Implications of cardiac markers in risk-stratification and management for COVID-19 patients

• Published in: Critical care (London, England) Vol. 25; no. 1; p. 158
• Main Authors: Li, Pengping, Wu, Wei, Zhang, Tingting, Wang, Ziyu, Li, Jie, Zhu, Mengyan, Liang, Yuan, You, Wenhua, Li, Kening, Ding, Rong, Huang, Bin, Wu, Lingxiang, Duan, Weiwei, Han, Yi, Li, Xuesong, Tang, Xin, Wang, Xin, Shen, Han, Wang, Qianghu, Yan, Hong, Xia, Xinyi, Ji, Yong, Chen, Hongshan
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 26.04.2021; BioMed Central; BMC
• Subjects: Aged; Biological markers; Biomarkers; Biomarkers - blood; Cardiac markers; Cardiovascular diseases; Care and treatment; China - epidemiology; Coronary Artery Disease - blood; Coronary Artery Disease - epidemiology; Coronaviruses; COVID-19; COVID-19 - blood; COVID-19 - epidemiology; COVID-19 - therapy; Critical care; Diagnosis; Female; Hospital patients; Hospitalization; Humans; Male; Medical research; Medicine, Experimental; Middle Aged; Mortality; Prognosis; Retrospective Studies; Risk Assessment - methods; Risk factors; SARS-CoV-2 receptor; Severe acute respiratory syndrome coronavirus 2; China; COVID-19; SARS-CoV-2 receptor; Cardiac markers
• ISSN: 1364-8535; 1466-609X; 1364-8535; 1366-609X
• DOI: 10.1186/s13054-021-03555-z

COVID-19 has resulted in high mortality worldwide. Information regarding cardiac markers for precise risk-stratification is limited. We aim to discover sensitive and reliable early-warning biomarkers for optimizing management and improving the prognosis of COVID-19 patients. A total of 2954 consecutive COVID-19 patients who were receiving treatment from the Wuhan Huoshenshan Hospital in China from February 4 to April 10 were included in this retrospective cohort. Serum levels of cardiac markers were collected after admission. Coronary artery disease diagnosis and survival status were recorded. Single-cell RNA-sequencing and bulk RNA-sequencing from different cohorts of non-COVID-19 were performed to analyze SARS-CoV-2 receptor expression. Among 2954 COVID-19 patients in the analysis, the median age was 60 years (50-68 years), 1461 (49.5%) were female, and 1515 (51.3%) were severe/critical. Compared to mild/moderate (1439, 48.7%) patients, severe/critical patients showed significantly higher levels of cardiac markers within the first week after admission. In severe/critical COVID-19 patients, those with abnormal serum levels of BNP (42 [24.6%] vs 7 [1.1%]), hs-TNI (38 [48.1%] vs 6 [1.0%]), α- HBDH (55 [10.4%] vs 2 [0.2%]), CK-MB (45 [36.3%] vs 12 [0.9%]), and LDH (56 [12.5%] vs 1 [0.1%]) had a significantly higher mortality rate compared to patients with normal levels. The same trend was observed in the ICU admission rate. Severe/critical COVID-19 patients with pre-existing coronary artery disease (165/1,155 [10.9%]) had more cases of BNP (52 [46.5%] vs 119 [16.5%]), hs-TNI (24 [26.7%] vs 9.6 [%], α- HBDH (86 [55.5%] vs 443 [34.4%]), CK-MB (27 [17.4%] vs 97 [7.5%]), and LDH (65 [41.9%] vs 382 [29.7%]), when compared with those without coronary artery disease. There was enhanced SARS-CoV-2 receptor expression in coronary artery disease compared with healthy controls. From regression analysis, patients with five elevated cardiac markers were at a higher risk of death (hazards ratio 3.4 [95% CI 2.4-4.8]). COVID-19 patients with pre-existing coronary artery disease represented a higher abnormal percentage of cardiac markers, accompanied by high mortality and ICU admission rate. BNP together with hs-TNI, α- HBDH, CK-MB and LDH act as a prognostic biomarker in COVID-19 patients with or without pre-existing coronary artery disease.