The Prognostic Value of Cardiac Biomarkers and Echocardiography in Critical COVID-19

Abstract

Background Early risk stratification is crucial in critically ill COVID-19 patients. Myocardial injury is associated with worse outcome. This study aimed to evaluate cardiac biomarkers and echocardiographic findings in critically ill COVID-19 patients and to assess their association with 30-day mortality in comparison to other biomarkers, risk factors and clinical severity scores.Methods Prospective, single-center, cohort study in patients with PCR-confirmed, critical COVID-19. Laboratory assessment included high sensitive troponin T (hs-cTnT) and N-terminal pro-brain natriuretic peptide (NT-proBNP) on admission to ICU: a hs-cTnT ≥ 14 pg/mL and a NT-proBNP ≥ 450 pg/mL were considered as elevated. Transthoracic echocardiographic evaluation was performed within the first 48 hours of ICU admission. The primary outcome was 30-day all-cause mortality. Predictive markers for mortality were assessed by ROC analysis and cut-off values by the Youden Index.Results A total of 100 patients were included. The median age was 63.5 years, the population was predominantly male (66%). At the time of ICU admission, 47% of patients had elevated hs-cTnT and 39% had elevated NT-proBNP. Left ventricular ejection fraction was below 50% in 19.1%. Elevated cardiac biomarkers (hs-cTnT P-value < 0.001, NT-proBNP P-value = 0.001) and impaired left ventricular function (P-value 0.011) were significantly associated with mortality, while other biomarkers (D-dimers, ferritin, C-reactive protein) and clinical scores (SOFA) did not differ significantly between survivors and non-survivors. An optimal cut-off value to predict increased risk for 30-day all-cause mortality was 16.5 pg/mL for hs-cTnT (OR 8.5, 95% CI: 2.9, 25.0) and 415.5 pg/ml for NT-proBNP (OR 5.1, 95% CI: 1.8, 14.7).Conclusion Myocardial injury in COVID-19 is common. Early detection of elevated hs-cTnT and NT-proBNP are predictive for 30-day mortality in patients with critical COVID-19. These markers outperform other routinely used biomarkers, as well as clinical indices of disease severity in ICU. The additive value of routine transthoracic echocardiography is disputable and should only be considered if it is likely to impact therapeutic management.

Preexisting coronary artery disease among coronavirus disease 2019 patients: a systematic review and meta-analysis

“…A higher prevalence of preexisting CAD was observed among those studies enrolling only patients admitted to the ICU (17.5%, 95% CI: 11.9–25.1, I 2 : 88.4%) (Fig. 2, panel b) 11,30,31,33,34 …”

“…The cumulative prevalence of preexisting CAD in hospitalized COVID-19 patients ranged between 3.6 and 44.0% among the 38 studies 11–48 . A random effect model revealed a pooled prevalence of preexisting CAD in 12.6% of cases (95% CI: 11.2–16.5%, I 2 : 95.6%) (Fig.…”

“…A random effect model revealed a pooled prevalence of preexisting CAD in 12.6% of cases (95% CI: 11.2–16.5%, I 2 : 95.6%) (Fig. 2, panel a) 11–48 . Both the Egger's test ( P = 0.44) and the relative funnel plot disclosed potential publication bias (Supplementary file 5, Supplemental Digital Content, http://links.lww.com/JCM/A473).…”

“…2, panel b). 11,30,31,33,34 A further sub-analysis performed stratifying the revised cohort according to the geographical location of enrolment revealed a higher prevalence of preexisting CAD among European cohorts (13.1%, 95% CI: 7.8-21.6%, P < 0.001, I 2 : 98.4%) followed by Asian (12.6%, 95% CI: 9.6-16.2%, I 2 : 93.0), and American patients (12.3%, 95% CI: 9.7-15.5%, I 2 : 58.7%) (Fig. 3, panels aÀc).…”