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, 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

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 high-sensitivity cardiac troponin I was 7.12 ([95% CI, 4.60–11.03] P<0.001), NT-proBNP (N-terminal pro-B-type 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 49% 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 cutoffs for of these values 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.