Serial cardiac biomarkers for risk stratification of patients with COVID-19

Serial cardiac biomarkers for risk stratification of patients with COVID-19

Several studies have demonstrated an association between elevated cardiac biomarkers and adverse outcomes in patients with COVID-19. However, the prognostic and predictive capability of a multimarker panel in a prospectively collected, diverse “all-comers” COVID-19 population has not been fully eluc...

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Veröffentlicht in:Clinical biochemistry 2022-09, Vol.107, p.24-32
Hauptverfasser: Tawiah, Kwaku, Jackson, Laurel, Omosule, Catherine, Ballman, Claire, Shahideh, Bobby, Scott, Mitchell G, Murtagh, Gillian, Farnsworth, Christopher W.
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Biomarkers
COVID-19
High sensitivity troponin
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container_end_page 32
container_issue
container_start_page 24
container_title Clinical biochemistry
container_volume 107
creator Tawiah, Kwaku
Jackson, Laurel
Omosule, Catherine
Ballman, Claire
Shahideh, Bobby
Scott, Mitchell G
Murtagh, Gillian
Farnsworth, Christopher W.
description Several studies have demonstrated an association between elevated cardiac biomarkers and adverse outcomes in patients with COVID-19. However, the prognostic and predictive capability of a multimarker panel in a prospectively collected, diverse “all-comers” COVID-19 population has not been fully elucidated. We prospectively assessed high sensitivity cardiac troponin I (hsTnI), NT-pro B-type Natriuretic Peptide (NT-proBNP), Galectin-3 (Gal-3), and procalcitonin (PCT) in 4,282 serial samples from 358 patients admitted with symptomatic, RT-PCR confirmed SARS-CoV-2 infection. Outcomes examined were 30-day in-hospital mortality and requirement for intubation within 10 days. Baseline hsTnI had the highest AUC for predicting 30-day mortality (0.81; 95% CI, 0.73–0.88), followed by NT-proBNP (0.80; 0.74–0.86), PCT (0.77; 0.70–0.84), and Gal-3 (0.68; 0.60–0.76). HsTnI 
doi_str_mv 10.1016/j.clinbiochem.2022.06.002
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However, the prognostic and predictive capability of a multimarker panel in a prospectively collected, diverse “all-comers” COVID-19 population has not been fully elucidated. We prospectively assessed high sensitivity cardiac troponin I (hsTnI), NT-pro B-type Natriuretic Peptide (NT-proBNP), Galectin-3 (Gal-3), and procalcitonin (PCT) in 4,282 serial samples from 358 patients admitted with symptomatic, RT-PCR confirmed SARS-CoV-2 infection. Outcomes examined were 30-day in-hospital mortality and requirement for intubation within 10 days. Baseline hsTnI had the highest AUC for predicting 30-day mortality (0.81; 95% CI, 0.73–0.88), followed by NT-proBNP (0.80; 0.74–0.86), PCT (0.77; 0.70–0.84), and Gal-3 (0.68; 0.60–0.76). HsTnI &lt; 3.5 ng/L at baseline identified patients at low risk for in-hospital mortality (NPV 95.9%, sensitivity 97.3%) and 10-day intubation (NPV 90.4%, sensitivity 88.5%). Continuous, log-2 increases in troponin concentration were associated with reduced survival (p &lt; 0.001) on Kaplan-Meier curves and increased risk of 30-day mortality: HR 1.26 (1.16–1.37) in univariate and 1.19 (1.03–1.4) in multivariate models. Time-varying doubling of concentrations of hsTnI and Gal-3 were associated with increased risk of 30-day mortality (adjusted HR 1.21, 1.06–1.4, and 1.92, 1.40–2.6). HsTnI, NT-proBNP, Gal-3, and PCT are elevated at baseline in patients that have worse outcomes from COVID-19. HsTnI was the only independent predictor of 30-day mortality and intubation. Time-varying, doubling in hsTnI and Gal-3 further aided in prognostication of adverse outcomes. These results support the use of hsTnI for triaging patients with COVID-19.</description><identifier>ISSN: 0009-9120</identifier><identifier>EISSN: 1873-2933</identifier><identifier>DOI: 10.1016/j.clinbiochem.2022.06.002</identifier><identifier>PMID: 35691587</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Biomarkers ; COVID-19 ; High sensitivity troponin</subject><ispartof>Clinical biochemistry, 2022-09, Vol.107, p.24-32</ispartof><rights>2022 The Canadian Society of Clinical Chemists</rights><rights>Copyright © 2022 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.</rights><rights>2022 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. 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However, the prognostic and predictive capability of a multimarker panel in a prospectively collected, diverse “all-comers” COVID-19 population has not been fully elucidated. We prospectively assessed high sensitivity cardiac troponin I (hsTnI), NT-pro B-type Natriuretic Peptide (NT-proBNP), Galectin-3 (Gal-3), and procalcitonin (PCT) in 4,282 serial samples from 358 patients admitted with symptomatic, RT-PCR confirmed SARS-CoV-2 infection. Outcomes examined were 30-day in-hospital mortality and requirement for intubation within 10 days. Baseline hsTnI had the highest AUC for predicting 30-day mortality (0.81; 95% CI, 0.73–0.88), followed by NT-proBNP (0.80; 0.74–0.86), PCT (0.77; 0.70–0.84), and Gal-3 (0.68; 0.60–0.76). HsTnI &lt; 3.5 ng/L at baseline identified patients at low risk for in-hospital mortality (NPV 95.9%, sensitivity 97.3%) and 10-day intubation (NPV 90.4%, sensitivity 88.5%). Continuous, log-2 increases in troponin concentration were associated with reduced survival (p &lt; 0.001) on Kaplan-Meier curves and increased risk of 30-day mortality: HR 1.26 (1.16–1.37) in univariate and 1.19 (1.03–1.4) in multivariate models. Time-varying doubling of concentrations of hsTnI and Gal-3 were associated with increased risk of 30-day mortality (adjusted HR 1.21, 1.06–1.4, and 1.92, 1.40–2.6). HsTnI, NT-proBNP, Gal-3, and PCT are elevated at baseline in patients that have worse outcomes from COVID-19. HsTnI was the only independent predictor of 30-day mortality and intubation. Time-varying, doubling in hsTnI and Gal-3 further aided in prognostication of adverse outcomes. 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However, the prognostic and predictive capability of a multimarker panel in a prospectively collected, diverse “all-comers” COVID-19 population has not been fully elucidated. We prospectively assessed high sensitivity cardiac troponin I (hsTnI), NT-pro B-type Natriuretic Peptide (NT-proBNP), Galectin-3 (Gal-3), and procalcitonin (PCT) in 4,282 serial samples from 358 patients admitted with symptomatic, RT-PCR confirmed SARS-CoV-2 infection. Outcomes examined were 30-day in-hospital mortality and requirement for intubation within 10 days. Baseline hsTnI had the highest AUC for predicting 30-day mortality (0.81; 95% CI, 0.73–0.88), followed by NT-proBNP (0.80; 0.74–0.86), PCT (0.77; 0.70–0.84), and Gal-3 (0.68; 0.60–0.76). HsTnI &lt; 3.5 ng/L at baseline identified patients at low risk for in-hospital mortality (NPV 95.9%, sensitivity 97.3%) and 10-day intubation (NPV 90.4%, sensitivity 88.5%). 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COVID-19
High sensitivity troponin
title Serial cardiac biomarkers for risk stratification of patients with COVID-19
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