1. Redefining Cardiac Biomarkers in Predicting Mortality of Inpatients With COVID-19.
- Author
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Qin JJ, Cheng X, Zhou F, Lei F, Akolkar G, Cai J, Zhang XJ, Blet A, Xie J, Zhang P, Liu YM, Huang Z, Zhao LP, Lin L, Xia M, Chen MM, Song X, Bai L, Chen Z, Zhang X, Xiang D, Chen J, Xu Q, Ma X, Touyz RM, Gao C, Wang H, Liu L, Mao W, Luo P, Yan Y, Ye P, Chen M, Chen G, Zhu L, She ZG, Huang X, Yuan Y, Zhang BH, Wang Y, Liu PP, and Li H
- Subjects
- Betacoronavirus isolation & purification, Biomarkers blood, COVID-19, China epidemiology, Female, Hospitalization statistics & numerical data, Humans, Male, Middle Aged, Mortality, Outcome Assessment, Health Care, Predictive Value of Tests, Prognosis, Retrospective Studies, SARS-CoV-2, Coronavirus Infections blood, Coronavirus Infections mortality, Coronavirus Infections therapy, Creatine Kinase, MB Form blood, Heart Diseases blood, Heart Diseases mortality, Heart Diseases virology, Natriuretic Peptide, Brain blood, Pandemics, Peptide Fragments blood, Pneumonia, Viral blood, Pneumonia, Viral mortality, Pneumonia, Viral therapy, Troponin I blood
- 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.
- Published
- 2020
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