Redefining Cardiac Biomarkers in Predicting Mortality of Inpatients With COVID-19

Qin, Juan Juan; Xu, Cheng; Zhou, Feng; Lei, Fang; Akolkar, Gauri; Cai, Jingjing; Zhang, Xiao Jing; Blet, Alice; Xie, Jing; Zhang, Peng; Liu, Ye Mao; Huang, Zizhen; Zhao, Lingli; Lin, Lijin; Meng, Xiaomei; Chen, Ming Ming; Song, Xiaohui; Bai, Lei; Chen, Ze; Zhang, Xingyuan; Da, Xiang; Chen, Jing; Xu, Qingbo; Ma, Xin‐Liang; Touyz, Rhian M.; Gao, Chen; Wang, Haitao; Li, Liming; Mao, Weiming; Luo, Pengfei; Yan, Youqin; Ye, Ping; Chen, Manhua; Chen, Guohua; Zhu, Lihua; She, Zhi Gang; Huang, Xiaodong; Yuan, Yufeng; Zhang, Bing Hong; Wang, Yibin; Liu, Peter P.; Li, Hongliang

doi:10.1161/hypertensionaha.120.15528

Cited by 128 publications

(145 citation statements)

References 19 publications

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“…Interestingly, our study confirms the major role of obesity, low oxygen saturation and high troponin levels in predicting mortality and need for a mechanical ventilation, as recently outlined [ 26 , 27 ]. These variables can be used as useful prognostic markers together with other cardiac and coagulation parameters [ 5 , 25 ].…”

Section: Discussionsupporting

confidence: 91%

Lupus anticoagulant and mortality in patients hospitalized for COVID-19

Gazzaruso¹,

Mariani

Ravetto

et al. 2020

J Thromb Thrombolysis

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Coronavirus disease 2019 (COVID-19) is characterized by a procoagulant state that can lead to fatal thromboembolic events. Several studies have documented a high prevalence of lupus anticoagulant that may at least partially explain the procoagulant profile of COVID-19. However, the association between lupus anticoagulant and thrombotic complications in COVID-19 is controversial and no study has specifically evaluated the impact of lupus anticoagulant on mortality. The aim of our study was to investigate the association between lupus anticoagulant and mortality in a large group of 192 consecutive patients hospitalized for COVID-19. Lupus anticoagulant was found in 95 patients (49.5%). No difference in the percentage of patients with lupus anticoagulant was observed between 130 survivors and 62 non-survivors (47.7 versus 53,2%; p = 0.4745). When the combined outcome of death or need for mechanical ventilation in survivors was taken into account, the difference in the prevalence of patients with lupus anticoagulant between the patients with the combined outcome (n = 76) and survivors who did not require mechanical ventilation (n = 116) was not significant (52.6% versus 47.4%; p = 0.4806). In multivariate analysis predictors of mortality or need for mechanical ventilation in survivors were obesity, low oxygen saturation and elevated troponin levels measured on admission. In conclusion, our study did not show any association of lupus anticoagulant with mortality and with need for mechanical ventilation in survivors. The role of obesity, low SaO2 and elevated troponin levels as predictors of a worse prognosis in patients hospitalized for COVID-19 was confirmed.

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Section: Discussionsupporting

confidence: 91%

Lupus anticoagulant and mortality in patients hospitalized for COVID-19

Gazzaruso¹,

Mariani

Ravetto

et al. 2020

J Thromb Thrombolysis

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“…In 28 studies [ 13 – 15 , 25 – 27 , 31 , 32 , 34 , 37 , 38 , 41 , 43 – 46 , 48 , 49 , 51 , 52 , 55 , 57 , 61 , 65 , 67 , 68 , 70 , 71 ], data on the relationship between troponins (on admission or during hospital stay) and mortality of patients with covid-19 could be extracted. The risks of bias of these studies in assessing the prognostic value of troponins are summarised in Table S 4 .…”

Section: Resultsmentioning

confidence: 99%

“…We conducted a meta-analysis of 11 studies (13,889 patients) that reported multivariable-adjusted associations between admission troponins above the upper reference limit and mortality [ 13 – 15 , 26 , 27 , 32 , 37 , 45 , 46 , 55 , 67 ]. Elevated troponins on admission were associated with an increased risk of death (RR 2.68, 95% CI 2.08–3.46).…”

Section: Resultsmentioning

confidence: 99%

“…To further characterise the predictive performance of troponins, we included 20 studies (15,488 patients) that reported the number of deaths in those admitted with elevated and non-elevated troponins in a bivariate meta-analysis [ 14 , 15 , 25 , 27 , 31 , 32 , 34 , 37 , 43 – 46 , 51 , 55 , 57 , 61 , 65 , 67 , 70 , 71 ]. The overall sensitivity of elevated troponins on admission for predicting death was 0.60 (95% CI 0.54–0.65); the specificity was 0.83 (0.77–0.88) (Fig.…”

