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Early detection of elevated cardiac biomarkers to optimise risk stratification in patients with COVID-19
  1. Giulio G. Stefanini1,2,
  2. Mauro Chiarito1,2,
  3. Giuseppe Ferrante1,2,
  4. Francesco Cannata1,2,
  5. Elena Azzolini1,2,
  6. Giacomo Viggiani1,2,
  7. Andrea De Marco1,2,
  8. Martina Briani1,2,
  9. Monica Bocciolone1,2,
  10. Renato Bragato1,2,
  11. Elena Corrada1,2,
  12. Gabriele L Gasparini1,2,
  13. Manuel Marconi1,2,
  14. Lorenzo Monti1,2,
  15. Paolo A Pagnotta1,2,
  16. Cristina Panico1,2,
  17. Daniela Pini1,2,
  18. Damiano Regazzoli1,2,
  19. Ilaria My1,2,
  20. Marinos Kallikourdis1,2,
  21. Michele Ciccarelli1,2,
  22. Salvatore Badalamenti1,2,
  23. Alessio Aghemo1,2,
  24. Bernhard Reimers1,2,
  25. Gianluigi Condorelli1,2
  26. On behalf of the Humanitas COVID-19 Task Force
  1. 1 Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
  2. 2 Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
  1. Correspondence to Prof Giulio G. Stefanini, Department of Biomedical Sciences, Humanitas University, Pieve Emanuele 20090, Italy; giulio.stefanini{at}


Objective Risk stratification is crucial to optimise treatment strategies in patients with COVID-19. We aimed to evaluate the impact on mortality of an early assessment of cardiac biomarkers in patients with COVID-19.

Methods Humanitas Clinical and Research Hospital (Rozzano-Milan, Lombardy, Italy) is a tertiary centre that has been converted to the management of COVID-19. Patients with confirmed COVID-19 were entered in a dedicated database for cohort observational analyses. Outcomes were stratified according to elevated levels (ie, above the upper level of normal) of high-sensitivity cardiac troponin I (hs-TnI), B-type natriuretic peptide (BNP) or both measured within 24 hours after hospital admission. The primary outcome was all-cause mortality.

Results A total of 397 consecutive patients with COVID-19 were included up to 1 April 2020. At the time of hospital admission, 208 patients (52.4%) had normal values for cardiac biomarkers, 90 (22.7%) had elevated both hs-TnI and BNP, 59 (14.9%) had elevated only BNP and 40 (10.1%) had elevated only hs-TnI. The rate of mortality was higher in patients with elevated hs-TnI (22.5%, OR 4.35, 95% CI 1.72 to 11.04), BNP (33.9%, OR 7.37, 95% CI 3.53 to 16.75) or both (55.6%, OR 18.75, 95% CI 9.32 to 37.71) as compared with those without elevated cardiac biomarkers (6.25%). A multivariate analysis identified concomitant elevation of both hs-TnI and BNP as a strong independent predictor of all-cause mortality (OR 3.24, 95% CI 1.06 to 9.93).

Conclusions An early detection of elevated hs-TnI and BNP predicts mortality in patients with COVID-19. Cardiac biomarkers should be systematically assessed in patients with COVID-19 at the time of hospital admission in order to optimise risk stratification.

  • coronary artery disease
  • global health
  • systemic inflammatory diseases
  • myocardial disease
  • cardiac risk factors and prevention

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

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  • Contributors GGS, MC, FC and GC conceived the idea and design for the study. GGS, MC and FC analysed the data. All authors contributed to interpret the data. GGS, MC and FC drafted the manuscript. All authors contributed to revise the draft critically for important intellectual content and approved the final manuscript.

  • Funding This work was supported by COVID-19 Welfare Funds of Regione Lombardia.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval The study complies with the Declaration of Helsinki and was approved by the Ethics Committee of Humanitas Clinical and Research Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request.