Serum sST2 was identified as an independent risk factor for COVID-19 patients with coexisting coronary artery disease, predicting ICU admission, longer hospital stays, and heart failure/ACS with similar accuracy to coronary angiography scoring.
sST2 matches invasive scoringA simple blood test for sST2 predicted ICU admission, hospital stay, and heart complications in COVID-19 patients with similar accuracy to the Gensini score from invasive coronary angiography.
What the researchers found
COVID-19 patients with coexisting coronary artery disease had significantly higher levels of sST2, myeloperoxidase, ALT, AST, BNP, and hs-cTnI, along with longer hospitalizations, more ICU admissions, and higher rates of heart failure and acute coronary syndrome compared to COVID-19 patients without CAD.
Multivariate analysis identified sST2 as an independent risk factor for COVID-19 patients with CAD (odds ratio 1.122). sST2 correlated positively with coronary angiography Gensini score (r=0.474, p<0.001) and was significantly elevated in patients with severe coronary disease (Gensini score ≥32). ROC analysis showed sST2 predicted ICU admission, hospital stay duration, and heart failure/ACS morbidity comparably to the invasive Gensini score.
Why it matters
COVID-19 patients with chest symptoms need rapid assessment of whether coronary artery disease is contributing to their condition, but invasive coronary angiography isn't always feasible during acute illness. A simple blood test (sST2) that predicts coronary disease severity and clinical outcomes could help clinicians quickly identify high-risk patients and prioritize treatment — particularly valuable in resource-limited settings or when invasive procedures carry additional COVID-related risks.
How the study worked
This observational study enrolled 75 COVID-19 patients and 68 non-COVID patients admitted between December 2022 and January 2023. Demographic, laboratory (including sST2, BNP, troponin, myeloperoxidase), and clinical data were collected at admission. Coronary atherosclerosis severity was assessed using the Gensini score from coronary angiography. Patients were categorized by Gensini score and clinical characteristics. Univariate and multivariate logistic regression identified independent risk factors. ROC analysis assessed predictive performance.
What this study cannot tell us
This is a single-center observational study with a relatively small sample size (143 patients). The study period was during a specific COVID-19 wave in China and may not generalize to other variants or populations. The cross-sectional design cannot establish causation between sST2 and clinical outcomes. Selection bias may exist in which patients underwent coronary angiography. Long-term follow-up and post-COVID syndrome outcomes were not assessed.
How to read the evidence
This is a single-center observational study with a modest sample size. While the findings are statistically significant and clinically plausible, validation in larger multicenter cohorts would be needed before sST2 could be recommended as a clinical screening tool for this specific population.
When this study was published
Published in 2025 using data from the December 2022-January 2023 COVID wave, this study addresses ongoing clinical questions about cardiovascular risk in COVID-19 patients.
The bigger picture
The intersection of COVID-19 and cardiovascular disease remains clinically important even as the pandemic has evolved. This study highlights how viral infection can unmask or worsen pre-existing coronary disease, and identifies biomarkers — including the natriuretic peptide BNP — that can guide clinical decision-making. The approach of using circulating biomarkers as non-invasive surrogates for coronary disease severity is broadly applicable beyond COVID-19.
Questions still open
- Could sST2 screening be used routinely in emergency departments to triage COVID-19 patients with cardiac symptoms?
- Do elevated sST2 levels during COVID-19 predict long-term cardiovascular complications in post-COVID syndrome?
- Would early intervention based on sST2 levels improve outcomes in COVID-19 patients with subclinical coronary disease?
Common questions
What is sST2 and why is it important in COVID-19?
Does COVID-19 make coronary artery disease more dangerous?
Read the original research
Serum sST2: key biomarkers in COVID-19 patients with implications for coronary artery disease.
BMC infectious diseases, 25(1), 471
Citation
Li, Xueqin; Tian, Yaxin; Cao, Hongyan; Cheng, Jinfang. (2025). Serum sST2: key biomarkers in COVID-19 patients with implications for coronary artery disease.. BMC infectious diseases, 25(1), 471. https://doi.org/10.1186/s12879-025-10849-y