Cardiac biomarkers and right ventricular dysfunction are independently associated with one year mortality in patients with COVID-19 receiving mechanical ventilation: a prospective cohort study

Abstract

Background: The cardiac biomarkers N-terminal pro-brain natriuretic peptide (NT-proBNP) and troponin frequently are raised in patients with acute COVID-19. As a secondary analysis of the Right Ventricular Dysfunction in Ventilated Patients With COVID-19 study, we sought to determine the association between raised cardiac biomarkers and 1-year mortality in patients with COVID-19 receiving invasive mechanical ventilation (IMV). As an exploratory investigation, we combined point-of-care echocardiography and cardiac biomarker analyses to determine whether the biomarker signal represented a global or regional cardiac injury. Study Question: Are abnormal cardiac biomarker levels associated with 1-year mortality in patients with COVID-19 requiring IMV? Study Design and Methods: In this prospective cardiac biomarker and echocardiography study in patients with COVID-19 across 10 ICUs in the west of Scotland, patients underwent contemporaneous cardiac biomarker testing with point-of-care echocardiography between days 2 and 14 after intubation. Survival analyses was performed using univariable log-rank and multivariable Cox regression. Results: One hundred twenty-one patients were recruited between September 2, 2020, and March 22, 2021. At 1 year, 57.6% of patients (68 of 118) had died. Patients with abnormal NT-proBNP levels and patients with abnormal troponin levels showed a 1-year mortality incidence of 71.4% (50 of 70) and 80.4% (45 of 56), respectively. Both abnormal NT-proBNP and abnormal troponin levels were associated with 1-year mortality (P < .001 for both). Abnormal troponin level was associated with subjective right ventricular dysfunction (RVD; P = .003), and no association with subjective left ventricular dysfunction was found (P = .342). On multivariable analysis, abnormal NT-proBNP level, abnormal troponin level, and subjective RVD were associated independently with 1-year mortality (hazard ratios, 2.82 [95% CI, 1.19-6.67], 2.84 [95% CI, 1.44-5.62], and 2.09 [95% CI, 1.07-4.07], respectively). Interpretation: Abnormal NT-proBNP level, abnormal troponin level, and subjective RVD are associated independently with 1-year mortality in patients with COVID-19 receiving IMV. Cardiac biomarker testing and point-of-care echocardiography are available readily during ICU admission and may identify a group of patients who are at very high risk of poor outcomes.

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http://creativecommons.org/licenses/by/4.0/

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DOI

http://dx.doi.org/10.1016/j.chstcc.2023.100015

Repository URI

https://eprints.gla.ac.uk/298662/