163 CMAAO CORONA FACTS and MYTH COVID Cardiac Markers

163 CMAAO CORONA FACTS and MYTH  COVID Cardiac Markers

Dr K Aggarwal

President CMAAO

With inputs from Dr Monica Vasudev

1007:  Redefine cardiac injury marker cut-offs to predict 28 days mortality in COVID-19 inpatients

The abnormal cardiac biomarker pattern seen in patients with COVID-19 is significantly associated with a higher risk of death, and the cut-offs of those markers for effective prognosis of 28-day mortality of COVID-19 appear to be much lower than for regular heart disease, at 49% of currently recommended thresholds, according to a study in Hypertension.

The biomarkers are high-sensitivity cardiac troponin I (hs-cTnI), creatine kinase-MB (CK-MB), NT-proB-type natriuretic peptide (NT-proBNP), creatine phosphokinase (CK) and myoglobin (MYO).

Their retrospective cohort study enrolled patients diagnosed as COVID-19 and admitted to 9 hospitals in Hubei Province, China, from December 31, 2019, to March 4, 2020. The study included 3219 patients with myocardial biomarker measurement, and 2814 without. The primary endpoint was 28-day all-cause mortality.

Compared to patients without cardiac injury biomarker measurement, patients with biomarker values were older (median age at 57) and had higher percentages of pre-existing comorbidities and more severe symptoms.

All five myocardial biomarkers were significantly associated with 28-day all-cause death of COVID-19. 

After adjusting for age, gender and comorbidities such as hypertension, diabetes, coronary heart disease and cerebrovascular disease, the 28-day mortality hazard ratio for hs-cTnI was 7.12, NT-proBNP was 5.11, CK-MB was 4.86, MYO was 4.50, and CK, a much less specific cardiac biomarker, was 3.56.

In patients showing heart injury during the entire hospitalization, neutrophil percentage and CRP were rapidly and simultaneously increased after disease onset, immediately followed by the increases of CK-MB, MYO, and hs-cTnI.

The significant elevation of IL-6 occurred only after the increases of these myocardial markers and was highly elevated mainly in patients with evidence of cardiac injury.