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The diagnostic and prognostic role of myocardial injury biomarkers in hospitalized patients with COVID-19.

ABSTRACT: OBJECTIVE:The aim of this study was to systematically and comprehensively evaluate the diagnostic and prognostic value of myocardial injury biomarkers in COVID-19 patients. METHODS:This is a retrospective cohort study of confirmed COVID-19 patients that were admitted to the Renmin Hospital of Wuhan University from January 30, 2020 to February 15, 2020. RESULTS:Receiver operating characteristic (ROC) curve analysis demonstrated that cTnI-ultra had the highest area under the curve (AUC) at 0.855, with a sensitivity of 67.3% and a specificity of 88.7% for the prediction of in-hospital mortality. Patients with higher troponin I-ultra (cTnI-ultra), creatinine kinase-myocardial band (CK-MB), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were associated with higher mortality, compared to those who lower levels. The multivariable cox regression indicated that age (hazard ratio (HR) 3.450, 95% confidence interval (CI) 1.627-7.314, P = 0.001), coronary heart disease (HR 1.855, 95% CI 1.006-3.421; P = 0.048), elevated cTnI-ultra (HR 3.083, 95% CI 1.616-5.883, P = 0.001), elevated CK-MB (HR 2.907, 95% CI 1.233-6.854; P = 0.015), and elevated NT-proBNP (HR 5.776, 95% CI 2.272-14.682; P < 0.001) were associated with in-hospital mortality. CONCLUSIONS:cTnI-ultra might be the best predictor of in-hospital mortality among myocardial injury biomarkers. Elevated cTnI-ultra, CK-MB, and NT-proBNP were independent biomarkers of the mortality in COVID-19 patients.

SUBMITTER: Deng P

PROVIDER: S-EPMC7363604 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

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The diagnostic and prognostic role of myocardial injury biomarkers in hospitalized patients with COVID-19.

Deng Pingji P Ke Zunqiong Z Ying Binwu B Qiao Bin B Yuan Leyong L

Clinica chimica acta; international journal of clinical chemistry 20200716

<h4>Objective</h4>The aim of this study was to systematically and comprehensively evaluate the diagnostic and prognostic value of myocardial injury biomarkers in COVID-19 patients.<h4>Methods</h4>This is a retrospective cohort study of confirmed COVID-19 patients that were admitted to the Renmin Hospital of Wuhan University from January 30, 2020 to February 15, 2020.<h4>Results</h4>Receiver operating characteristic (ROC) curve analysis demonstrated that cTnI-ultra had the highest area under the ...[more]

PMID: 32681933

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Project description:Rationale & objectiveAcute kidney injury (AKI) is common in patients with coronavirus disease 2019 (COVID-19) and associated with poor outcomes. Urinary biomarkers have been associated with adverse kidney outcomes in other settings and may provide additional prognostic information in patients with COVID-19. We investigated the association between urinary biomarkers and adverse kidney outcomes among patients hospitalized with COVID-19.Study designProspective cohort study.Setting & participantsPatients hospitalized with COVID-19 (n=153) at 2 academic medical centers between April and June 2020.Exposure19 urinary biomarkers of injury, inflammation, and repair.OutcomeComposite of KDIGO (Kidney Disease: Improving Global Outcomes) stage 3 AKI, requirement for dialysis, or death within 60 days of hospital admission. We also compared various kidney biomarker levels in the setting of COVID-19 versus other common AKI settings.Analytical approachTime-varying Cox proportional hazards regression to associate biomarker level with composite outcome.ResultsOut of 153 patients, 24 (15.7%) experienced the primary outcome. Twofold higher levels of neutrophil gelatinase-associated lipocalin (NGAL) (HR, 1.34 [95% CI, 1.14-1.57]), monocyte chemoattractant protein (MCP-1) (HR, 1.42 [95% CI, 1.09-1.84]), and kidney injury molecule 1 (KIM-1) (HR, 2.03 [95% CI, 1.38-2.99]) were associated with highest risk of sustaining primary composite outcome. Higher epidermal growth factor (EGF) levels were associated with a lower risk of the primary outcome (HR, 0.61 [95% CI, 0.47-0.79]). Individual biomarkers provided moderate discrimination and biomarker combinations improved discrimination for the primary outcome. The degree of kidney injury by biomarker level in COVID-19 was comparable to other settings of clinical AKI. There was evidence of subclinical AKI in COVID-19 patients based on elevated injury biomarker level in patients without clinical AKI defined by serum creatinine.LimitationsSmall sample size with low number of composite outcome events.ConclusionsUrinary biomarkers are associated with adverse kidney outcomes in patients hospitalized with COVID-19 and may provide valuable information to monitor kidney disease progression and recovery.

