Multi-marker risk assessment in patients hospitalized with coronavirus disease-2019: Results from the American heart association covid-19 cardiovascular disease registry

ABSTRACT

Introduction: The pathobiology of inflammation, thrombosis, and myocardial injury associated with SARS-CoV2 may be assessed by circulating biomarkers. However, their relative prognostic importance has been incompletely described. Methods: We analyzed data from pts hospitalized with COVID-19 in Jan to Nov, 2020 at 107 US hospitals in the AHA COVID-19 Cardiovascular (CV) Disease Registry who had biomarker data for D-Dimer, CRP, ferritin, natriuretic peptides [NP], or cTn at admission. We assessed the association between each biomarker by quintile [Q] and odds of in-hospital death and a composite of CV death, myocarditis, AMI, HF, or ischemic stroke. cTn quintiles were indexed to the assay-specific 99 %ile ref limits. Multivariable logistic regression determined the relative prognostic performance of each biomarker. Results: 17,829 (83% of total) had admission values reported for at least 1 of the 5 key biomarkers (n= 2422 with values for all). Each biomarker revealed a gradient of mortality risk from Q1 to Q5 Ddimer 17-35%, CRP 11-30%, ferritin 11-29%, cTn 13-42%, and NPs 7-35% (p for each <0.001;Panel A). After adjustment for all biomarkers, the highest values (Q5) of NP, CRP, and cTn independently identified pts at greater odds of death (Panel B) and the highest values of NP, CRP, cTn and D-dimer identified greater odds of the CV composite. After further adjustment for clinical variables, Q5 values for NPs (OR4.07, 95% CI 2.40 to 6.92) and CRP (OR 2.43, 95% CI1.62 to 3.66) retained the strongest prognostic value for death;NP (OR6.79, 95% CI 3.56 to 12.94) and cTn (OR4.44, 95% CI2.75 to 7.18) were associated with the greatest odds of the CV composite. Conclusions: Among pts hospitalized with COVID-19, high levels of NPs, CRP and hsTn at the time of admission were associated with the greatest risk of death, independent of other biomarkers and clinical variables, whereas D-dimer and ferritin did not offer independent prognostic information for mortality.