JOPIC

The JoPIC is an independent-unbiased, peer-reviewed, and open-access journal of current national and international issues and reviews for original clinical and experimental research, interesting case reports, surgical techniques, differential diagnoses, editorial opinions, letters to the editor, and educational papers in pulmonology, thoracic surgery, occupational diseases, allergology, and intensive care medicine. This journal is indexed by indices that are considered international scientific journal indices (DRJI, ESJI, OAJI, etc.). According to the current Associate Professorship criteria, it is within the scope of International Article 1-d. Each article published in this journal corresponds to 5 points.

EndNote Style
Index
Original Article
Cardiovascular prognostic factors, gamma glutamil transferase levels and other biochemical parameters related to morbidity and mortality in COVID-19
Aims: COVID-19 may exacerbate cardiovascular risk factors and pre-existing cardiovascular disease or lead to the development of new cardiovascular complications. Gama glutamil transferaz (GGT) is an enzyme found in the cell membranes of many tissues, especially the liver, bile duct and kidneys. Recent studies have shown that increased GGT levels are strongly associated with prognosis in cardiopulmonary disorders. Studies to date have reported on the increased predictive value of serum GGT level for cardiovascular disease and have shown marginal improvements in risk estimation. In the light of all this information, in this study, it was aimed to investigate the effect of serum GGT level on the clinical classification of the disease, cardiovascular risk and morbidity and mortality in COVID-19, in addition to known cardiovascular prognostic markers.
Methods: The study included 128 patients over the age of 18 who were found to have positive SARS-CoV-2 reverse transcription polymerase chain reaction (RT-PCR) in the nasopharyngeal and oropharyngeal samples taken during their admission to Kahramanmaraş Sütçü İmam University (KSU) Medical Faculty Chest Diseases outpatient clinic and emergency department. According to the most recently published 2019 novel coronavirus pneumonia diagnosis and treatment program (version 7), COVID-19 disease is divided into groups as mild, moderate, severe and critical illness. Demographic data, comorbidities, symptoms and signs, laboratory findings, and chest computed tomography (CT) scans were reviewed. The presence of heart failure, coronary artery disease or arrhythmia in the included patients was defined as cardiovascular disease. Patients were excluded if they were younger than 18 years old, pregnant, had a history of hepatobiliary disorders, alcohol abuse or other acute illnesses, died at the time of admission, had incomplete baseline data, or were transferred to other designated hospitals during hospitalization.
Results: Fifty-five (43%) of the participants were female and 73 (57%) were male, with a mean age of 55.6 years. When examined in terms of age, the difference between the groups was statistically significant. The difference between the individuals with and without hypertension and diabetes mellitus was found to be significant in terms of disease severity. When examined in terms of symptoms, 23 (71.9%) of the patients in the mild group were symptomatic, 9 (28.1%) were asymptomatic, and all of the patients in the moderate, severe and critical groups were symptomatic (100%). Cardiovascular biomarkers and GGT values were found to be significantly higher in the severe and critical disease group than in the mild and moderate disease group. However, having cardiovascular disease did not cause a significant difference in GGT levels fo the disease groups. GGT levels were found to be statistically similar in individuals with and without the disease. When blood gas parameters were analyzed in terms of disease severity, oxygen saturation (SpO2) and PO2 were found to be significantly lower in the severe and critical illness group than in the mild and moderate disease group. When the effect of blood parameters on mortality was analyzed by logistic regression analysis, only the effect of PO2 parameter on mortality was found to be statistically significant. In addition, the effects of cardiovascular diseases and age variables on mortality were found to be statistically significant (p=0.031, p=0.007; respectively). The effect of cardiovascular disease on mortality was 4,325 times (ODDS ratio) higher compared to individuals without cardiovascular disease.
Conclusion: In this study, we determined two important findings. First, the serum level of GGT was found to be significantly higher in the severe and critical disease group than in the mild and moderate disease group. Second, cardiovascular disease, advanced age, and hypoxemia were associated with mortality from COVID-19 disease. Although GGT provides no increased benefit for predicting cardiovascular disease risk, its potential causal relationship with cardiovascular disease deserves attention.


1. Zhou P, Yang XL, Wang XG etal. A pneumonia outbreak associated with a new coronavirus of probable bat origin. <em>Nature</em>. 2020;579(7798):270-273.
