TY - JOUR
T1 - Early detection of elevated cardiac biomarkers to optimise risk stratification in patients with COVID-19
AU - Humanitas COVID-19 Task Force
AU - Stefanini, Giulio G
AU - Chiarito, Mauro
AU - Ferrante, Giuseppe
AU - Cannata, Francesco
AU - Azzolini, Elena
AU - Viggiani, Giacomo
AU - De Marco, Andrea
AU - Briani, Martina
AU - Bocciolone, Monica
AU - Bragato, Renato
AU - Corrada, Elena
AU - Gasparini, Gabriele L
AU - Marconi, Manuel
AU - Monti, Lorenzo
AU - Pagnotta, Paolo A
AU - Panico, Cristina
AU - Pini, Daniela
AU - Regazzoli, Damiano
AU - My, Ilaria
AU - Kallikourdis, Marinos
AU - Ciccarelli, Michele
AU - Badalamenti, Salvatore
AU - Aghemo, Alessio
AU - Reimers, Bernhard
AU - Condorelli, Gianluigi
N1 - © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2020/10
Y1 - 2020/10
N2 - OBJECTIVE: Risk stratification is crucial to optimise treatment strategies in patients with COVID-19. We aimed to evaluate the impact on mortality of an early assessment of cardiac biomarkers in patients with COVID-19.METHODS: Humanitas Clinical and Research Hospital (Rozzano-Milan, Lombardy, Italy) is a tertiary centre that has been converted to the management of COVID-19. Patients with confirmed COVID-19 were entered in a dedicated database for cohort observational analyses. Outcomes were stratified according to elevated levels (ie, above the upper level of normal) of high-sensitivity cardiac troponin I (hs-TnI), B-type natriuretic peptide (BNP) or both measured within 24 hours after hospital admission. The primary outcome was all-cause mortality.RESULTS: A total of 397 consecutive patients with COVID-19 were included up to 1 April 2020. At the time of hospital admission, 208 patients (52.4%) had normal values for cardiac biomarkers, 90 (22.7%) had elevated both hs-TnI and BNP, 59 (14.9%) had elevated only BNP and 40 (10.1%) had elevated only hs-TnI. The rate of mortality was higher in patients with elevated hs-TnI (22.5%, OR 4.35, 95% CI 1.72 to 11.04), BNP (33.9%, OR 7.37, 95% CI 3.53 to 16.75) or both (55.6%, OR 18.75, 95% CI 9.32 to 37.71) as compared with those without elevated cardiac biomarkers (6.25%). A multivariate analysis identified concomitant elevation of both hs-TnI and BNP as a strong independent predictor of all-cause mortality (OR 3.24, 95% CI 1.06 to 9.93).CONCLUSIONS: An early detection of elevated hs-TnI and BNP predicts mortality in patients with COVID-19. Cardiac biomarkers should be systematically assessed in patients with COVID-19 at the time of hospital admission in order to optimise risk stratification.
AB - OBJECTIVE: Risk stratification is crucial to optimise treatment strategies in patients with COVID-19. We aimed to evaluate the impact on mortality of an early assessment of cardiac biomarkers in patients with COVID-19.METHODS: Humanitas Clinical and Research Hospital (Rozzano-Milan, Lombardy, Italy) is a tertiary centre that has been converted to the management of COVID-19. Patients with confirmed COVID-19 were entered in a dedicated database for cohort observational analyses. Outcomes were stratified according to elevated levels (ie, above the upper level of normal) of high-sensitivity cardiac troponin I (hs-TnI), B-type natriuretic peptide (BNP) or both measured within 24 hours after hospital admission. The primary outcome was all-cause mortality.RESULTS: A total of 397 consecutive patients with COVID-19 were included up to 1 April 2020. At the time of hospital admission, 208 patients (52.4%) had normal values for cardiac biomarkers, 90 (22.7%) had elevated both hs-TnI and BNP, 59 (14.9%) had elevated only BNP and 40 (10.1%) had elevated only hs-TnI. The rate of mortality was higher in patients with elevated hs-TnI (22.5%, OR 4.35, 95% CI 1.72 to 11.04), BNP (33.9%, OR 7.37, 95% CI 3.53 to 16.75) or both (55.6%, OR 18.75, 95% CI 9.32 to 37.71) as compared with those without elevated cardiac biomarkers (6.25%). A multivariate analysis identified concomitant elevation of both hs-TnI and BNP as a strong independent predictor of all-cause mortality (OR 3.24, 95% CI 1.06 to 9.93).CONCLUSIONS: An early detection of elevated hs-TnI and BNP predicts mortality in patients with COVID-19. Cardiac biomarkers should be systematically assessed in patients with COVID-19 at the time of hospital admission in order to optimise risk stratification.
KW - Aged
KW - Aged, 80 and over
KW - Betacoronavirus
KW - Biomarkers/blood
KW - COVID-19
KW - Cardiovascular Diseases/epidemiology
KW - Coronavirus Infections/blood
KW - Early Diagnosis
KW - Female
KW - Hospitalization
KW - Humans
KW - Italy
KW - Male
KW - Middle Aged
KW - Natriuretic Peptide, Brain/blood
KW - Pandemics
KW - Pneumonia, Viral/blood
KW - Predictive Value of Tests
KW - Retrospective Studies
KW - Risk Assessment
KW - SARS-CoV-2
KW - Troponin I/blood
U2 - 10.1136/heartjnl-2020-317322
DO - 10.1136/heartjnl-2020-317322
M3 - Article
C2 - 32817312
SN - 1355-6037
VL - 106
SP - 1512
EP - 1518
JO - Heart
JF - Heart
IS - 19
ER -