Early detection of elevated cardiac biomarkers to optimise risk stratification in patients with COVID-19

Heart. 2020 Oct;106(19):1512-1518. doi: 10.1136/heartjnl-2020-317322. Epub 2020 Aug 14.

Abstract

Objective: Risk stratification is crucial to optimise treatment strategies in patients with COVID-19. We aimed to evaluate the impact on mortality of an early assessment of cardiac biomarkers in patients with COVID-19.

Methods: Humanitas Clinical and Research Hospital (Rozzano-Milan, Lombardy, Italy) is a tertiary centre that has been converted to the management of COVID-19. Patients with confirmed COVID-19 were entered in a dedicated database for cohort observational analyses. Outcomes were stratified according to elevated levels (ie, above the upper level of normal) of high-sensitivity cardiac troponin I (hs-TnI), B-type natriuretic peptide (BNP) or both measured within 24 hours after hospital admission. The primary outcome was all-cause mortality.

Results: A total of 397 consecutive patients with COVID-19 were included up to 1 April 2020. At the time of hospital admission, 208 patients (52.4%) had normal values for cardiac biomarkers, 90 (22.7%) had elevated both hs-TnI and BNP, 59 (14.9%) had elevated only BNP and 40 (10.1%) had elevated only hs-TnI. The rate of mortality was higher in patients with elevated hs-TnI (22.5%, OR 4.35, 95% CI 1.72 to 11.04), BNP (33.9%, OR 7.37, 95% CI 3.53 to 16.75) or both (55.6%, OR 18.75, 95% CI 9.32 to 37.71) as compared with those without elevated cardiac biomarkers (6.25%). A multivariate analysis identified concomitant elevation of both hs-TnI and BNP as a strong independent predictor of all-cause mortality (OR 3.24, 95% CI 1.06 to 9.93).

Conclusions: An early detection of elevated hs-TnI and BNP predicts mortality in patients with COVID-19. Cardiac biomarkers should be systematically assessed in patients with COVID-19 at the time of hospital admission in order to optimise risk stratification.

Keywords: cardiac risk factors and prevention; coronary artery disease; global health; myocardial disease; systemic inflammatory diseases.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Betacoronavirus*
  • Biomarkers / blood
  • Cardiovascular Diseases / epidemiology*
  • Coronavirus Infections / blood*
  • Coronavirus Infections / complications
  • Coronavirus Infections / mortality*
  • Early Diagnosis
  • Female
  • Hospitalization
  • Humans
  • Italy
  • Male
  • Middle Aged
  • Natriuretic Peptide, Brain / blood*
  • Pandemics
  • Pneumonia, Viral / blood*
  • Pneumonia, Viral / complications
  • Pneumonia, Viral / mortality*
  • Predictive Value of Tests
  • Retrospective Studies
  • Risk Assessment
  • Troponin I / blood*

Substances

  • Biomarkers
  • Troponin I
  • Natriuretic Peptide, Brain

Supplementary concepts

  • COVID-19
  • severe acute respiratory syndrome coronavirus 2