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 multi-centered retrospective study, we enrolled 3,219 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-effect Cox model, after adjusting for age, gender and comorbidities, the adjusted hazard ratios of 28-day mortality for high-sensitivity cardiac troponin I (hs-cTnI) was 7.12 (95%CI, 4.60-11.03; P<0.001), NT-proB-type natriuretic peptide (NT-proBNP) was 5.11 (95%CI, 3.50-7.47; P<0.001), CK-MB was 4.86 (95%CI, 3.33-7.09; P<0.001), 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 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.
© 2020 The Authors. Hypertension is published on behalf of the American Heart Association, Inc., by Wolters Kluwer Health, Inc. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution, and reproduction in any medium, provided that the original work is properly cited.
Qin, J., Cheng, X., Zhou, F., Lei, F., Akolkar, G., Cai, J., Zhang, X., Blet, A., Xie, J., Zhang, P., Liu, Y., Huang, Z., Zhao, L., Lin, L., Xia, M., Chen, M., Song, X., Bai, L., Chen, Z., Zhang, X., Xiang, D., Chen, J., Xu, Q., Ma, X., Touyz, R., Gao, C., Wang, H., Liu, L., Mao, W., Luo, P., Yan, Y., Ye, P., Chen, M., Chen, G., Zhu, L., She, Z., Huang, X., Yuan, Y., Zhang, B., Wang, Y., Liu, P. & Li, H. 2020, 'Redefining cardiac biomarkers in predicting mortality and adverse outcomes of inpatients with COVID-19', Hypertension, 76(4), pp. 1104-1112. http://dx.doi.org/10.1161/HYPERTENSIONAHA.120.15528