Abstract
Background The independent prognostic value of troponin and other biomarker elevation among patients with coronavirus disease 2019 (COVID-19) are unclear. We sought to characterize biomarker levels in patients hospitalized with COVID-19 and develop and validate a mortality risk score. Methods and Results An observational cohort study of 1053 patients with COVID-19 was conducted. Patients with all of the following biomarkers measured-troponin-I, B-type natriuretic peptide, C-reactive protein, ferritin, and d-dimer (n=446) -were identified. Maximum levels for each biomarker were recorded. The primary end point was 30-day in-hospital mortality. Multivariable logistic regression was used to construct a mortality risk score. Validation of the risk score was performed using an independent patient cohort (n=440). Mean age of patients was 65.0±15.2 years and 65.3% were men. Overall, 444 (99.6%) had elevation of any biomarker. Among tested biomarkers, troponin-I ≥0.34 ng/mL was the only independent predictor of 30-day mortality (adjusted odds ratio, 4.38; P <0.001). Patients with a mortality score using hypoxia on presentation, age, and troponin-I elevation, age (HA 2 T 2 ) ≥3 had a 30-day mortality of 43.7% while those with a score <3 had mortality of 5.9%. Area under the receiver operating characteristic curve of the HA 2 T 2 score was 0.834 for the derivation cohort and 0.784 for the validation cohort. Conclusions Elevated troponin and other biomarker levels are commonly seen in patients hospitalized with COVID-19. High troponin levels are a potent predictor of 30-day in-hospital mortality. A simple risk score can stratify patients at risk for COVID-19-associated mortality.
Keywords: COVID‐19; biomarkers; mortality; troponin.
【저자키워드】 Biomarkers, Mortality, troponin, COVID‐19, 【초록키워드】 COVID-19, coronavirus disease, Coronavirus disease 2019, Biomarker, Biomarkers, hypoxia, peptide, C-reactive protein, risk, D-dimer, troponin, ferritin, Cohort, validation, Patient, Logistic regression, age, characteristic, in-hospital mortality, 30-Day mortality, mortality risk, receiver operating characteristic, Observational cohort study, Prognostic value, adjusted odds ratio, multivariable logistic regression, dimer, Elevation, Troponin-I, maximum, primary end point, validation cohort, receiver, patient cohort, men, independent, Result, tested, was used, develop, conducted, was performed, Area, were recorded, patients hospitalized, patients with COVID-19, troponin level, with COVID-19, 【제목키워드】 COVID-19, validation, Other, score, derivation, Level,