Supplemental Digital Content is available in the text. The prognostic power of circulating cardiac biomarkers, their utility, and pattern of release in coronavirus disease 2019 (COVID-19) patients have not been clearly defined. In this multicentered retrospective study, we enrolled 3219 patients with diagnosed COVID-19 admitted to 9 hospitals from December 31, 2019 to March 4, 2020, to estimate the associations and prognostic power of circulating cardiac injury markers with the poor outcomes of COVID-19. In the mixed-effects Cox model, after adjusting for age, sex, and comorbidities, the adjusted hazard ratio of 28-day mortality for hs-cTnI (high-sensitivity cardiac troponin I) was 7.12 ([95% CI, 4.60–11.03] P<0.001), (NT-pro)BNP (N-terminal pro-B-type natriuretic peptide or brain natriuretic peptide) was 5.11 ([95% CI, 3.50–7.47] P<0.001), CK (creatine phosphokinase)-MB was 4.86 ([95% CI, 3.33–7.09] P<0.001), MYO (myoglobin) was 4.50 ([95% CI, 3.18–6.36] P<0.001), and CK was 3.56 ([95% CI, 2.53–5.02] P<0.001). The cutoffs of those cardiac biomarkers for effective prognosis of 28-day mortality of COVID-19 were found to be much lower than for regular heart disease at about 19%–50% of the currently recommended thresholds. Patients with elevated cardiac injury markers above the newly established cutoffs were associated with significantly increased risk of COVID-19 death. In conclusion, cardiac biomarker elevations are significantly associated with 28-day death in patients with COVID-19. The prognostic cutoff values of these biomarkers might be much lower than the current reference standards. These findings can assist in better management of COVID-19 patients to improve outcomes. Importantly, the newly established cutoff levels of COVID-19–associated cardiac biomarkers may serve as useful criteria for the future prospective studies and clinical trials.

中文翻译：

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重新定义心脏生物标志物以预测 COVID-19 住院患者的死亡率

文本中提供了补充数字内容。循环心脏生物标志物的预后能力、效用以及在 2019 年冠状病毒病 (COVID-19) 患者中的释放模式尚未明确定义。在这项多中心回顾性研究中，我们招募了 2019 年 12 月 31 日至 2020 年 3 月 4 日期间在 9 家医院收治的 3219 名确诊为 COVID-19 的患者，以估计循环心脏损伤标志物与 COVID-19 不良预后的关联和预后能力. 在混合效应 Cox 模型中，在调整了年龄、性别和合并症后，hs-cTnI（高敏心肌肌钙蛋白 I）的 28 天死亡率调整后的风险比为 7.12（[95% CI，4.60–11.03 ] P<0.001), (NT-pro)BNP (N-末端 pro-B 型利钠肽或脑利钠肽) 为 5.11 ([95% CI, 3.50–7.47] P<0.001), CK（肌酸磷酸激酶）-MB 为 4.86（[95% CI，3.33–7.09] P<0.001），MYO（肌红蛋白）为 4.50（[95% CI，3.18–6.36] P<0.001），CK 为 3.56（ [95% CI，2.53–5.02] P<0.001）。发现有效预后 COVID-19 28 天死亡率的心脏生物标志物的临界值远低于常规心脏病，约为目前推荐阈值的 19%–50%。心脏损伤标志物高于新确定的临界值的患者与 COVID-19 死亡风险显着增加相关。总之，心脏生物标志物升高与 COVID-19 患者的 28 天死亡显着相关。这些生物标志物的预后临界值可能远低于当前的参考标准。这些发现有助于更好地管理 COVID-19 患者以改善预后。重要的是，新确定的与 COVID-19 相关的心脏生物标志物的截止水平可作为未来前瞻性研究和临床试验的有用标准。