RT Journal Article
SR Electronic
T1 Early detection of elevated cardiac biomarkers to optimise risk stratification in patients with COVID-19
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 1512
OP 1518
DO 10.1136/heartjnl-2020-317322
VO 106
IS 19
A1 Giulio G. Stefanini
A1 Mauro Chiarito
A1 Giuseppe Ferrante
A1 Francesco Cannata
A1 Elena Azzolini
A1 Giacomo Viggiani
A1 Andrea De Marco
A1 Martina Briani
A1 Monica Bocciolone
A1 Renato Bragato
A1 Elena Corrada
A1 Gabriele L Gasparini
A1 Manuel Marconi
A1 Lorenzo Monti
A1 Paolo A Pagnotta
A1 Cristina Panico
A1 Daniela Pini
A1 Damiano Regazzoli
A1 Ilaria My
A1 Marinos Kallikourdis
A1 Michele Ciccarelli
A1 Salvatore Badalamenti
A1 Alessio Aghemo
A1 Bernhard Reimers
A1 Gianluigi Condorelli
A1 ,
YR 2020
UL http://heart.bmj.com/content/106/19/1512.abstract
AB 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.