Prognostic value of cardiac biomarkers in COVID-19 infection

Abstract

Multiple Biomarkers have recently been shown to be elevated in COVID-19, a respiratory infection with multi-organ dysfunction; however, information regarding the prognostic value of cardiac biomarkers as it relates to disease severity and cardiac injury are inconsistent. The goal of this meta-analysis was to summarize the evidence regarding the prognostic relevance of cardiac biomarkers from data available in published reports. PubMed, Embase and Web of Science were searched from inception through April 2020 for studies comparing median values of cardiac biomarkers in critically ill versus non-critically ill COVID-19 patients, or patients who died versus those who survived. The weighted mean differences (WMD) and 95% confidence interval (CI) between the groups were calculated for each study and combined using a random effects meta-analysis model. The odds ratio (OR) for mortality based on cardiac injury was combined from studies reporting it. Troponin levels were significantly higher in COVID-19 patients who died or were critically ill versus those who were alive or not critically ill (WMD 0.57, 95% CI 0.43–0.70, p < 0.001). Additionally, BNP levels were also significantly higher in patients who died or were critically ill (WMD 0.45, 95% CI − 0.21–0.69, p < 0.001). Cardiac injury was independently associated with significantly increased odds of mortality (OR 6.641, 95% CI 1.26–35.1, p = 0.03). A significant difference in levels of D-dimer was seen in those who died or were critically ill. CK levels were only significantly higher in those who died versus those who were alive (WMD 0.79, 95% CI 0.25–1.33, p = 0.004). Cardiac biomarkers add prognostic value to the determination of the severity of COVID-19 and can predict mortality.

Risk factors and early prediction of clinical deterioration and mortality in adult COVID‐19 inpatients: an Australian tertiary hospital experience

“…Sheth et al . reported troponin levels were significantly higher in COVID‐19 patients who died or were critically ill versus those who survived or not critically ill (WMD 0.57; 95% CI, 0.43–0.70; P < 0.001) 22 . However, in our study elevated high‐sensitivity troponin (a cut‐off of 26 ng/L was chosen as it is the overall population 99th percentile) was associated with clinical deterioration in the overall cohort analysis, but not in the GOPC A and B population.…”

The Right Ventricle in COVID-19

“…In several cohort studies from China, myocardial injury, as defined by elevated values of serum TnI, was reported in 7-28% of patients and was significantly associated with severe forms of the disease, the levels of inflammatory biomarkers, and mortality [38,116,117]. An elevation of cardiac biomarkers, including TnI and natriuretic peptides, has been reported in numerous cohort studies, with a prevalence reaching up to 50%, most notably in ICU-hospitalized patients [118][119][120] and with considerable prognostic value (OR for mortality 6.64, p = 0.03), according to a recent meta-analysis [121].…”

Interferon pathway lupus risk alleles modulate risk of death from acute COVID-19

“…We next analyzed the IFN pathway genotype data in the context of biomarkers that are known to be associated with mortality in acute COVID-19, including age, D-Dimer, CRP, and troponin ( 16 , 17 , 18 ). We designated risk genotype as either PRKG1 rs7897633 AA homozygous or IRF5 TCTA haplotype carrier ( Figure 3 ).…”

“…In secondary analyses, we examined blood biomarkers of severe COVID-19, including D-dimer, troponin, and CRP levels in the context of the same genotypes to generate overall predictive models ( 16 , 17 , 18 ). Given the significant multi-factor interdependencies, we utilized regression models to detect interactions and reduce redundancy due to correlated variables.…”