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This multicenter retrospective study of 3219 patients diagnosed with COVID-19 and admitted to the hospital evaluated the patients via cardiac biomarkers to determine if biomarkers could be used to determine poor clinical outcomes. The adjusted hazard ratios for 28-day mortality for cardiac biomarkers included: hs-cTnI (7.12); NT-proBNP (5.11); CK-MB (4.86); myoglobin (4.5); and CK (3.56). The cutoff value for these biomarkers was 49% lower than for regular heart disease. Those patients with elevated biomarkers above this new cutoff level had a significantly increased risk for death.
These new findings can help in the management of COVID-19 patients to improve clinical outcomes.
This abstract is available on the publisher's site.
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.
Redefining Cardiac Biomarkers in Predicting Mortality of Inpatients With COVID-19
Hypertension 2020 Jul 14;[EPub Ahead of Print], JJ Qin, X Cheng, F Zhou, F Lei, G Akolkar, J Cai, XJ Zhang, A Blet, J Xie, P Zhang, YM Liu, Z Huang, LP Zhao, L Lin, M Xia, MM Chen, X Song, L Bai, Z Chen, X Zhang, D Xiang, J Chen, Q Xu, XL Ma, RM Touyz, C Gao, H Wang, L Liu, W Mao, P Luo, Y Yan, P Ye, M Chen, G Chen, L Zhu, ZG She, X Huang, Y Yuan, BH Zhang, Y Wang, PP Liu, H Li