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Redefining cardiac biomarkers in predicting mortality of inpatients with COVID-19
- Qin, Juan-Juan;
- Cheng, Xu;
- Zhou, Feng;
- Lei, Fang;
- Akolkar, Gauri;
- Cai, Jingjing;
- Zhang, Xiao-Jing;
- Blet, Alice;
- Xie, Jing;
- Zhang, Peng;
- Liu, Ye-Mao;
- Huang, Zizhen;
- Zhao, Ling-Ping;
- Lin, Lijin;
- Xia, Meng;
- Chen, Ming-Ming;
- Song, Xiaohui;
- Bai, Liangjie;
- Chen, Ze;
- Zhang, Xingyuan;
- Xiang, Da;
- Chen, Jing;
- Xu, Qingbo;
- Ma, Xin-Liang;
- Touyz, Rhian M;
- Gao, Chen;
- Wang, Haitao;
- Liu, Liming;
- Mao, Weiming;
- Luo, Pengcheng;
- Yan, Youqin;
- Ye, Ping;
- Chen, Manhua;
- Chen, Guohua;
- Zhu, Lihua;
- She, Zhi-Gang;
- Huang, Xiaodong;
- Yuan, Yufeng;
- Zhang, Bing-Hong;
- Wang, Yibin;
- Liu, Peter P;
- Li, Hongliang
- et al.
Published Web Location
https://doi.org/10.1161/hypertensionaha.120.15528Abstract
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 multicentered retrospective study, we enrolled 3219 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-effects Cox model, after adjusting for age, sex, and comorbidities, the adjusted hazard ratio of 28-day mortality for hs-cTnI (high-sensitivity cardiac troponin I) was 7.12 ([95% CI, 4.60-11.03] P<0.001), (NT-pro)BNP (N-terminal pro-B-type natriuretic peptide or brain natriuretic peptide) was 5.11 ([95% CI, 3.50-7.47] P<0.001), CK (creatine phosphokinase)-MB was 4.86 ([95% CI, 3.33-7.09] P<0.001), MYO (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 19%-50% 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 cutoff values of these biomarkers might be much lower than the current reference standards. These findings can assist in 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.
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