Creatine Kinase in SARS-CoV-2-Related Encephalopathy as a Prognostic Biomarker for Post-Acute Sequelae of COVID-19 (PASC)
Iqra Faiz1, Narjis Jaffry2, Shriya Mandava2, Mustafa Jaffry1, Ronak Trivedi1, Kranthi Mandava1, Anam Shaikh1, Kazim Jaffry1, Muhammed Ors1, Pratibha Surathi3, Toluwalase Tofade4, Evan Huff1, Sviatoslav Redko5, Nizar Souayah1
1New Jersey Medical School, 2Rutgers University, 3Weill Cornell Medical School, 4Massachusetts General Hospital, 5Icahn School of Medicine at Mount Sinai
Objective:
To investigate whether creatine kinase is a prognostic factor in SARS-CoV-2 related encephalopathy in development of PASC.
Background:
Elevated CK levels have been demonstrated as a poor prognostic factor of outcomes in acute COVID-19 infection but its role as a marker of PASC is unclear.
Design/Methods:
A retrospective chart review was performed on hospitalized encephalopathic patients who developed COVID-19 infection during March-May of 2020 at an urban tertiary care center. Patients were divided into two subgroups according to elevated CK levels (E-CK) vs non-elevated CK levels (N-CK) with elevated defined as >200 u/L. Charts were analyzed for patients who had follow-up between 4 weeks and 1 year from initial visit to analyze subsequent development of new or persisting respiratory, cardiac, renal, or neurological symptoms to determine incidence of PASC.
Results:
Of the 43 encephalopathic COVID-19 infection patients reviewed, 25 and 18 patients were found to be in the E-CK and N-CK groups, respectively (average serum CK level of 1485 u/L vs 87.11 u/L, p = 0.0026). Among the E-CK group, 14 patients (56%) had follow-up at least 4 weeks post admission in the outpatient setting vs 13 patients (72.22%) in the N-CK group (p > 0.05), with an average total follow up time of 477.37 days post initial admission in the E-CK group and 466.7857 days for N-CK (p > 0.05). In the follow-up E-CK group, 6 patients (42.85%) reported any one of the PASC symptoms whereas in the follow-up N-CK group, 9 patients (69.23%) reported any one of the PASC symptoms. (RR = 0.73, 95% CI [0.32-1.69], p = 0.47).
Conclusions:
Encephalopathic patients who had elevated CK levels on COVID-19 infection admission did not have an increased risk of developing PASC. Work is in progress to confirm these findings by expanding sample size, increasing follow up time, and stratifying for confounding factors.