Cardiovascular Biomarkers and COVID-19
- Biomarker measurements on admission in unselected patients with COVID-19 may not be useful in establishing in-hospital prognosis.
- The study has numerous limitations: the small sample size, single-center design, and unselected patients preclude deriving definitive conclusions.
Do C-reactive protein (CRP), lactate dehydrogenase (LDH), high-sensitivity troponin (hs-Tn), N-terminal pro–B-type natriuretic peptide (NT-proBNP), and D-dimer improve prognostication in patients hospitalized with coronavirus disease 2019 (COVID-19)?
In this single-center observational study, CRP, LDH, hs-Tn, NT-proBNP, and D-dimer levels were measured on admission in 131 patients hospitalized with COVID-19 between March 18–May 4. The authors examined the association between the aforementioned biomarkers and the primary composite endpoint of hospital mortality, and the need for mechanical ventilation for ≥24 hours. Risk discrimination ability of the biomarkers was compared to the National Early Warning Score (NEWS).
The mean age of the cohort was 60 years, and included 61% males, and 60% with ≥1 comorbidity, the most prevalent being hypertension (30%). Overall, 40 patients (31%) met the primary endpoint, of whom eight died. Biomarker levels were higher in those who met the primary endpoint compared to those who did not; however, in multivariable analyses, only ferritin and LDH remained independently associated with the outcome. All biomarkers’ risk discrimination ability as assessed by area under the curve were inferior to the NEWS score, and none improved prognostic reclassification when added to the NEWS score.
In this small study of patients hospitalized with COVID-19, CRP, LDH, hs-Tn, and NT-proBNP levels measured on admission did not improve risk discrimination compared to the NEWS score.
Biomarker studies in COVID-19 are challenging to perform and interpret. Patients typically present with various degrees of illness severity; from cough and mild dyspnea to hypoxic respiratory failure and altered mental status. Biomarker levels are inevitably altered in those with clinically more severe disease on admission, lending to an inherent selection bias, amplified by smaller sample sizes of studies. An ideal biomarker study in COVID-19 would select a large sample of patients presenting with similar clinical severity (mild to moderate), in which biomarkers could help with triage. Until such a study is completed, no definite conclusions can be made on the usefulness of biomarkers for triage of COVID-19 patients.
Keywords: Biological Markers, Coronavirus, COVID-19, C-Reactive Protein, Ferritins, Hospital Mortality, Hypertension, L-Lactate Dehydrogenase, Natriuretic Peptide, Brain, Primary Prevention, Respiration, Artificial, severe acute respiratory syndrome coronavirus 2, Triage, Troponin
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