tetano
Editor, Senior Moderator
Am Heart J
. 2023 Jan 17;S0002-8703(22)00334-9.
doi: 10.1016/j.ahj.2022.12.014. Online ahead of print.
Multi-Marker Risk Assessment in Patients Hospitalized with COVID-19: Results from the American Heart Association COVID-19 Cardiovascular Disease Registry
Ankeet S Bhatt[SUP] 1 [/SUP], Lori B Daniels[SUP] 2 [/SUP], James de Lemos[SUP] 3 [/SUP], Erica Goodrich[SUP] 4 [/SUP], Erin A Bohula[SUP] 5 [/SUP], David A Morrow[SUP] 5 [/SUP]
Affiliations
Abstract
Background: The pathobiology of inflammation, thrombosis, and myocardial injury associated with SARS-CoV2 may be assessed by circulating biomarkers. However, their relative prognostic importance has been incompletely described.
Methods: We analyzed data from patients hospitalized with COVID-19 from 1/2020 to 4/2021 at 122 US hospitals in the AHA COVID-19 Cardiovascular (CV) Disease Registry. Patients with data for D-dimer, C-reactive protein (CRP), ferritin, natriuretic peptides [NP], or cardiac troponin (cTn) at admission were included. cTn quintiles were indexed to the assay-specific 99[SUP]th[/SUP]%ile reference limits. Using multivariable logistic regression, we assessed the association between each biomarker by quintile [Q] and odds of in-hospital death and a cardiovascular and thrombotic composite.
Results: Of 32,636 registry patients, 26,424 (81%) had admission values for ≥1 of the key biomarkers, of which 4527 (17%) had admission values for all five biomarkers. Each biomarker revealed a significant gradient for in-hospital mortality from Q1-Q5: D-dimer 14%-35%, CRP 11%-32%, ferritin 11%-30%, cTn 13%-43%, and NPs 7%-35% (p[SUB]trend[/SUB] for each <0.001). After adjustment for other biomarkers and clinical variables, Q5 for NPs (OR:4.67, 95% CI: 3.05-7.14) retained the greatest relative odds for death; cTn (OR:2.68, 95% CI: 2.00-3.59) and NPs (OR:7.14, 95% CI: 4.92-10.37) were associated with the greatest odds of the CV composite. Q5 for D-dimer were associated with the highest risk of thrombotic events (OR: 9.02, 95% CI: 5.36-15.18).
Conclusions: Among patients hospitalized with COVID-19, cTn and NPs identified patients at high risk for an in-hospital adverse cardiovascular outcome, while elevations in D-dimer identified patients at risk for thrombotic complications.
Keywords: Biomarkers; C-reactive protein; D-dimer; NT-proBNP; coronavirus disease 2019; ferritin; troponin.
. 2023 Jan 17;S0002-8703(22)00334-9.
doi: 10.1016/j.ahj.2022.12.014. Online ahead of print.
Multi-Marker Risk Assessment in Patients Hospitalized with COVID-19: Results from the American Heart Association COVID-19 Cardiovascular Disease Registry
Ankeet S Bhatt[SUP] 1 [/SUP], Lori B Daniels[SUP] 2 [/SUP], James de Lemos[SUP] 3 [/SUP], Erica Goodrich[SUP] 4 [/SUP], Erin A Bohula[SUP] 5 [/SUP], David A Morrow[SUP] 5 [/SUP]
Affiliations
- PMID: 36669711
- DOI: 10.1016/j.ahj.2022.12.014
Abstract
Background: The pathobiology of inflammation, thrombosis, and myocardial injury associated with SARS-CoV2 may be assessed by circulating biomarkers. However, their relative prognostic importance has been incompletely described.
Methods: We analyzed data from patients hospitalized with COVID-19 from 1/2020 to 4/2021 at 122 US hospitals in the AHA COVID-19 Cardiovascular (CV) Disease Registry. Patients with data for D-dimer, C-reactive protein (CRP), ferritin, natriuretic peptides [NP], or cardiac troponin (cTn) at admission were included. cTn quintiles were indexed to the assay-specific 99[SUP]th[/SUP]%ile reference limits. Using multivariable logistic regression, we assessed the association between each biomarker by quintile [Q] and odds of in-hospital death and a cardiovascular and thrombotic composite.
Results: Of 32,636 registry patients, 26,424 (81%) had admission values for ≥1 of the key biomarkers, of which 4527 (17%) had admission values for all five biomarkers. Each biomarker revealed a significant gradient for in-hospital mortality from Q1-Q5: D-dimer 14%-35%, CRP 11%-32%, ferritin 11%-30%, cTn 13%-43%, and NPs 7%-35% (p[SUB]trend[/SUB] for each <0.001). After adjustment for other biomarkers and clinical variables, Q5 for NPs (OR:4.67, 95% CI: 3.05-7.14) retained the greatest relative odds for death; cTn (OR:2.68, 95% CI: 2.00-3.59) and NPs (OR:7.14, 95% CI: 4.92-10.37) were associated with the greatest odds of the CV composite. Q5 for D-dimer were associated with the highest risk of thrombotic events (OR: 9.02, 95% CI: 5.36-15.18).
Conclusions: Among patients hospitalized with COVID-19, cTn and NPs identified patients at high risk for an in-hospital adverse cardiovascular outcome, while elevations in D-dimer identified patients at risk for thrombotic complications.
Keywords: Biomarkers; C-reactive protein; D-dimer; NT-proBNP; coronavirus disease 2019; ferritin; troponin.