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