Redefining cardiac biomarkers in predicting mortality and adverse outcomes of inpatients with COVID-19

Qin, J.-J. et al. (2020) Redefining cardiac biomarkers in predicting mortality and adverse outcomes of inpatients with COVID-19. Hypertension, 76(4), pp. 1104-1112. (doi: 10.1161/HYPERTENSIONAHA.120.15528) (PMID:32673499) (PMCID:PMC7375179)

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 multi-centered retrospective study, we enrolled 3,219 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-effect Cox model, after adjusting for age, gender and comorbidities, the adjusted hazard ratios of 28-day mortality for high-sensitivity cardiac troponin I (hs-cTnI) was 7.12 (95%CI, 4.60-11.03; P<0.001), NT-proB-type natriuretic peptide (NT-proBNP) was 5.11 (95%CI, 3.50-7.47; P<0.001), CK-MB was 4.86 (95%CI, 3.33-7.09; P<0.001), 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 49% 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 cutoffs for of these values might be much lower than the current reference standards. These findings can assist 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.

• Item Type: Articles
• Keywords: SARS-CoV-2, COVID-19, heart injury, cardiac biomarkers, mortality.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Touyz, Professor Rhian
• Authors: Qin, J.-J., Cheng, X., Zhou, F., Lei, F., Akolkar, G., Cai, J., Zhang, X.-J., Blet, A., Xie, J., Zhang, P., Liu, Y.-M., Huang, Z., Zhao, L.-P., Lin, L., Xia, M., Chen, M.-M., Song, X., Bai, L., Chen, Z., Zhang, X., Xiang, D., Chen, J., Xu, Q., Ma, X., Touyz, R. M., Gao, C., Wang, H., Liu, L., Mao, W., Luo, P., Yan, Y., Ye, P., Chen, M., Chen, G., Zhu, L., She, Z.-G., Huang, X., Yuan, Y., Zhang, B.-H., Wang, Y., Liu, P. P., and Li, H.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Hypertension
• Publisher: American Heart Association
• ISSN: 0194-911X
• ISSN (Online): 1524-4563
• Published Online: 14 July 2020
• Copyright Holders: Copyright © 2020 The Authors
• First Published: First published in Hypertension 76(4): 1104-1112
• Publisher Policy: Reproduced under a Creative Commons License