Supplemental Digital Content is available in the text. The prognostic power of circulating cardiac biomarkers, their utility, and pattern of release in coronavirus disease 2019 (COVID-19) patients have not been clearly defined. In this multicentered retrospective study, we enrolled 3219 patients with diagnosed COVID-19 admitted to 9 hospitals from December 31, 2019 to March 4, 2020, to estimate the associations and prognostic power of circulating cardiac injury markers with the poor outcomes of COVID-19. In the mixed-effects Cox model, after adjusting for age, sex, and comorbidities, the adjusted hazard ratio of 28-day mortality for hs-cTnI (high-sensitivity cardiac troponin I) was 7.12 ([95% CI, 4.60–11.03] P <0.001), (NT-pro)BNP (N-terminal pro-B-type natriuretic peptide or brain natriuretic peptide) was 5.11 ([95% CI, 3.50–7.47] P <0.001), CK (creatine phosphokinase)-MB was 4.86 ([95% CI, 3.33–7.09] P <0.001), MYO (myoglobin) was 4.50 ([95% CI, 3.18–6.36] P <0.001), and CK was 3.56 ([95% CI, 2.53–5.02] P <0.001). The cutoffs of those cardiac biomarkers for effective prognosis of 28-day mortality of COVID-19 were found to be much lower than for regular heart disease at about 19%–50% of the currently recommended thresholds. Patients with elevated cardiac injury markers above the newly established cutoffs were associated with significantly increased risk of COVID-19 death. In conclusion, cardiac biomarker elevations are significantly associated with 28-day death in patients with COVID-19. The prognostic cutoff values of these biomarkers might be much lower than the current reference standards. These findings can assist in better management of COVID-19 patients to improve outcomes. Importantly, the newly established cutoff levels of COVID-19–associated cardiac biomarkers may serve as useful criteria for the future prospective studies and clinical trials.
【저자키워드】 Biomarkers, Mortality, Prognosis, Heart diseases, heart injuries, 【초록키워드】 COVID-19, coronavirus disease, Biomarker, hospital, Prospective Study, Comorbidities, 28-day mortality, peptide, clinical trials, Sex, outcome, Brain, cardiac troponin, outcomes, Retrospective study, management, Patient, Digital, death, age, prognostic, utility, disease, association, Myoglobin, COVID-19 patient, criteria, adjusted hazard ratio, Elevation, Cutoff, circulating, content, cutoff value, thresholds, N-terminal, risk of COVID-19, effective, Cox model, significantly increased, IMPROVE, enrolled, defined, significantly, diagnosed, elevated, assist, much lower, cardiac injury marker, patients with COVID-19, pro-B-type natriuretic peptide, 【제목키워드】 COVID-19, cardiac, Inpatient,