Abstract
The coronavirus disease 2019 (COVID-19) pandemic has become a global threat. Increases in cardiac biomarkers are common and are associated with adverse outcomes in patients with COVID-19. Although these increases are more likely to occur in cases with concomitant cardiac disease, the differences in cardiac biomarker levels between patients with and without cardiac disease and their associations with in-hospital mortality are largely unknown. A consecutive serial of laboratory-confirmed COVID-19 cases was retrospectively enrolled. Clinical characteristics, laboratory results, and outcome data were collected. The levels of cardiac biomarkers were evaluated and compared by stratifying patients according to concomitant cardiac conditions and clinical classifications. The prognostic efficacy of cardiac biomarker levels on admission was also assessed. Among the overall study population and survived patients, the cardiac biomarker levels at both the early and late stages in cardiac patients were significantly higher than those in non-cardiac patients. However, their concentrations in cardiac patients were comparable to non-cardiac ones among non-survivors. The cardiac biomarker levels at the late stage of the disease were significantly decreased compared to those at the early stage among patients who were alive. Whereas, the late-stage biomarker levels were significantly increased in patients who ultimately died. Subgroup analysis illustrated that increases in cardiac biomarkers were closely related to the severity of the disease, and were prognostic for high risks of in-hospital mortality in non-cardiac, rather than in cardiac patients. Myo and NT-proBNP, rather than Hs-TnI and CK-MB, were independently associated with in-hospital mortality in the overall population and non-cardiac patients. However, these associations were not significant among cardiac patients. In conclusion, our results helped better understand the release pattern and prognostic performance of cardiac biomarkers in patients with COVID-19. Increased levels of Myo and NT-proBNP on admission could be useful markers for early identifying high-risk patients. However, special attention must be paid when implementing the prognostic function for cardiac patients.
Highlights
The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) has become a global threat [1]
A total of 60 (5.9%) all-cause death occurred during the followup. 17 (13.5%) deaths occurred in the cardiac disease group and 43 (4.8%) occurred in the non-cardiac group
The cut-off point of high sensitivity troponin I (Hs-TnI), Myo, and NT-proBNP was 8.65 pg/mL, 82.10 ng/mL, and 352.5 pg/mL, respectively. These results suggest that Myo, an early release biomarker of cardiac injury, had the highest overall performance to predict the in-hospital mortality of COVID-19, followed by NT-proBNP, and Hs-TnI
Summary
The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) has become a global threat [1]. Among hospitalized patients with COVID-19, increases in cardiac biomarkers indicative of myocardial injury are common and are associated with adverse outcomes [2,3,4,5,6]. This study aimed to evaluate the levels of cardiac biomarkers and to investigate their prognostic role in COVID19 patients with or without concomitant cardiac disease. Investigating their release and prognostic values is of great significance for the early identification of high-risk patients and improving outcomes by making corresponding decisions
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