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

Journal Article (Journal Article;Multicenter Study)

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.

Full Text

Duke Authors

Cited Authors

  • Qin, J-J; Cheng, X; Zhou, F; Lei, F; Akolkar, G; Cai, J; Zhang, X-J; Blet, A; Xie, J; Zhang, P; Liu, Y-M; Huang, Z; Zhao, L-P; Lin, L; Xia, M; Chen, M-M; 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, Z-G; Huang, X; Yuan, Y; Zhang, B-H; Wang, Y; Liu, PP; Li, H

Published Date

  • October 2020

Published In

Volume / Issue

  • 76 / 4

Start / End Page

  • 1104 - 1112

PubMed ID

  • 32673499

Pubmed Central ID

  • PMC7375179

Electronic International Standard Serial Number (EISSN)

  • 1524-4563

Digital Object Identifier (DOI)

  • 10.1161/HYPERTENSIONAHA.120.15528


  • eng

Conference Location

  • United States