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

Hypertension. 2020 Oct;76(4):1104-1112. doi: 10.1161/HYPERTENSIONAHA.120.15528. Epub 2020 Jul 14.

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.

Keywords: biomarkers; heart diseases; heart injuries; mortality; prognosis.

Publication types

  • Multicenter Study

MeSH terms

  • Betacoronavirus / isolation & purification
  • Biomarkers / blood
  • COVID-19
  • China / epidemiology
  • Coronavirus Infections* / blood
  • Coronavirus Infections* / mortality
  • Coronavirus Infections* / therapy
  • Creatine Kinase, MB Form / blood*
  • Female
  • Heart Diseases* / blood
  • Heart Diseases* / mortality
  • Heart Diseases* / 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
  • Pneumonia, Viral* / mortality
  • Pneumonia, Viral* / therapy
  • Predictive Value of Tests
  • Prognosis
  • Retrospective Studies
  • SARS-CoV-2
  • Troponin I / blood*

Substances

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