Project description:BackgroundMyocardial injury is a prevalent complication observed in patients hospitalized with COVID-19 and is strongly associated with severe illness and in-hospital mortality. However, the long-term consequences of myocardial injury on clinical outcomes remain poorly understood. This study aimed to assess the impact of myocardial injury on both acute-phase and long-term prognosis in COVID-19 patients.MethodsA retrospective, observational study was conducted on all patients who received treatment at the Intensive Care Center for COVID-19 patient, University Medical Center Ho Chi Minh City (UCICC), from August 3rd, 2021, to October 28th, 2021.ResultsA total of 582 patients were enrolled in the study, of which 55.3% were female. The mean age of participants was 63.3 ± 16.2. Out of these patients, 330 cases (56.8%) showed myocardial injury. Compared to patients without myocardial injury, those with myocardial injury were older and had a higher incidence of chronic diseases including hypertension, ischemic heart disease, atrial fibrillation, heart failure, diabetes mellitus, chronic kidney disease. They also presented with more severe respiratory failure upon admission and showed a more pronounced abnormality in inflammation and kidney function tests. Furthermore, the in-hospital mortality rate was significantly higher in the group with myocardial injury (49.7% vs 14.3%, p < 0.001). After adjusting for age, gender, comorbidities, renal function, and disease severity at admission, myocardial injury emerged as an independent risk factor for in-hospital mortality (OR = 3.758, 95% CI 1.854-7.678, p < 0.001). Among successfully discharged COVID-19 patients, the all-cause mortality rate after a median follow-up of 18.4 months was 7.9%. Patients with myocardial injury had a significantly higher long-term mortality rate compared to those without myocardial injury (14.0% vs. 3.2%, p < 0.001). However, multivariable Cox regression analysis did not find myocardial injury to be a significant predictor of long-term mortality (HR = 2.128, 95% CI 0.792-5.712, p = 0.134).ConclusionsMyocardial injury is a common and serious complication in hospitalized COVID-19 patients, associated with increased in-hospital mortality. However, it does not significantly impact long-term mortality in successfully discharged COVID-19 patients.

Project description:Background: Since December 2019, Coronavirus disease 2019 (COVID-19) has emerged as an international pandemic. COVID-19 patients with myocardial injury might need special attention. However, understanding on this aspect remains unclear. This study aimed to illustrate clinical characteristics and the prognostic value of myocardial injury to COVID-19 patients. Methods: This retrospective, single-center study finally included 304 hospitalized COVID-19 cases confirmed by real-time RT-PCR from January 11 to March 25, 2020. Myocardial injury was determined by serum high-sensitivity troponin I (Hs-TnI). The primary endpoint was COVID-19 associated mortality. Results: Of 304 COVID-19 patients (median age, 65 years; 52.6% males), 88 patients (27.3%) died (61 patients with myocardial injury, 27 patients without myocardial injury on admission). COVID-19 patients with myocardial injury had more comorbidities (hypertension, chronic obstructive pulmonary disease, cardiovascular disease, and cerebrovascular disease); lower lymphocyte counts, higher C-reactive protein (CRP, median, 84.9 vs 28.5 mg/L, p<0.001), procalcitonin levels (median, 0.29 vs 0.06 ng/ml, p<0.001), inflammatory and immune response markers; more frequent need for noninvasive ventilation, invasive mechanical ventilation; and was associated with higher mortality incidence (hazard ratio, HR=7.02, 95% confidence interval, CI, 4.45-11.08, p<0.001) than those without myocardial injury. Myocardial injury (HR=4.55, 95% CI, 2.49-8.31, p<0.001), senior age, CRP levels, and novel coronavirus pneumonia (NCP) types on admission were independent predictors to mortality in COVID-19 patients. Conclusions: COVID patients with myocardial injury on admission is associated with more severe clinical presentation and biomarkers. Myocardial injury and higher HsTNI are both strongest independent predictors to COVID related mortality after adjusting confounding factors. In addition, senior age, CRP levels and NCP types are also associated with mortality. Trial registration: Not applicable.

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The diagnostic and prognostic role of myocardial injury biomarkers in hospitalized patients with COVID-19.

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The diagnostic and prognostic role of myocardial injury biomarkers in hospitalized patients with COVID-19.

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