Cardiac biomarkers on admission and in‑hospital mortality in COVID‑19 patients with or without concomitant heart failure

Abstract

INTROduCTION High-sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro–B-type natriuretic peptide (NT-proBNP) are known markers of cardiac injury. However, their role in predicting the severity of COVID-19 remains to be investigated. ObjECTIvEs We aimed to analyze the association between hs-cTnT and NT-proBNP levels and in-hospital mortality in patients with COVID-19, with emphasis on those with concomitant chronic heart failure (CHF). PATIENTs ANd mEThOds A total of 1729 consecutive patients with COVID-19 were enrolled. Demographic data, laboratory parameters, and clinical outcomes (discharge or death) were analyzed. Receiver operating characteristic (ROC) and logistic regression analyses were performed to evaluate the association between hs-cTnT and NT-proBNP values and the risk of death. REsuLTs Evaluation of hs-cTnT was performed in 1041 patients, while NT-proBNP was assessed in 715 individuals. CHF was present in 179 cases (10.4% of the cohort). Median values of hs-cTnT and NT-proBNP and in-hospital mortality were higher in CHF patients than in those without CHF. Among patients without CHF, mortality was the highest in those with hs-cTnT or NT-proBNP values in the fourth quartile. In ROC analysis, hs-cTnT equal to or above 142 ng/l and NT-proBNP equal to or above 969 pg/ml predicted in-hospital death. In patients without CHF, each 10-ng/l increase in hs-cTnT or 100-pg/ml increase in NT-proBNP was associated with a higher risk of death (odds ratio [OR], 1.01 and OR, 1.02, respectively; P <0.01 for both). CONCLusIONs The level of hs-cTnT or NT-proBNP predicts in-hospital mortality in COVID-19 patients. Both hs-cTnT and NT-proBNP should be routinely measured on admission in all patients hospitalized due to COVID-19 for early detection of individuals with an increased risk of in-hospital death, even if they do not have concomitant heart failure.