2. Su S, Wong G, Shi W et al. Epidemiology, genetic recombination, and pathogenesis of coronaviruses. <em>Trends Microbiol</em>. 2016;24(6):490-502.
3. Hoffmann M, Kleine-Weber H, Schroeder S, et al. SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor.<em>Cell</em>. 2020;181(2):271-280.e8.
4. Guo J, Huang Z, Lin L, Lv J. Coronavirus disease 2019 (COVID-19) and cardiovascular disease: a viewpoint on the potential influence of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers on onset and severity of severe acute respiratory syndrome coronavirus 2 infection.<em>J Am Heart Assoc</em>. 2020;9(7):e016219.
5. Aboughdir M, Kirwin T, Abdul Khader A, Wang B. Prognostic value of cardiovascular biomarkers in COVID-19: a review.<em>Viruses</em>. 2020;12(5):527.
6. Gohar A, Chong JPC, Liew OW et al. The prognostic value of highly sensitive cardiac troponin assays for adverse events in men and women with stable heart failure and a preserved vs. reduced ejection fraction. <em>Eur J Heart Fail.</em> 2017;19(12):1638-1647.
7. Shi S, Qin M, Shen B et al. Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China. <em>JAMA Cardiol</em>. 2020:5(7):802-810.
8. Emdin M, Passino C, Michelassi C, et al. Prognostic value of serum gamma-glutamyl transferase activity after myocardial infarction. <em>Eur Heart J</em>. 2001;22(19):1802-1807.
9. Diagnosis and treatment protocol for novel coronavirus pneumonia (trial version 7). <em>Chin Med J (Engl).</em> 2020;133(9):1087-1095.
10. Khomich OA, Kochetkov SN, Bartosch B, Ivanov AV. Redox biology of respiratory viral infections.<em>Viruses</em>. 2018;10(8):392.
11. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. <em>Lancet.</em> 2020;395(10223):497-506.
12. van den Brand JMA, Haagmans BL, van Riel D, et al. The pathology and pathogenesis of experimental severe acute respiratory syndrome and influenza in animal models. <em>J Comp Pathol.</em> 2014;151(1):83-112.
13. Hanigan MH, Gallagher BC, Townsend DM, Gabarra V. Gamma-glutamyl transpeptidase accelerates tumor growth and increases the resistance of tumors to cisplatin in vivo. <em>Carcinogenesis</em>. 1999;20(4):553-559.
14. Wannamethee G, Ebrahim S, Shaper AG. Gamma-glutamyltransferase: determinants and association with mortality from ischemic heart diseases and all cause. <em>Am J Epidemiol</em>. 1995;142(7):699-708.
15. Fraternale A, Paoletti MF, Casabianca A, et al. Antiviral and immunomodulatory properties of new pro-glutathione (GSH) molecules. <em>Curr Med Chem</em>. 2006;13(15):1749-1755.
16. Polonikov A. Endogenous defciency of glutathione as the most likely cause of serious manifestations and death in COVID19 patients. <em>ACS Infect Dis.</em> 2020;6(7):1558-1562.
17. Fauci AS, Lane HC, Redfield RR. Covid-19- navigating the uncharted. <em>N Engl J Med.</em> 2020;382(13):1268-1269.
18. Ji D, Zhang D, Xu J et al. Prediction for progression risk in patients with COVID-19 pneumonia: the CALL score. <em>Clin Infect Dis</em>. 2020;71(6):1393-1399.
19. Xie J, Covassin N, Fan Z, et al. Association between hypoxemia and mortality in patients with COVID-19. <em>Mayo Clin Proc</em>. 2020;95(6):1138-1147.
20. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72314 cases from the Chinese center for disease control and prevention. <em>JAMA</em>. 2020;323(13):1239-1242.
21. Xu Z, Shi L, Wang Y et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. <em>Lancet Respir Med</em>. 2020;8(4):420-422.
22. Shi S, Qin M, Shen B et al. Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China. <em>JAMA Cardiol</em>. 2020;5(7):802-810.
