# Novel Insights into CKMB, Myoglobin, and Troponin I Levels as Predictors of COVID-19 Severity and Hospitalization Outcomes

## TL;DR

This study shows that combining specific heart-related biomarkers can predict how severe a patient's COVID-19 will be and how long they'll stay in the hospital.

## Contribution

The novel contribution is the combination of CKMB, myoglobin, and troponin I as a predictive model for hospitalization outcomes in COVID-19.

## Key findings

- Elevated CKMB and myoglobin levels significantly increase the odds of prolonged hospital stays.
- The combination of CKMB, myoglobin, and troponin I effectively predicts hospital length of stay.
- Higher levels of these biomarkers correlate with severe disease and complications.

## Abstract

Background: COVID-19 has largely become an endemic disease in many regions, with sporadic outbreaks, with some areas where the disease shows a seasonal pattern like the influenza virus. The focus has shifted towards managing mild and moderate forms of disease through outpatient care, aiming to prevent healthcare system overload. Consequently, identifying markers that could be used in stratifying the risk and the prognostic assessment has become crucial. Cardiovascular implications of COVID-19 are a critical area of research due to their significant impact on disease severity, mortality, and morbidity. Methods: We conducted a retrospective, observational study and included 472 patients, diagnosed with COVID-19, all of whom were admitted to Prof. Dr. Matei Bals National Institute of Infectious Disease, Bucharest, Romania. Levels of cardiac biomarkers like creatine kinase (CK), creatine kinase-myocardial band (CKMB), myoglobin, troponins, and NT-pro-BNP were measured and analyzed in relation to clinical presentation and outcomes. Results: We combined CKMB, myoglobin, and troponin I to predict hospital length of stay (LOS). Our model significantly predicted LOS (F = 12.537, p = 0.0001), with higher levels associated with prolonged stays (β = 0.166, p = 0.000). Logistic regression demonstrated that the combination of elevated CKMB and myoglobin levels significantly increased the odds of a longer LOS (OR = 1.679, p = 0.000). Furthermore, we found significant correlations with acute respiratory failure (p = 0.001), severe forms of disease (p = 0.000), and the development of complications during hospitalization (p = 0.027). Conclusions: These findings emphasize the value of combining cardiac biomarkers to stratify risk and predict hospital outcomes in COVID-19 patients. Routine cardiac monitoring and targeted management strategies could decrease the risk of complications, reducing the LOS. Our findings highlight the potential of cardiac biomarkers as prognostic tools to stratify risk, guide clinical interventions, and improve outcomes in COVID-19 patients.