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With inputs from Dr Monica Vasudev
1007: Redefine cardiac injury marker cut-offs to predict 28 days mortality in COVID-19 inpatients
The abnormal cardiac biomarker pattern that is observed in patients with COVID-19 has a significant association with an increased risk of death. The cut-offs of these markers for effective prognosis of 28-day mortality of COVID-19 seems to be much lower than that for regular heart disease, at 49% of currently recommended thresholds, suggests a study published in Hypertension.
The biomarkers include high-sensitivity cardiac troponin I (hs-cTnI), creatine kinase-MB (CK-MB), NT-proB-type natriuretic peptide (NT-proBNP), creatine phosphokinase (CK) and myoglobin (MYO).
This retrospective cohort study included COVID-19 patients admitted to 9 hospitals in Hubei Province, China, between December 31, 2019, and March 4, 2020. In all, 3219 patients with myocardial biomarker measurement, and 2814 without were included. The primary endpoint was 28-day all-cause mortality.
In comparison with patients without cardiac injury biomarker measurement, those with biomarker values were older (median age 57) and also had higher percentages of pre-existing comorbidities and more severe symptoms. All five myocardial biomarkers appeared to have a significant correlation with 28-day all-cause death of COVID-19.
Adjusting for age, gender and comorbidities including hypertension, diabetes, coronary heart disease and cerebrovascular disease, revealed the 28-day mortality hazard ratio for hs-cTnI as 7.12, NT-proBNP as 5.11, CK-MB as 4.86, MYO as 4.50, and CK, as 3.56. CK was a much less specific biomarker.
In patients showing cardiac injury during the entire hospitalization, neutrophil percentage and CRP demonstrated a rapid and simultaneous elevation after disease onset, immediately followed by the increased CK-MB, MYO, and hs-cTnI.
There was a significant elevation of IL-6 only after the increases of these myocardial markers and was highly increased mainly in patients with cardiac injury. [DG Alerts]
Dr KK Aggarwal
President CMAAO, HCFI and Past National President IMA
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Update can help decisions regarding testing for IL6 and subsequent use of immunomodulatory drugs, which are double edged weapons if used indiscriminately.