McErlane, J., McCall, P. , Willder, J., Berry, C. and Shelley, B. (2023) Cardiac biomarkers and right ventricular dysfunction are independently associated with one year mortality in patients with COVID-19 receiving mechanical ventilation: a prospective cohort study. CHEST Critical Care, 1(3), 100015. (doi: 10.1016/j.chstcc.2023.100015)
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Abstract
Background: The cardiac biomarkers N-terminal pro-brain natriuretic peptide (NT-proBNP) and troponin frequently are raised in patients with acute COVID-19. As a secondary analysis of the Right Ventricular Dysfunction in Ventilated Patients With COVID-19 study, we sought to determine the association between raised cardiac biomarkers and 1-year mortality in patients with COVID-19 receiving invasive mechanical ventilation (IMV). As an exploratory investigation, we combined point-of-care echocardiography and cardiac biomarker analyses to determine whether the biomarker signal represented a global or regional cardiac injury. Study Question: Are abnormal cardiac biomarker levels associated with 1-year mortality in patients with COVID-19 requiring IMV? Study Design and Methods: In this prospective cardiac biomarker and echocardiography study in patients with COVID-19 across 10 ICUs in the west of Scotland, patients underwent contemporaneous cardiac biomarker testing with point-of-care echocardiography between days 2 and 14 after intubation. Survival analyses was performed using univariable log-rank and multivariable Cox regression. Results: One hundred twenty-one patients were recruited between September 2, 2020, and March 22, 2021. At 1 year, 57.6% of patients (68 of 118) had died. Patients with abnormal NT-proBNP levels and patients with abnormal troponin levels showed a 1-year mortality incidence of 71.4% (50 of 70) and 80.4% (45 of 56), respectively. Both abnormal NT-proBNP and abnormal troponin levels were associated with 1-year mortality (P < .001 for both). Abnormal troponin level was associated with subjective right ventricular dysfunction (RVD; P = .003), and no association with subjective left ventricular dysfunction was found (P = .342). On multivariable analysis, abnormal NT-proBNP level, abnormal troponin level, and subjective RVD were associated independently with 1-year mortality (hazard ratios, 2.82 [95% CI, 1.19-6.67], 2.84 [95% CI, 1.44-5.62], and 2.09 [95% CI, 1.07-4.07], respectively). Interpretation: Abnormal NT-proBNP level, abnormal troponin level, and subjective RVD are associated independently with 1-year mortality in patients with COVID-19 receiving IMV. Cardiac biomarker testing and point-of-care echocardiography are available readily during ICU admission and may identify a group of patients who are at very high risk of poor outcomes.
| Item Type: | Articles |
|---|---|
| Additional Information: | This work was supported by Medical Research Scotland [Grant CVG-1730-2020] and the Engineering and Physical Sciences Research Council (EPSRC) [Grants EP/R511705/1 and EP/S030875/1]. B. S. is supported by the National Institute of Academic Anaesthesia/Royal College of Anaesthetists British Oxygen Company Chair of Anaesthesia Research Grant. C. B. receives research funding from the British Heart Foundation [Grant RE/18/6/34217], Chief Scientist Office, EPSRC [Grants EP/R511705/1 and EP/S030875/1], European Union [Grant 754946-2], Medical Research Council [Grant MR/S018905/1], and United Kingdom Research and Innovation [Grant MC/PC/20014]. |
| Status: | Published |
| Refereed: | Yes |
| Glasgow Author(s) Enlighten ID: | Berry, Professor Colin and McCall, Dr Philip and Shelley, Dr Benjamin and McErlane, Dr James and Willder, Dr Jennifer |
| Authors: | McErlane, J., McCall, P., Willder, J., Berry, C., and Shelley, B. |
| College/School: | College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing |
| Journal Name: | CHEST Critical Care |
| Publisher: | Elsevier |
| ISSN: | 2949-7884 |
| Published Online: | 18 October 2023 |
| Copyright Holders: | Copyright © 2023 The Authors |
| First Published: | First published in CHEST Critical Care 1(3):100015 |
| Publisher Policy: | Reproduced under a Creative Commons licence |
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