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Implications of cardiac markers in risk-stratification and management for COVID-19 patients
Pengping Li1, Wei Wu1, Tingting Zhang1
1Department of Bioinformatics, Nanjing Medical University, Nanjing, China.
Insights
Elevated cardiac markers like BNP and hs-TNI indicate higher mortality risk in COVID-19 patients, especially those with coronary artery disease. These markers aid in predicting prognosis for COVID-19 patients.
Area of Science:
- Cardiology
- Infectious Diseases
- Biomarkers
Background:
- COVID-19 has caused significant global mortality.
- Precise risk-stratification using cardiac markers in COVID-19 patients remains limited.
- Identifying reliable early-warning biomarkers is crucial for patient management and prognosis.
Purpose of the Study:
- To discover sensitive and reliable early-warning cardiac biomarkers for COVID-19 patients.
- To optimize management strategies and improve the prognosis of COVID-19 patients.
- To investigate the association between cardiac markers, coronary artery disease, and COVID-19 outcomes.
Main Methods:
- Retrospective cohort study of 2954 COVID-19 patients.
- Analysis of serum cardiac marker levels (BNP, hs-TNI, α-HBDH, CK-MB, LDH) upon admission.
- Recording of coronary artery disease diagnosis, survival status, and ICU admission rates.
- Exploration of SARS-CoV-2 receptor expression using RNA-sequencing.
Main Results:
- Severe/critical COVID-19 patients exhibited higher cardiac marker levels within the first week.
- Abnormal levels of BNP, hs-TNI, α-HBDH, CK-MB, and LDH were significantly associated with higher mortality and ICU admission rates.
- COVID-19 patients with pre-existing coronary artery disease showed higher abnormal cardiac marker percentages and increased mortality risk.
Conclusions:
- Pre-existing coronary artery disease in COVID-19 patients is linked to elevated cardiac markers, higher mortality, and ICU admission.
- BNP, hs-TNI, α-HBDH, CK-MB, and LDH serve as prognostic biomarkers for COVID-19 patients, regardless of coronary artery disease status.
Background:
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.
Methods:
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.
Results:
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]).
Conclusions:
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.
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