Elevated cardiac biomarkers may be effective prognostic predictors for patients with COVID-19: A multicenter, observational study

Jie Yang; Xuelian Liao; Wanhong Yin; Bo Wang; Jirong Yue; Lang Bai; Dan Liu; Ting Zhu; Zhixin Huang; Yan Kang; Study of 2019 Novel Coronavirus Pneumonia Infected Critically Ill Patients in Sichuan Province (SUNRISE) Group

doi:10.1016/j.ajem.2020.10.013

Elevated cardiac biomarkers may be effective prognostic predictors for patients with COVID-19: A multicenter, observational study

Am J Emerg Med. 2020 Oct 13:39:34-41. doi: 10.1016/j.ajem.2020.10.013. Online ahead of print.

Affiliations

¹ Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province 610041, China.
² Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province 610041, China; COVID19 Medical Team (Hubei) of West China Hospital, Sichuan University, China.
³ COVID19 Medical Team (Hubei) of West China Hospital, Sichuan University, China; Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province 610041, China.
⁴ COVID19 Medical Team (Hubei) of West China Hospital, Sichuan University, China; Center of Infectious Disease, West China Hospital, Sichuan University, Chengdu, Sichuan Province 610041, China.
⁵ COVID19 Medical Team (Hubei) of West China Hospital, Sichuan University, China; Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province 610041, China.
⁶ Department of Otolaryngology-Head and Neck Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei Province 430060, China.
⁷ Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province 430060, China.
⁸ Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province 610041, China; COVID19 Medical Team (Hubei) of West China Hospital, Sichuan University, China. Electronic address: kangyan@scu.edu.cn.
⁹ The SUNRISE Group, China.

Abstract

Purpose: The coronavirus disease 19 (COVID-19) has become a global health event. Cardiac biomarkers like creatine kinase isoenzyme (CK-MB), myoglobin, and high-sensitivity troponin T were usually elevated in early stages. This study aimed to investigate whether the elevated cardiac biomarkers could become effective prognostic predictors for COVID-19 patients.

Methods: The present study involved 357 COVID-19 patients. The potential predictors for two study outcomes (in-hospital death and recovery status) in 28 days were selected by LASSO regression analysis. Prognostic values of cardiac biomarkers selected were evaluated using the receiver operating characteristic curve (ROC) and the area under ROC (AUC).

Results: After 28-day follow-up, overall 357 patients were divided into death group (n = 25) and survival group (n = 332), or non-recovery group (n = 43) and recovery group (n = 314). The LASSO regression analysis showed elevated CK-MB and myoglobin were independent risk predictors for in-hospital death, and CK-MB and myoglobin were also independent risk predictors for non-recovery. The AUC of CK-MB and myoglobin for in-hospital death were 0.862 (95%CL: 0.804-0.920, p < 0.001) and 0.838 respectively (95%CL: 0.729-0.947, p < 0.001). The AUC of CK-MB and myoglobin for non-recovery were 0.839 (95%CL: 0.786-0.892, p < 0.001) and 0.841 (95%CL: 0.765-0.918, p < 0.001) respectively. We also found AUC of combined use of CK-MB and myoglobin for in-hospital death and non-recovery were 0.883 (95CL: 0.813-0.952, p < 0.001), and 0.873 (95%CL: 0.817-0.930, p < 0.001) respectively.

Conclusions: In patients with COVID-19, elevated CK-MB and myoglobin on admission may be effective predictors for adverse outcomes, and combined use of CK-MB and myoglobin had a better performance for prediction.

Keywords: COVID-19; Creatine kinase isoenzyme; Myoglobin; Prognosis; Risk predictors.