key: cord-0707598-otc0tywl
authors: Omland, Torbjørn; Prebensen, Christian; Røysland, Ragnhild; Søvik, Signe; Sørensen, Vibecke; Røsjø, Helge; Svensson, My; Berdal, Jan Erik; Myhre, Peder L.
title: Established Cardiovascular Biomarkers Provide Limited Prognostic Information in Unselected Patients Hospitalized With COVID-19
date: 2020-09-10
journal: Circulation
DOI: 10.1161/circulationaha.120.050089
sha: b35bb1ba624ac021da299b416692b855fc531226
doc_id: 707598
cord_uid: otc0tywl

nan

Circulation. 2020;142:1878-1880. DOI: 10.1161/CIRCULATIONAHA.120.050089

November 10, 2020 1879 CORRESPONDENCE and had a comparable comorbidity burden (66% versus 54%; P=0.18) to non-Whites. Time from symptom start to hospitalization was 9.4±4.5 days; 106 (81%) patients had a fever, 106 (81%) had cough, and 94 (72%) had dyspnea. Admission body temperature was 38.0±0.9 °C, respiratory rate was 27±9/min, systolic blood pressure was 132±18 mm Hg, and oxygen saturation was 93±6%.

Forty patients (31%) reached the primary end point, of whom 36 were admitted to the intensive care unit (34 were treated with invasive mechanical ventilation) and 8 died. NEWS score at admission, white blood cell count, C-reactive protein, ferritin, lactate dehydrogenase, D-dimer, N-terminal pro-B-type natriuretic peptide, and high-sensitivity cardiac troponin T were higher among patients reaching the primary end point (Table) . However, after adjusting for demographics (model 1), this association was attenuated for the cardiovascular biomarkers D-dimer, N-terminal pro-B-type natriuretic peptide, and high-sensitivity cardiac troponin T. In models additionally adjusting for CVD, body mass index, estimated glomerular filtration rate, and symptom duration (model 2) and NEWS score (model 3), only ferritin and lactate dehydrogenase remained associated with the primary end point. The areas under the receiver operating curve of all biomarkers for the primary end point were inferior to the NEWS score. No biomarker improved prognostic reclassification of patients if added to the NEWS score. Similar results were found when assessing in-hospital mortality: unadjusted associations between outcome and D-dimer (P=0.01), N-terminal pro-B-type natriuretic peptide (P=0.016), and high-sensitivity cardiac troponin T (P<0.001) were attenuated when adjusting for demographics (P=0.11, P=0.28, and P=0.57, respectively).

In our prospective study of unselected patients hospitalized with COVID-19, measurements of established cardiovascular biomarkers at admission did not provide prognostic information beyond that obtained from clinical characteristics and NEWS. Higher concentrations of ferritin and lactate dehydrogenase were associated with poor outcome, but were inferior to NEWS as discriminators for the primary end point. Although cardiovascular biomarker levels were higher among patients in the intensive care unit and nonsurvivors, this difference did not persist when accounting for clinical characteristics. These findings are in contrast with retrospective reports from China. [1] [2] [3] [4] The discrepancies may relate to differences in trial design. If baseline risk influences the indication for measuring biomarkers, selection bias is introduced. In addition, we measured troponin by a high-sensitivity assay as a continuous variable, which allowed precise quantification of concentrations within the normal range. This provides a more comprehensive assessment of myocardial injury than conventional assays and the use of arbitrary cutoffs. Our study had limited sample size, it might suffer from type 2 errors, and we did not adjust Concentrations are reported as median (Q1, Q3). All biomarker values were log-transformed in the adjusted regression models. Model 1 is adjusted for age, sex, and race. Model 2 is adjusted for model 1 plus body mass index, cardiovascular disease, estimated glomerular filtration rate at admission and symptom duration. Model 3 is adjusted for model 2 plus the National Early Warning Score. for multiple testing. We only evaluated admission biomarker levels and did not assess their diagnostic value. In conclusion, our findings do not support routine measurements of cardiovascular and inflammatory biomarkers on admission for prognostic purposes in patients hospitalized for COVID-19.

This manuscript was sent to Prof Allan S. Jaffe, Guest Editor, for review by expert referees, editorial decision, and final disposition. 

China Medical Treatment Expert Group for Covid-19. Clinical characteristics of coronavirus disease 2019 in China

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China

Acute myocardial injury at hospital admission is associated with all-cause mortality in COVID-19

National Early Warning Score (NEWS) 2. December 19

We are grateful for the invaluable contributions by study biochemists S. Navaruban and A. Meklif, and study nurses J. Dokken and A. Abueg. We also thank H. Husby and the Unit of Data Analysis at Akershus University Hospital, Lørenskog, Norway, for help with clinical data acquisition from the data warehouse at Akershus University Hospital.

Dr Myhre is supported by grants from the South-Eastern Norway Regional Health Authority.

Dr Omland has served on advisory boards for Abbott Diagnostics, Roche Diagnostics, and Bayer, and has received research support from Abbott Diagnostics, Novartis, Roche Diagnostics, Singulex, and SomaLogic via Akershus University Hospital, and speaker's or consulting honoraria from Roche Diagnostics, Siemens Healthineers, and CardiNor. Dr Røsjø has received personal fees from Novartis and Thermo Fischer BRAMS, CardiNor, and SpinChip Diagnostics. Dr Myhre has served on advisory boards for Novartis and Novo Nordisk, and has received consulting honoraria from Novartis, AmGen, and Novo Nordisk. All other authors report no relevant disclosures.