Cardiovascular prognostic factors, gamma glutamil transferase levels and other biochemical parameters related to morbidity and mortality in COVID-19
Authors: Çulpan Ali , Bozkuş Fulsen , Akkök Burcu , Atilla Nurhan , Kahraman Hasan , Gezgin Tahsin , Doğaner Adem , Nazik Selçuk 
Published: December 2024

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.