23. Lippi G, Lavie CJ, Sanchis-Gomar F. Cardiac troponin I in patients with coronavirus disease 2019 (COVID-19): Evidence from a meta-analysis. <em>Prog Cardiovasc Dis.</em> 2020;63(3): 390-391
24. Vestjens SMT, Spoorenberg SMC, Rijkers GT, et al. High-sensitivity cardiac troponin T predicts mortality after hospitalization for community-acquired pneumonia.<em>Respirology</em>. 2017;22(5):1000-1006.
25. Metkus TS, Guallar E, Sokoll L et al. Prevalence and prognostic association of circulating troponin in the acute respiratory distress syndrome. <em>Crit Care Med</em>. 2017;45(10):1709-1717.
26. Guo T, Fan Y, Chen M, et al. Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19). <em>JAMA Cardiol</em>. 2020;5(7):811-818.
27. Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. <em>JAMA</em>. 2020;323(11):1061-1069.
28. Mason JE, Starke RD, Van Kirk JE. Gamma-glutamyl transferase: a novel cardiovascular risk biomarker. <em>Prev Cardiol</em>. 2010;13(1):36-41.
29. Turgut O, Tandogan I. Gamma-glutamyltransferase to determine cardiovascular risk: shifting the paradigm forward. <em>J Atheroscler Thromb</em>. 2011;18(3):177-181.
30. Brennan PN, Dillon JF, Tapper EB. Gamma-glutamyl transferase (&gamma;-GT) - an old dog with new tricks? <em>Liver Int</em>. 2022;42(1):9-15.
31. Sanguinetti C, Scalise V, Neri T et al. Binding of gamma-glutamyl transferase to TLR4 signalling allows tissue factor activation in monocytes.<em>Int J Mol Sci</em>. 2022;23(20):12207.
32. Mitric A, Castellano I. Targeting gamma-glutamyl transpeptidase: a pleiotropic enzyme involved in glutathione metabolism and in the control of redox homeostasis.<em>Free Radic Biol Med</em>. 2023;208:672-683.
33. Kim YG, Han K, Jeong JH et al. Metabolic syndrome, gamma-glutamyl transferase, and risk of sudden cardiac death.<em>J Clin Med</em>. 2022;11(7):1781.
34. Kaya A, Kaya Y, Gunaydin ZY et al. Relationship between serum gamma-glutamyl transferase levels with ascending aortic dilatation.<em>Eurasian J Med</em>. 2014;46(2):89-95.
35. Jung CH, Yu JH, Bae SJ et al. Serum gamma-glutamyl transferase is associated with arterial stiffness in healthy individuals.<em>Clin Endocrinol (Oxf).</em> 2011;75(3):328-334.
36. Li M, Xu W, Chen H, et al. Correlation analysis of gamma-glutamyl transferase to lymphocyte ratio and patients with acute aortic syndrome in China: a propensity score-matched analysis.<em>Front Cardiovasc Med</em>. 2024; 11:1333153.
37. Ndrepepa G, Colleran R, Kastrati A. Gamma-glutamyl transferase and the risk of atherosclerosis and coronary heart disease.<em>Clin Chim Acta</em>. 2018; 476:130-138.
38. Clerkin KJ, Fried JA, Raikhelkar J, et al. COVID-19 and cardiovascular disease. <em>Circulation</em>. 2020;141(20):1648-1655.
39. Duffy EY, Cainzos-Achirica M, Michos ED. Primary and secondary prevention of cardiovascular disease in the era of the coronavirus pandemic. <em>Circulation</em>. 2020;141(24):1943.
40. Kunutsor SK, Bakker SJ, Kootstra-Ros JE, Gansevoort RT, Dullaart RP. Circulating gamma glutamyltransferase and prediction of cardiovascular disease.<em>Atherosclerosis</em>. 2015;238(2):356-364.
41. Lee DS, Evans JC, Robins SJ, et al. Gamma glutamyl transferase and metabolic syndrome, cardiovascular disease, and mortality risk: the Framingham Heart Study.<em>Arterioscler Thromb Vasc Biol</em>. 2007;27(1):127-133.
42. Ndrepepa G, Braun S, Schunkert H, Laugwitz KL, Kastrati A. Gamma-glutamyl transferase and prognosis in patients with coronary artery disease.<em>Clin Chim Acta</em>. 2016;452:155-160.
Volume 2, Issue 4, 2024
Page : 70-76
_Footer