tetano
Editor, Senior Moderator
J Am Heart Assoc
. 2020 Oct 30;e018477.
doi: 10.1161/JAHA.120.018477. Online ahead of print.
Troponin and Other Biomarker Levels and Outcomes Among Patients Hospitalized with COVID-19: Derivation and Validation of the HA [SUB]2[/SUB] T [SUB]2[/SUB] COVID-19 Mortality Risk Score
Kevin K Manocha[SUP] 1 [/SUP], Jared Kirzner[SUP] 1 [/SUP], Xiaohan Ying[SUP] 1 [/SUP], Ilhwan Yeo[SUP] 2 [/SUP], Bradley Peltzer[SUP] 1 [/SUP], Bryan Ang[SUP] 1 [/SUP], Han A Li[SUP] 1 [/SUP], Bruce B Lerman[SUP] 1 [/SUP], Monika M Safford[SUP] 3 [/SUP], Parag Goyal[SUP] 1 [/SUP], Jim W Cheung[SUP] 1 [/SUP]
Affiliations
Abstract
Background The independent prognostic value of troponin and other biomarker elevation among patients with coronavirus-19 (COVID-19) are unclear. We sought to characterize biomarker levels in patients hospitalized with COVID-19 and develop and validate a mortality risk score. Methods and Results An observational cohort study of 1053 patients with COVID-19 was conducted. Patients with all of the following biomarkers measured: troponin-I (TnI), B-type natriuretic peptide, C-reactive protein, ferritin and D-dimer (n = 446) were identified. Maximum levels for each biomarker were recorded. Primary endpoint was 30-day in-hospital mortality. Multivariable logistic regression was used to construct a mortality risk score. Validation of the risk score was performed using an independent patient cohort (n = 440). Mean age of patients was 65.0 ? 15.2 years and 65.3% were men. Overall, 444 (99.6%) had elevation of any biomarker. Among tested biomarkers, TnI ≥ 0.34 ng/ml was the only independent predictor of 30-day mortality (adjusted OR 4.38; P < 0.001). Patients with a mortality score using hypoxia on presentation, age and TnI elevation, age (HA[SUB]2[/SUB]T[SUB]2[/SUB]) ≥ 3 had a 30-day mortality of 43.7% while those with a score < 3 had mortality of 5.9%. Area under the receiver operating characteristic curve of the HA[SUB]2[/SUB]T[SUB]2[/SUB] score was 0.834 for the derivation cohort and 0.784 for the validation cohort. Conclusions Elevated troponin and other biomarker levels are commonly seen in patients hospitalized with COVID-19. High troponin levels are a potent predictor of 30-day in-hospital mortality. A simple risk score can stratify patients at risk for COVID-19-associated mortality.
Keywords: Biomarkers; COVID‐19; mortality; troponin.
. 2020 Oct 30;e018477.
doi: 10.1161/JAHA.120.018477. Online ahead of print.
Troponin and Other Biomarker Levels and Outcomes Among Patients Hospitalized with COVID-19: Derivation and Validation of the HA [SUB]2[/SUB] T [SUB]2[/SUB] COVID-19 Mortality Risk Score
Kevin K Manocha[SUP] 1 [/SUP], Jared Kirzner[SUP] 1 [/SUP], Xiaohan Ying[SUP] 1 [/SUP], Ilhwan Yeo[SUP] 2 [/SUP], Bradley Peltzer[SUP] 1 [/SUP], Bryan Ang[SUP] 1 [/SUP], Han A Li[SUP] 1 [/SUP], Bruce B Lerman[SUP] 1 [/SUP], Monika M Safford[SUP] 3 [/SUP], Parag Goyal[SUP] 1 [/SUP], Jim W Cheung[SUP] 1 [/SUP]
Affiliations
- PMID: 33121304
- DOI: 10.1161/JAHA.120.018477
Abstract
Background The independent prognostic value of troponin and other biomarker elevation among patients with coronavirus-19 (COVID-19) are unclear. We sought to characterize biomarker levels in patients hospitalized with COVID-19 and develop and validate a mortality risk score. Methods and Results An observational cohort study of 1053 patients with COVID-19 was conducted. Patients with all of the following biomarkers measured: troponin-I (TnI), B-type natriuretic peptide, C-reactive protein, ferritin and D-dimer (n = 446) were identified. Maximum levels for each biomarker were recorded. Primary endpoint was 30-day in-hospital mortality. Multivariable logistic regression was used to construct a mortality risk score. Validation of the risk score was performed using an independent patient cohort (n = 440). Mean age of patients was 65.0 ? 15.2 years and 65.3% were men. Overall, 444 (99.6%) had elevation of any biomarker. Among tested biomarkers, TnI ≥ 0.34 ng/ml was the only independent predictor of 30-day mortality (adjusted OR 4.38; P < 0.001). Patients with a mortality score using hypoxia on presentation, age and TnI elevation, age (HA[SUB]2[/SUB]T[SUB]2[/SUB]) ≥ 3 had a 30-day mortality of 43.7% while those with a score < 3 had mortality of 5.9%. Area under the receiver operating characteristic curve of the HA[SUB]2[/SUB]T[SUB]2[/SUB] score was 0.834 for the derivation cohort and 0.784 for the validation cohort. Conclusions Elevated troponin and other biomarker levels are commonly seen in patients hospitalized with COVID-19. High troponin levels are a potent predictor of 30-day in-hospital mortality. A simple risk score can stratify patients at risk for COVID-19-associated mortality.
Keywords: Biomarkers; COVID‐19; mortality; troponin.