Section: Resultsmentioning

confidence: 99%

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Prevalence and prognostic value of elevated troponins in patients hospitalised for coronavirus disease 2019: a systematic review and meta-analysis

et al. 2020

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Background The clinical significance of cardiac troponin measurement in patients hospitalised for coronavirus disease 2019 (covid-19) is uncertain. We investigated the prevalence of elevated troponins in these patients and its prognostic value for predicting mortality. Methods Studies were identified by searching electronic databases and preprint servers. We included studies of hospitalised covid-19 patients that reported the frequency of troponin elevations above the upper reference limit and/or the association between troponins and mortality. Meta-analyses were performed using random-effects models. Results Fifty-one studies were included. Elevated troponins were found in 20.8% (95% confidence interval [CI] 16.8–25.0 %) of patients who received troponin test on hospital admission. Elevated troponins on admission were associated with a higher risk of subsequent death (risk ratio 2.68, 95% CI 2.08–3.46) after adjusting for confounders in multivariable analysis. The pooled sensitivity of elevated admission troponins for predicting death was 0.60 (95% CI 0.54–0.65), and the specificity was 0.83 (0.77–0.88). The post-test probability of death was about 42% for patients with elevated admission troponins and was about 9% for those with non-elevated troponins on admission. There was significant heterogeneity in the analyses, and many included studies were at risk of bias due to the lack of systematic troponin measurement and inadequate follow-up. Conclusion Elevated troponins were relatively common in patients hospitalised for covid-19. Troponin measurement on admission might help in risk stratification, especially in identifying patients at high risk of death when troponin levels are elevated. High-quality prospective studies are needed to validate these findings. Systematic review registration PROSPERO CRD42020176747

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“…17,19,20 Interestingly, elevated troponin levels, a marker of cardiac injury, predicted increased need for mechanical ventilation in multivariable analysis whereas chronic statin use was associated with reduced in-hospital mortality, further underscoring the strong link between underlying cardiovascular disease and worse outcomes with COVID-19. 8,[21][22][23][24][25][26][27][28][29] Importantly, we developed two novel prediction models to calculate risk of hospitalized COVID-19 developing severe outcomes. These models were effective at predicting risk of ventilation need and death in both our derivation and validation cohorts.…”

Section: Discussionmentioning

confidence: 99%

Estimating Risk of Mechanical Ventilation and Mortality Among Adult COVID-19 patients Admitted to Mass General Brigham: The VICE and DICE Scores

Nicholson

Wooster

Sigurslid

et al. 2020

Preprint

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Background: Risk stratification of COVID-19 patients upon hospital admission is key for their successful treatment and efficient utilization of hospital resources. Objective: To evaluate the risk factors associated with ventilation need and mortality. Design, setting and participants: We established a retrospective cohort of COVID-19 patients from Mass General Brigham hospitals. Demographic, clinical, and admission laboratory data were obtained from electronic medical records of patients admitted to hospital with laboratory-confirmed COVID-19 before May 19th, 2020. Using patients admitted to Massachusetts General Hospital (MGH, derivation cohort), multivariable logistic regression analyses were used to construct the Ventilation in COVID Estimator (VICE) and Death in COVID Estimator (DICE) risk scores. Measurements: The primary outcomes were ventilation status and death. Results: The entire cohort included 1042 patients (median age, 64 years; 56.8% male). The derivation and validation cohorts for the risk scores included 578 and 464 patients, respectively. We found seven factors to be independently predictive for ventilation requirement (diabetes mellitus, dyspnea, alanine aminotransferase, troponin, C-reactive protein, neutrophil-lymphocyte ratio, and lactate dehydrogenase), and 10 factors to be predictors of in-hospital mortality (age, sex, diabetes mellitus, chronic statin use, albumin, C-reactive protein, neutrophil-lymphocyte ratio, mean corpuscular volume, platelet count, and procalcitonin). Using these factors, we constructed the VICE and DICE risk scores, which performed with C-statistics of at least 0.8 in our cohorts. Importantly, the chronic use of a statin was associated with protection against death due to COVID-19. The VICE and DICE score calculators have been placed on an interactive website freely available to the public (https://covid-calculator.com/). Limitations: One potential limitation is the modest sample sizes in both our derivation and validation cohorts. Conclusion: The risk scores developed in this study may help clinicians more appropriately determine which COVID-19 patients will need to be managed with greater intensity.

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Redefining Cardiac Biomarkers in Predicting Mortality of Inpatients With COVID-19

Cited by 128 publications

References 19 publications

Lupus anticoagulant and mortality in patients hospitalized for COVID-19

Lupus anticoagulant and mortality in patients hospitalized for COVID-19

Prevalence and prognostic value of elevated troponins in patients hospitalised for coronavirus disease 2019: a systematic review and meta-analysis

Estimating Risk of Mechanical Ventilation and Mortality Among Adult COVID-19 patients Admitted to Mass General Brigham: The VICE and DICE Scores

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