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Redefining Cardiac Biomarkers in Predicting Mortality of Inpatients With COVID-19.
- Source :
-
Hypertension (Dallas, Tex. : 1979) [Hypertension] 2020 Oct; Vol. 76 (4), pp. 1104-1112. Date of Electronic Publication: 2020 Jul 14. - Publication Year :
- 2020
-
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.
- 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
Subjects
Details
- Language :
- English
- ISSN :
- 1524-4563
- Volume :
- 76
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Hypertension (Dallas, Tex. : 1979)
- Publication Type :
- Academic Journal
- Accession number :
- 32673499
- Full Text :
- https://doi.org/10.1161/HYPERTENSIONAHA.120.15528