Center for Environment and Health in Water Source Area of South-to-North Water Diversion, Hubei University of Medicine, Shiyan 442000, Hubei, China; School of Public Health and Management, Hubei University of Medicine, Shiyan 442000, Hubei, China.
Department of Pharmacy, Renmin Hospital, Hubei University of Medicine, Shiyan 442000, Hubei, China.
Clin Chim Acta. 2020 Nov;510:186-190. doi: 10.1016/j.cca.2020.07.018. Epub 2020 Jul 16.
The aim of this study was to systematically and comprehensively evaluate the diagnostic and prognostic value of myocardial injury biomarkers in COVID-19 patients.
This is a retrospective cohort study of confirmed COVID-19 patients that were admitted to the Renmin Hospital of Wuhan University from January 30, 2020 to February 15, 2020.
Receiver operating characteristic (ROC) curve analysis demonstrated that cTnI-ultra had the highest area under the curve (AUC) at 0.855, with a sensitivity of 67.3% and a specificity of 88.7% for the prediction of in-hospital mortality. Patients with higher troponin I-ultra (cTnI-ultra), creatinine kinase-myocardial band (CK-MB), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were associated with higher mortality, compared to those who lower levels. The multivariable cox regression indicated that age (hazard ratio (HR) 3.450, 95% confidence interval (CI) 1.627-7.314, P = 0.001), coronary heart disease (HR 1.855, 95% CI 1.006-3.421; P = 0.048), elevated cTnI-ultra (HR 3.083, 95% CI 1.616-5.883, P = 0.001), elevated CK-MB (HR 2.907, 95% CI 1.233-6.854; P = 0.015), and elevated NT-proBNP (HR 5.776, 95% CI 2.272-14.682; P < 0.001) were associated with in-hospital mortality.
cTnI-ultra might be the best predictor of in-hospital mortality among myocardial injury biomarkers. Elevated cTnI-ultra, CK-MB, and NT-proBNP were independent biomarkers of the mortality in COVID-19 patients.
本研究旨在系统全面地评估心肌损伤生物标志物在 COVID-19 患者中的诊断和预后价值。
这是一项回顾性队列研究，纳入了 2020 年 1 月 30 日至 2 月 15 日期间入住武汉大学人民医院的确诊 COVID-19 患者。
接受者操作特征（ROC）曲线分析表明，cTnI-ultra 的曲线下面积（AUC）最高，为 0.855，预测住院死亡率的敏感性为 67.3%，特异性为 88.7%。与低水平组相比，肌钙蛋白 I 超敏（cTnI-ultra）、肌酸激酶同工酶-心肌带（CK-MB）和 N 末端 pro-B 型利钠肽（NT-proBNP）水平较高的患者死亡率更高。多变量 Cox 回归表明，年龄（危险比（HR）3.450，95%置信区间（CI）1.627-7.314，P=0.001）、冠心病（HR 1.855，95%CI 1.006-3.421；P=0.048）、cTnI-ultra 升高（HR 3.083，95%CI 1.616-5.883，P=0.001）、CK-MB 升高（HR 2.907，95%CI 1.233-6.854；P=0.015）和 NT-proBNP 升高（HR 5.776，95%CI 2.272-14.682；P<0.001）与住院死亡率相关。
cTnI-ultra 可能是心肌损伤生物标志物中预测住院死亡率的最佳指标。cTnI-ultra、CK-MB 和 NT-proBNP 升高是 COVID-19 患者死亡的独立生物标志物。
