Hypertension . Redefining cardiac biomarkers in predicting mortality of inpatients with COVID-19

[tetano]

Hypertension


. 2020 Jul 14.
doi: 10.1161/HYPERTENSIONAHA.120.15528. Online ahead of print.
Redefining cardiac biomarkers in predicting mortality of inpatients with COVID-19


Juan-Juan Qin ¹ , Xu Cheng ¹ , Feng Zhou ² , Fang Lei ³ , Gauri Akolkar ⁴ , Jingjing Cai ⁵ , Xiao-Jing Zhang ¹ , Alice Blet ⁶ , Jing Xie ¹ , Peng Zhang ¹ , Ye-Mao Liu ¹ , Zizhen Huang ⁷ , Ling-Ping Zhao ⁸ , Lijin Lin ³ , Meng Xia ³ , Ming-Ming Chen ⁹ , Xiaohui Song ⁸ , Liangjie Bai ¹⁰ , Ze Chen ¹¹ , Xingyuan Zhang ⁷ , Da Xiang ¹² , Jing Chen ¹³ , Qingbo Xu ¹⁴ , Xin-Liang Ma ¹⁵ , Rhian M Touyz ¹⁶ , Chen Gao ¹⁷ , Haitao Wang ¹⁸ , Liming Liu ¹⁹ , Weiming Mao ²⁰ , Pengcheng Luo ²¹ , Youqin Yan ²² , Ping Ye ²³ , Manhua Chen ²⁴ , Guohua Chen ²⁵ , Lihua Zhu ¹ , Zhi-Gang She ¹ , Xiaodong Huang ²⁶ , Yufeng Yuan ²⁷ , Bing-Hong Zhang ²⁸ , Yibin Wang ²⁹ , Peter P Liu ³⁰ , Hongliang Li ³¹



Affiliations

• PMID: 32673499
• DOI: 10.1161/HYPERTENSIONAHA.120.15528

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 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.

Keywords: COVID-19; SARS-CoV-2; cardiac biomarkers; heart injury; mortality.