Prognostic Value of Caspase-3 and Cardiac Troponin I in Assessing Cardiovascular Risk in Pediatric COVID-19 and Multisystem Inflammatory Syndrome

Kateryna Kozak; Halyna Pavlyshyn; Sandor George Vari

doi:10.2147/JMDH.S514776

Prognostic Value of Caspase-3 and Cardiac Troponin I in Assessing Cardiovascular Risk in Pediatric COVID-19 and Multisystem Inflammatory Syndrome

J Multidiscip Healthc. 2025 May 30:18:3009-3019. doi: 10.2147/JMDH.S514776. eCollection 2025.

Authors

Kateryna Kozak¹, Halyna Pavlyshyn¹, Sandor George Vari²

Affiliations

¹ Department of Pediatrics, No.2, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine.
² International Research and Innovation in Medicine Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA.

Abstract

Purpose: The studies of COVID-19-related cardiovascular events in children are not widespread. Criteria for cardiovascular dysfunction have been explicitly proposed for multisystem inflammatory syndrome in children (MIS-C), while for other COVID-19 manifestations, it remains unclear. Although instrumental confirmation of cardiovascular injury is well-known, laboratory markers for such injuries have not been thoroughly studied. Our study aimed to identify prognostic cut-off values for caspase-3 and cardiac troponin I (cTI) to define cardiovascular injury in pediatric COVID-19 patients during acute infection and MIS-C.

Patients and methods: A cross-sectional study was conducted in Ternopil, Ukraine, involving two hundred sixty children aged one month to 17 years who had not previously been vaccinated against SARS-CoV-2. The research focused on different severities of COVID-19: mild (n=87); moderate (n=66); severe COVID-19 (n=22); MIS-C (n=40) and 45 non-SARS-CoV-2 infected persons. ELISA tests were used to measure caspase-3 and cardiac troponin I levels.

Results: Caspase-3 and cTI levels were significantly higher in patients with severe COVID-19 and MIS-C compared to non-infected individuals. Furthermore, COVID-19 and MIS-C patients with cardiac abnormalities had substantially higher levels of caspase-3 and cTI compared to those without structural changes. The study also revealed a positive correlation between caspase-3 and cardiac troponin I levels in both the COVID-19 group (r = 0.41; p < 0.05) and the MIS-C group (r = 0.55; p < 0.05). The study has identified specific cut-off values for caspase-3 and cTI that can be used to predict cardiovascular structural changes in pediatric patients with COVID-19 and MIS-C. These values are caspase-3 ≥ 5.22 ng/mL, cTI≥ 1.34 ng/mL for COVID-19, and caspase-3 ≥ 6.52 ng/mL and cTI ≥ 0.39 ng/mL for MIS-C.

Conclusion: Current research has demonstrated that children with severe COVID-19, as well as patients with MIS-C, must undergo careful screening for cardiovascular events that could include biomarkers.

Keywords: COVID-19; MIS-C; cardiac troponin I; caspase-3; children.