• Heart · Oct 2020

    Early detection of elevated cardiac biomarkers to optimise risk stratification in patients with COVID-19.

    • Giulio G Stefanini, Mauro Chiarito, Giuseppe Ferrante, Francesco Cannata, Elena Azzolini, Giacomo Viggiani, Andrea De Marco, Martina Briani, Monica Bocciolone, Renato Bragato, Elena Corrada, Gabriele L Gasparini, Manuel Marconi, Lorenzo Monti, Paolo A Pagnotta, Cristina Panico, Daniela Pini, Damiano Regazzoli, Ilaria My, Marinos Kallikourdis, Michele Ciccarelli, Salvatore Badalamenti, Alessio Aghemo, Bernhard Reimers, Gianluigi Condorelli, and Humanitas COVID-19 Task Force.
    • Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy giulio.stefanini@gmail.com.
    • Heart. 2020 Oct 1; 106 (19): 1512-1518.

    ObjectiveRisk 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.MethodsHumanitas 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.ResultsA 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).ConclusionsAn 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.© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.

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