Risk stratification and prognosis prediction using cardiac biomarkers in COVID-19: a single-centre retrospective cohort study

Abstract

Objective There is a need for a robust tool to stratify the patient’s risk with COVID-19. We assessed the prognostic values of cardiac biomarkers for COVID-19 patients.Methods This is a single-centre retrospective cohort study. Consecutive laboratory-confirmed COVID-19 patients admitted to the Kobe City Medical Center General Hospital from July 2020 to September 2021 were included. We obtained cardiac biomarker values from electronic health records and institutional blood banks. We stratified patients with cardiac biomarkers as high-sensitive troponin I (hsTnI), N-terminal pro-B-type natriuretic peptide (NT-proBNP), creatine kinase (CK) and CK myocardial band (CK-MB), using the clinically relevant thresholds. Prespecified primary outcome measure was all-cause death.Results A total of 917 patients were included. hsTnI, NT-proBNP, CK and CK-MB were associated with the significantly higher cumulative 30-day incidence of all-cause death (hsTnI: <5.0 ng/L group; 4.3%, 5.0 ng/L–99%ile upper reference limit (URL) group; 8.8% and ≥99% ile URL group; 25.2%, p<0.001. NT-proBNP: <125 pg/mL group; 5.3%, 125–900 pg/mL group; 10.5% and ≥900 pg/mL group; 31.9%, p<0.001. CK: <upper normal limit (UNL) group; 10.6%, UNL to 3 times of UNL group; 16.4% and ≥3 times of UNL group; 23.5%, p<0.001. CK-MB: <UNL group; 7.8%, UNL to 3 times of UNL group; 20.4% and ≥3 times of UNL group; 38.9%, p<0.001). The adjusted risk for all-cause death remained significant for each threshold of cardiac biomarkers.Conclusions Elevation of cardiac biomarkers was associated with poor prognosis of COVID-19 patients.