 10 (pg/ml) 73.9 70 0.804 23.55 0.006 D-dimer 1 (ng/ml) 76.3 63.1 0.773 717 < 0.001 D-dimer 2 (ng/ml) 76.9 74.2 0.858 878 < 0.001 D-dimer 3 (ng/ml) 72.7 72.7 0.780 933 < 0.001 D-dimer 4 (ng/ml) 65 63 0.685 854 0.002 D-dimer 5 (ng/ml) 69.7 68.6 0.747 897 < 0.001 D-dimer 6 (ng/ml) 67.6 66.7 0.758 907 < 0.001 D-dimer 7 (ng/ml) 68.8 66.7 0.746 818 0.001 D-dimer 8 (ng/ml) 76.7 75 0.742 880 0.002 D-dimer 9 (ng/ml) 71.9 70.4 0.741 832 0.002 D-dimer 10 (ng/ml) 78.3 73.7 0.844 1028 < 0.001 AUC: area under the curve.
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