Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, MO, United States.
Core Diagnostics, Abbott Laboratories, Abbott Park, IL, United States.
Clin Biochem. 2022 Sep;107:24-32. doi: 10.1016/j.clinbiochem.2022.06.002. Epub 2022 Jun 9.
Several studies have demonstrated an association between elevated cardiac biomarkers and adverse outcomes in patients with COVID-19. However, the prognostic and predictive capability of a multimarker panel in a prospectively collected, diverse "all-comers" COVID-19 population has not been fully elucidated.
DESIGN & METHODS: We prospectively assessed high sensitivity cardiac troponin I (hsTnI), NT-pro B-type Natriuretic Peptide (NT-proBNP), Galectin-3 (Gal-3), and procalcitonin (PCT) in 4,282 serial samples from 358 patients admitted with symptomatic, RT-PCR confirmed SARS-CoV-2 infection. Outcomes examined were 30-day in-hospital mortality and requirement for intubation within 10 days.
Baseline hsTnI had the highest AUC for predicting 30-day mortality (0.81; 95% CI, 0.73-0.88), followed by NT-proBNP (0.80; 0.74-0.86), PCT (0.77; 0.70-0.84), and Gal-3 (0.68; 0.60-0.76). HsTnI < 3.5 ng/L at baseline identified patients at low risk for in-hospital mortality (NPV 95.9%, sensitivity 97.3%) and 10-day intubation (NPV 90.4%, sensitivity 88.5%). Continuous, log-2 increases in troponin concentration were associated with reduced survival (p < 0.001) on Kaplan-Meier curves and increased risk of 30-day mortality: HR 1.26 (1.16-1.37) in univariate and 1.19 (1.03-1.4) in multivariate models. Time-varying doubling of concentrations of hsTnI and Gal-3 were associated with increased risk of 30-day mortality (adjusted HR 1.21, 1.06-1.4, and 1.92, 1.40-2.6).
HsTnI, NT-proBNP, Gal-3, and PCT are elevated at baseline in patients that have worse outcomes from COVID-19. HsTnI was the only independent predictor of 30-day mortality and intubation. Time-varying, doubling in hsTnI and Gal-3 further aided in prognostication of adverse outcomes. These results support the use of hsTnI for triaging patients with COVID-19.
多项研究表明，COVID-19 患者中心脏生物标志物升高与不良结局相关。然而，在前瞻性收集的、多样化的“所有患者”COVID-19 人群中，多标志物组合对预后和预测能力尚未完全阐明。
我们前瞻性评估了高敏肌钙蛋白 I（hsTnI）、氨基末端 B 型利钠肽前体（NT-proBNP）、半乳糖凝集素-3（Gal-3）和降钙素原（PCT）在 358 例因有症状、经 RT-PCR 证实的 SARS-CoV-2 感染而入院的患者的 4282 份连续样本中的变化。观察的结局是 30 天住院死亡率和 10 天内需要插管。
基线 hsTnI 对预测 30 天死亡率的 AUC 最高（0.81；95%CI，0.73-0.88），其次是 NT-proBNP（0.80；0.74-0.86）、PCT（0.77；0.70-0.84）和 Gal-3（0.68；0.60-0.76）。基线 hsTnI<3.5ng/L 可识别出住院死亡率低的患者（NPV 95.9%，敏感性 97.3%）和 10 天内插管的患者（NPV 90.4%，敏感性 88.5%）。肌钙蛋白浓度的连续对数 2 增加与生存降低相关（p<0.001），并增加 30 天死亡率的风险：在单变量和多变量模型中，HR 分别为 1.26（1.16-1.37）和 1.19（1.03-1.4）。hsTnI 和 Gal-3 浓度的时间变化倍增与 30 天死亡率的增加相关（调整后的 HR 分别为 1.21、1.06-1.4 和 1.92、1.40-2.6）。
在 COVID-19 预后较差的患者中，hsTnI、NT-proBNP、Gal-3 和 PCT 在基线时升高。hsTnI 是 30 天死亡率和插管的唯一独立预测因子。hsTnI 和 Gal-3 的时间变化倍增进一步有助于预测不良结局。这些结果支持使用 hsTnI 对 COVID-19 患者进行分诊。
