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Redefining Cardiac Biomarkers in Predicting Mortality of Inpatients With COVID-19.

  • Author(s): 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, Xinliang;
  • 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.
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 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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