key: cord-0889394-6p7k4g3x
authors: Su, Minghua; Wang, Yichao; Peng, Jieru; Wu, Meng-Jun; Deng, Wuquan; Yang, You-Sheng
title: Elevated cardiac biomarkers are associated with increased mortality for inpatients with COVID-19: A retrospective case-control study
date: 2020-05-20
journal: J Clin Anesth
DOI: 10.1016/j.jclinane.2020.109894
sha: e845f7beb65d9b6ca63e6ed9df3bcd9826b9d4ca
doc_id: 889394
cord_uid: 6p7k4g3x

nan

J o u r n a l P r e -p r o o f myoglobin, and Troponin I. For every increase of 112 in serum myoglobin levels, mortality increased by 3.15% in generalized estimation equation analysis. A receiver operating characteristic (ROC) curve analysis showed that the optimal myoglobin cut-off value was 306.5 μg/L (Youden's index=0.426). The area under the ROC curve was 0.81 (95%CI: 0.68-0.95, p=0.003). The sensitivity was 60.6% while specificity was 82% (Fig. 1) . In the subgroup analyses, the values of cardiac biomarkers in elderly subjects (>65 years) with cardiovascular disease were significantly higher than ones in elderly without cardiovascular disease and young patients. In the early period, serum levels of myoglobin and CK-MB had a strong negative correlation with hs-CRP.

In the later period, these biomarkers had a moderate positive correlation.

To our knowledge, this is the first study to report the association between serum myoglobin and mortality in non-survivors with NCIP. Our results indicated that an elevated serum concentration of myoglobin (≥306.5μg/L) was associated with an increased risk of hospitalization mortality in non-survivors, independent of elevation in CK-MB and Troponin I. We found that cut-off (≥306.5μg/L) of myoglobin was high. In the context of 2019-nCOV, the deceased with NCIP usually had concurrent refractory hypoxia, hypotension and reduced renal perfusion, which may result in increased skeletal muscle and heart release of myoglobin. 5 Particularly, elderly (>65years) non-survivor patients with cardiovascular diseases had more severe cardiac injury. Accordingly, we suggest that: firstly, in addition to the protection of the lungs first, the time window of therapeutic interventions about cardiac injury should be as early as possible for severe patients; secondly, inflammatory factor release should be blocked early, especially in elderly (>65 years) patients with cardiovascular diseases.

In conclusion, our study provides important documentation that in this single-center, an elevated serum concentration of myoglobin (≥306.5μg/L) is associated with an increased risk of hospitalization mortality in non-survivor with NCIP, independent of elevation in CK-MB and Troponin I levels.

Journal Pre-proof

A Novel Coronavirus from Patients with Pneumonia in China

Emerging understandings of 2019-nCoV

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