Cardiac Biomarker Levels and Their Prognostic Values in COVID-19 Patients With or Without Concomitant Cardiac Disease

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has become a global threat. Increases in cardiac biomarkers are common and are associated with adverse outcomes in patients with COVID-19. Although these increases are more likely to occur in cases with concomitant cardiac disease, the differences in cardiac biomarker levels between patients with and without cardiac disease and their associations with in-hospital mortality are largely unknown. A consecutive serial of laboratory-confirmed COVID-19 cases was retrospectively enrolled. Clinical characteristics, laboratory results, and outcome data were collected. The levels of cardiac biomarkers were evaluated and compared by stratifying patients according to concomitant cardiac conditions and clinical classifications. The prognostic efficacy of cardiac biomarker levels on admission was also assessed. Among the overall study population and survived patients, the cardiac biomarker levels at both the early and late stages in cardiac patients were significantly higher than those in non-cardiac patients. However, their concentrations in cardiac patients were comparable to non-cardiac ones among non-survivors. The cardiac biomarker levels at the late stage of the disease were significantly decreased compared to those at the early stage among patients who were alive. Whereas, the late-stage biomarker levels were significantly increased in patients who ultimately died. Subgroup analysis illustrated that increases in cardiac biomarkers were closely related to the severity of the disease, and were prognostic for high risks of in-hospital mortality in non-cardiac, rather than in cardiac patients. Myo and NT-proBNP, rather than Hs-TnI and CK-MB, were independently associated with in-hospital mortality in the overall population and non-cardiac patients. However, these associations were not significant among cardiac patients. In conclusion, our results helped better understand the release pattern and prognostic performance of cardiac biomarkers in patients with COVID-19. Increased levels of Myo and NT-proBNP on admission could be useful markers for early identifying high-risk patients. However, special attention must be paid when implementing the prognostic function for cardiac patients.

Keywords: COVID-19; cardiac biomarkers; cardiac disease; in-hospital mortality; prognostic value.

Figure 1

The cardiac biomarker levels at the early stage of disease in cardiac and non-cardiac patients stratified by mortality.

Figure 2

The cardiac biomarker levels at the late stage of disease in cardiac and non-cardiac patients stratified by mortality.

Figure 3

The cardiac biomarker levels at both the early and the late stages in patients stratified based on clinical classifications.

Figure 4

Kaplan-Meier curves showing the cumulative survival rate of COVID-19 patients with and without concomitant cardiac disease. Line in blue, patients with cardiac disease, n = 126; line in green, patients without cardiac disease, n = 897; log-rank test for trend, p = 0.002.

Figure 5

Receiver operating characteristic (ROC) curves showing the prognostic value of cardiac biomarkers for predicting in-hospital death in overall study population (A), non-cardiac (B), and cardiac (C) patients.

Figure 6

Kaplan-Meier curves between groups categorized by the cut-off value of each biomarker in the overall study population (A–D), non-cardiac (E–H), and cardiac (I–K) patients.