The Prognostic Value of Cardiac Biomarkers and Echocardiography in Critical COVID-19

Background: Early risk stratification is crucial in critically ill COVID-19 patients. Myocardial injury is associated with worse outcome. This study aimed to evaluate cardiac biomarkers and echocardiographic findings in critically ill COVID-19 patients and to assess their association with 30-day mor...

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Autores principales:	Bert Zwaenepoel, Sebastiaan Dhont, Eric Hoste, Sofie Gevaert, Hannah Schaubroeck
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	COVID-19 hs-cTnT NT-proBNP ICU myocardial injury myocardial biomarker Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/042c293720554194a9fe776a38e3ed9c
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spelling	oai:doaj.org-article:042c293720554194a9fe776a38e3ed9c2021-11-05T09:05:55ZThe Prognostic Value of Cardiac Biomarkers and Echocardiography in Critical COVID-192297-055X10.3389/fcvm.2021.752237https://doaj.org/article/042c293720554194a9fe776a38e3ed9c2021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fcvm.2021.752237/fullhttps://doaj.org/toc/2297-055XBackground: Early risk stratification is crucial in critically ill COVID-19 patients. Myocardial injury is associated with worse outcome. This study aimed to evaluate cardiac biomarkers and echocardiographic findings in critically ill COVID-19 patients and to assess their association with 30-day mortality in comparison to other biomarkers, risk factors and clinical severity scores.Methods: Prospective, single-center, cohort study in patients with PCR-confirmed, critical COVID-19. Laboratory assessment included high sensitive troponin T (hs-cTnT) and N-terminal pro-brain natriuretic peptide (NT-proBNP) on admission to ICU: a hs-cTnT ≥ 14 pg/mL and a NT-proBNP ≥ 450 pg/mL were considered as elevated. Transthoracic echocardiographic evaluation was performed within the first 48 h of ICU admission. The primary outcome was 30-day all-cause mortality. Predictive markers for mortality were assessed by ROC analysis and cut-off values by the Youden Index.Results: A total of 100 patients were included. The median age was 63.5 years, the population was predominantly male (66%). At the time of ICU admission, 47% of patients had elevated hs-cTnT and 39% had elevated NT-proBNP. Left ventricular ejection fraction was below 50% in 19.1%. Elevated cardiac biomarkers (hs-cTnT P-value < 0.001, NT-proBNP P-value = 0.001) and impaired left ventricular function (P-value = 0.011) were significantly associated with mortality, while other biomarkers (D-dimer, ferritin, C-reactive protein) and clinical scores (SOFA) did not differ significantly between survivors and non-survivors. An optimal cut-off value to predict increased risk for 30-day all-cause mortality was 16.5 pg/mL for hs-cTnT (OR 8.5, 95% CI: 2.9, 25.0) and 415.5 pg/ml for NT-proBNP (OR 5.1, 95% CI: 1.8, 14.7).Conclusion: Myocardial injury in COVID-19 is common. Early detection of elevated hs-cTnT and NT-proBNP are predictive for 30-day mortality in patients with critical COVID-19. These markers outperform other routinely used biomarkers, as well as clinical indices of disease severity in ICU. The additive value of routine transthoracic echocardiography is disputable and should only be considered if it is likely to impact therapeutic management.Bert ZwaenepoelSebastiaan DhontEric HosteEric HosteSofie GevaertHannah SchaubroeckFrontiers Media S.A.articleCOVID-19hs-cTnTNT-proBNPICUmyocardial injurymyocardial biomarkerDiseases of the circulatory (Cardiovascular) systemRC666-701ENFrontiers in Cardiovascular Medicine, Vol 8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	COVID-19 hs-cTnT NT-proBNP ICU myocardial injury myocardial biomarker Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	COVID-19 hs-cTnT NT-proBNP ICU myocardial injury myocardial biomarker Diseases of the circulatory (Cardiovascular) system RC666-701 Bert Zwaenepoel Sebastiaan Dhont Eric Hoste Eric Hoste Sofie Gevaert Hannah Schaubroeck The Prognostic Value of Cardiac Biomarkers and Echocardiography in Critical COVID-19
description	Background: Early risk stratification is crucial in critically ill COVID-19 patients. Myocardial injury is associated with worse outcome. This study aimed to evaluate cardiac biomarkers and echocardiographic findings in critically ill COVID-19 patients and to assess their association with 30-day mortality in comparison to other biomarkers, risk factors and clinical severity scores.Methods: Prospective, single-center, cohort study in patients with PCR-confirmed, critical COVID-19. Laboratory assessment included high sensitive troponin T (hs-cTnT) and N-terminal pro-brain natriuretic peptide (NT-proBNP) on admission to ICU: a hs-cTnT ≥ 14 pg/mL and a NT-proBNP ≥ 450 pg/mL were considered as elevated. Transthoracic echocardiographic evaluation was performed within the first 48 h of ICU admission. The primary outcome was 30-day all-cause mortality. Predictive markers for mortality were assessed by ROC analysis and cut-off values by the Youden Index.Results: A total of 100 patients were included. The median age was 63.5 years, the population was predominantly male (66%). At the time of ICU admission, 47% of patients had elevated hs-cTnT and 39% had elevated NT-proBNP. Left ventricular ejection fraction was below 50% in 19.1%. Elevated cardiac biomarkers (hs-cTnT P-value < 0.001, NT-proBNP P-value = 0.001) and impaired left ventricular function (P-value = 0.011) were significantly associated with mortality, while other biomarkers (D-dimer, ferritin, C-reactive protein) and clinical scores (SOFA) did not differ significantly between survivors and non-survivors. An optimal cut-off value to predict increased risk for 30-day all-cause mortality was 16.5 pg/mL for hs-cTnT (OR 8.5, 95% CI: 2.9, 25.0) and 415.5 pg/ml for NT-proBNP (OR 5.1, 95% CI: 1.8, 14.7).Conclusion: Myocardial injury in COVID-19 is common. Early detection of elevated hs-cTnT and NT-proBNP are predictive for 30-day mortality in patients with critical COVID-19. These markers outperform other routinely used biomarkers, as well as clinical indices of disease severity in ICU. The additive value of routine transthoracic echocardiography is disputable and should only be considered if it is likely to impact therapeutic management.
format	article
author	Bert Zwaenepoel Sebastiaan Dhont Eric Hoste Eric Hoste Sofie Gevaert Hannah Schaubroeck
author_facet	Bert Zwaenepoel Sebastiaan Dhont Eric Hoste Eric Hoste Sofie Gevaert Hannah Schaubroeck
author_sort	Bert Zwaenepoel
title	The Prognostic Value of Cardiac Biomarkers and Echocardiography in Critical COVID-19
title_short	The Prognostic Value of Cardiac Biomarkers and Echocardiography in Critical COVID-19
title_full	The Prognostic Value of Cardiac Biomarkers and Echocardiography in Critical COVID-19
title_fullStr	The Prognostic Value of Cardiac Biomarkers and Echocardiography in Critical COVID-19
title_full_unstemmed	The Prognostic Value of Cardiac Biomarkers and Echocardiography in Critical COVID-19
title_sort	prognostic value of cardiac biomarkers and echocardiography in critical covid-19
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/042c293720554194a9fe776a38e3ed9c
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The Prognostic Value of Cardiac Biomarkers and Echocardiography in Critical COVID-19

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