Cardiology Unit, Cardiovascular Department, Papa Giovanni XXIII Hospital-Bergamo, Bergamo, Italy.
Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
Am J Cardiol. 2022 Mar 15;167:125-132. doi: 10.1016/j.amjcard.2021.11.054. Epub 2022 Jan 19.
Data concerning the combined prognostic role of natriuretic peptide (NP) and troponin in patients with COVID-19 are lacking. The aim of the study is to evaluate the combined prognostic value of NPs and troponin in hospitalized COVID-19 patients. From March 1, 2020 to April 9, 2020, consecutive patients with COVID-19 and available data on cardiac biomarkers at admission were recruited. Patients admitted for acute coronary syndrome were excluded. Troponin levels were defined as elevated when greater than the 99 percentile of normal values. NPs were considered elevated if above the limit for ruling in acute heart failure (HF). A total of 341 patients were included in this study, mean age 68 ± 13 years, 72% were men. During a median follow-up period of 14 days, 81 patients (24%) died. In the Cox regression analysis, patients with elevated both NPs and troponin levels had higher risk of death compared with those with normal levels of both (hazard ratio 2.94; 95% confidence interval 1.31 to 6.64; p = 0.009), and this remained significant after adjustment for age, gender, oxygen saturation, HF history, and chronic kidney disease. Interestingly, NPs provided risk stratification also in patients with normal troponin values (hazard ratio 2.86; 95% confidence interval 1.21 to 6.72; p = 0.016 with high NPs levels). These data show the combined prognostic role of troponin and NPs in COVID-19 patients. NPs value may be helpful in identifying patients with a worse prognosis among those with normal troponin values. Further, NPs' cut-point used for diagnosis of acute HF has a predictive role in patients with COVID-19.
关于新冠肺炎患者中心钠肽（NP）和肌钙蛋白联合预后作用的数据尚缺乏。本研究旨在评估 NP 和肌钙蛋白联合在住院新冠肺炎患者中的预后价值。2020 年 3 月 1 日至 2020 年 4 月 9 日，连续招募了有心脏生物标志物入院数据的新冠肺炎患者。排除了因急性冠状动脉综合征而入院的患者。当肌钙蛋白水平大于正常值的第 99 百分位数时，定义为升高。如果 NP 值高于急性心力衰竭（HF）的诊断界值，则认为 NP 值升高。本研究共纳入 341 例患者，平均年龄 68 ± 13 岁，72%为男性。中位随访 14 天期间，81 例（24%）患者死亡。在 Cox 回归分析中，NP 和肌钙蛋白水平均升高的患者与 NP 和肌钙蛋白水平均正常的患者相比，死亡风险更高（危险比 2.94；95%置信区间 1.31 至 6.64；p = 0.009），且在调整年龄、性别、血氧饱和度、HF 病史和慢性肾脏病后仍有意义。有趣的是，NP 还可以对肌钙蛋白正常的患者进行风险分层（危险比 2.86；95%置信区间 1.21 至 6.72；p = 0.016，NP 值高）。这些数据显示了肌钙蛋白和 NP 在新冠肺炎患者中的联合预后作用。在肌钙蛋白正常的患者中，NP 值可能有助于识别预后较差的患者。此外，NP 用于诊断急性 HF 的界值对新冠肺炎患者具有预测作用。
