Cardiac Biomarker Levels and Their Prognostic Values in COVID-19 Patients With or Without Concomitant Cardiac Disease

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.

Myoglobin Offers Higher Accuracy Than Other Cardiac-Specific Biomarkers for the Prognosis of COVID-19

“…More importantly, MYO, but not hs-TnI or CK-MB, was an independent factor associated with the risk of in-hospital mortality. These results are consistent with multivariate regression analyses in our and others' previous studies showing that elevated serum myoglobin concentrations were an independent predictor of in-hospital mortality in patients with COVID-19 ( 10 , 12 – 15 ).…”

“…However, in our previous study and studies by other investigators, multifactorial analysis combining most clinical indicators showed that hypersensitive troponin I (hs-TnI) and CK-MB were not independent predictors of mortality in COVID-19. In contrast, myoglobin (MYO), a noncardiac-specific indicator also expressed in skeletal muscle cells, was independent prognostic (10)(11)(12)(13)(14)(15). The reasons underlying this curious phenomenon were not fully understood, but a comprehensive comparison of the predictive capabilities of myocardial biomarkers can help clarify the mechanisms involved and may contribute to our understanding of the significance of cardiac injury in COVID-19.…”

The level of liver and renal function biomarker abnormalities among hospitalized COVID-19 patients in Ethiopia

“…Underlying cardiac disease was reported as among the major risk factors in susceptible to COVID-19 [24, 47, 48]. Myocardial injury, with elevation of cardiac biomarkers above the 99th percentile of the upper reference limit, occurred in 20–30% of hospitalized patients with COVID-19, with higher rates (55%) among those with pre-existing cardiovascular disease [49-51].…”

Markers of Infection-Mediated Cardiac Damage in Influenza and COVID-19

“…The aim of the present study was to evaluate pathological alterations of cardiac biomarkers among patients with influenza or COVID-19 during hospital stay and to study their correlation with intensive care unit (ICU) admission and early mortality. The novelty of our study lies in the direct comparison between these two infections, whereas previous studies analyzed the role played by cardiac biomarkers in each individual disease [ 27 , 28 , 29 , 30 ].…”