Markers of myocardial injury in the prediction of short-term COVID-19 prognosis

Introduction and objectives: COVID-19 is currently causing high mortality and morbidity worldwide Information on cardiac injury is scarce We aimed to evaluate cardiovascular damage in patients with COVID-19 and determine the correlation of high-sensitivity cardiac-specific troponin T (hs-cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) with the severity of COVID-19 Methods: We included 872 consecutive patients with confirmed COVID-19 from February to April 2020 We tested 651 patients for high-sensitivity troponin T (hs-TnT) and 506 for NT-proBNP on admission Cardiac injury was defined as hs-TnT  > 14ng/L, the upper 99th percentile Levels of NT-proBNP  > 300 pg/mL were considered related to some extent of cardiac injury The primary composite endpoint was 30-day mortality or mechanical ventilation (MV) Results: Cardiac injury by hs-TnT was observed in 34 6% of our COVID-19 patients Mortality or MV were higher in cardiac injury than noncardiac injury patients (39 1% vs 9 1%) Hs-TnT and NT-proBNP levels were independent predictors of death or MV (HR, 2 18;95%CI, 1 23-3 83 and 1 87 (95%CI, 1 05-3 36), respectively) and of mortality alone (HR, 2 91;95%CI, 1 211-7 04 and 5 47;95%CI, 2 10-14 26, respectively) NT-ProBNP significantly improved the troponin model discrimination of mortality or MV (C-index 0 83 to 0 84), and of mortality alone (C-index 0 85 to 0 87) Conclusions: Myocardial injury measured at admission was a common finding in patients with COVID-19 It reliably predicted the occurrence of mortality and need of MV, the most severe complications of the disease NT-proBNP improved the prognostic accuracy of hs-TnT RESUMEN Introduccion y objetivos: La informacion sobre el dano miocardico en la poblacion con COVID-19 es muy escasa Nuestro objetivo es evaluar el dano cardiaco en pacientes con COVID-19 y determinar la correlacion entre las concentraciones de troponina T ultrasensible (TnT-us) y fraccion aminoterminal del propeptido natriuretico cerebral (NT-proBNP) con la gravedad del COVID-19 Metodos: Se incluyo a 872 pacientes consecutivos con COVID-19 confirmada desde febrero a abril de 2020 Se determino al ingreso la TnT-us a 651 pacientes y la NT-proBNP a 506 El dano miocardico se definio como una TnT-us > 14 ng/l, > percentil 99 La cifras de NT-proBNP > 300 pg/ml se consideraron relacionadas con dano miocardico El objetivo primario es muerte o ventilacion mecanica (VM) a 30 dias Resultados: Se observo dano miocardico segun la TnT-us en el 34,6% Las tasas del evento muerte o VM fue superior en los pacientes con dano miocardico (el 39,1 frente al 9,1%) Los valores de TnT-us y NT-proBNP fueron predictores independientes de muerte o VM (HR = 2,18;IC95%, 1,23-3,83, y HR = 1,87;IC95%, 1,05-3,36), y de mortalidad total (HR = 2,91;IC95%, 1,211-7,04, y HR = 5,47;IC95%, 2,10-14,26) Se observo que la NT-proBNP mejoro de manera significativa el modelo predictivo de la troponina para muerte o VM (estadistico C, 0,83-0,84) y mortalidad total (estadistico C, 0,85-0,87) Conclusiones: El dano miocardico analizado al ingreso se observo con frecuencia entre los pacientes con COVID-19 y es un potente predictor de muerte y necesidad de VM La NT-proBNP mejoro la precision pronostica de la determinacion de troponina