Redefining Cardiac Biomarkers in Predicting Mortality of Inpatients With COVID-19.

Abstract

The prognostic power of circulating cardiac biomarkers, their utility, and pattern of release in coronavirus disease 2019 (COVID-19) patients have not been clearly defined. In this multicentered retrospective study, we enrolled 3219 patients with diagnosed COVID-19 admitted to 9 hospitals from December 31, 2019 to March 4, 2020, to estimate the associations and prognostic power of circulating cardiac injury markers with the poor outcomes of COVID-19. In the mixed-effects Cox model, after adjusting for age, sex, and comorbidities, the adjusted hazard ratio of 28-day mortality for hs-cTnI (high-sensitivity cardiac troponin I) was 7.12 ([95% CI, 4.60-11.03] P<0.001), (NT-pro)BNP (N-terminal pro-B-type natriuretic peptide or brain natriuretic peptide) was 5.11 ([95% CI, 3.50-7.47] P<0.001), CK (creatine phosphokinase)-MB was 4.86 ([95% CI, 3.33-7.09] P<0.001), MYO (myoglobin) was 4.50 ([95% CI, 3.18-6.36] P<0.001), and CK was 3.56 ([95% CI, 2.53-5.02] P<0.001). The cutoffs of those cardiac biomarkers for effective prognosis of 28-day mortality of COVID-19 were found to be much lower than for regular heart disease at about 19%-50% of the currently recommended thresholds. Patients with elevated cardiac injury markers above the newly established cutoffs were associated with significantly increased risk of COVID-19 death. In conclusion, cardiac biomarker elevations are significantly associated with 28-day death in patients with COVID-19. The prognostic cutoff values of these biomarkers might be much lower than the current reference standards. These findings can assist in better management of COVID-19 patients to improve outcomes. Importantly, the newly established cutoff levels of COVID-19-associated cardiac biomarkers may serve as useful criteria for the future prospective studies and clinical trials.

• Authors: Juan-Juan Qin, Xu Cheng, Feng Zhou, Fang Lei, Gauri Akolkar, Jingjing Cai, Xiao-Jing Zhang, Alice Blet, Jing Xie, Peng Zhang, Ye-Mao Liu, Zizhen Huang, Ling-Ping Zhao, Lijin Lin, Meng Xia, Ming-Ming Chen, Xiaohui Song, Liangjie Bai, Ze Chen, Xingyuan Zhang, Da Xiang, Jing Chen, Qingbo Xu, Xinliang Ma, Rhian M Touyz, Chen Gao, Haitao Wang, Liming Liu, Weiming Mao, Pengcheng Luo, Youqin Yan, Ping Ye, Manhua Chen, Guohua Chen, Lihua Zhu, Zhi-Gang She, Xiaodong Huang, Yufeng Yuan, Bing-Hong Zhang, Yibin Wang, Peter P Liu, Hongliang Li
• Journal: Hypertension (Dallas, Tex. : 1979) (Hypertension) Vol. 76 Issue 4 Pg. 1104-1112 (10 2020) ISSN: 1524-4563 [Electronic] United States
• PMID: 32673499 (Publication Type: Journal Article, Multicenter Study)

Chemical References

• Biomarkers
• Peptide Fragments
• Troponin I
• pro-brain natriuretic peptide (1-76)
• Natriuretic Peptide, Brain
• Creatine Kinase, MB Form

Topics

• Betacoronavirus (isolation & purification)
• Biomarkers (blood)
• COVID-19
• China (epidemiology)
• Coronavirus Infections (blood, mortality, therapy)
• Creatine Kinase, MB Form (blood)
• Female
• Heart Diseases (blood, mortality, virology)
• Hospitalization (statistics & numerical data)
• Humans
• Male
• Middle Aged
• Mortality
• Natriuretic Peptide, Brain (blood)
• Outcome Assessment, Health Care
• Pandemics
• Peptide Fragments (blood)
• Pneumonia, Viral (blood, mortality, therapy)
• Predictive Value of Tests
• Prognosis
• Retrospective Studies
• SARS-CoV-2
• Troponin I (blood)