Improvement of outcome prediction of hospitalized patients with COVID-19 by a dual marker strategy using high-sensitive cardiac troponin I and copeptin,Clinical Research in Cardiology

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Improvement of outcome prediction of hospitalized patients with COVID-19 by a dual marker strategy using high-sensitive cardiac troponin I and copeptin
Clinical Research in Cardiology ( IF 3.8 ) Pub Date : 2021-11-15 , DOI: 10.1007/s00392-021-01970-4
Christoph C. Kaufmann ₁ , Amro Ahmed ₁ , Mona Kassem ₁ , Matthias K. Freynhofer ₁ , Bernhard Jäger ₁ , Kurt Huber _{1,

2,

3} , Gabriele Aicher ₄ , Susanne Equiluz-Bruck ₅ , Alexander O. Spiel ₆ , Florian Vafai-Tabrizi ₇ , Michael Gschwantler _{2,

8} , Peter Fasching ₉ , Johann Wojta _{3,

10,

11} , Evangelos Giannitsis ₁₂

Affiliation

3Rd Medical Department, Cardiology and Intensive Care Medicine, Klinik Ottakring (Wilhelminenhospital), Montleartstrasse 37, 1160, Vienna, Austria
Medical School, Sigmund Freud University, Vienna, Austria
Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria
Department of Laboratory Medicine, Klinik Ottakring (Wilhelminenhospital), Vienna, Austria
Department of Hospital Hygiene, Klinik Ottakring (Wilhelminenhospital), Vienna, Austria
Department of Emergency Medicine, Klinik Ottakring (Wilhelminenhospital), Vienna, Austria
2nd Medical Department with Pneumology and Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Klinik Ottakring (Wilhelminenhospital), Vienna, Austria
Department of Gastroenterology and Hepatology, Klinik Ottakring (Wilhelminenhospital), Vienna, Austria
Department of Endocrinology and Rheumatology, Klinik Ottakring (Wilhelminenhospital), Vienna, Austria
Department of Internal Medicine 2, Division of Cardiology, Medical University of Vienna, Vienna, Austria
Core Facilities, Medical University of Vienna, Vienna, Austria
Medizinische Klinik III, University Hospital Heidelberg, Heidelberg, Germany

Background

COVID-19 has been associated with a high prevalence of myocardial injury and increased cardiovascular morbidity. Copeptin, a marker of vasopressin release, has been previously established as a risk marker in both infectious and cardiovascular disease.

Methods

This prospective, observational study of patients with laboratory-confirmed COVID-19 infection was conducted from June 6th to November 26th, 2020 in a tertiary care hospital. Copeptin and high-sensitive cardiac troponin I (hs-cTnI) levels on admission were collected and tested for their association with the primary composite endpoint of ICU admission or 28-day mortality.

Results

A total of 213 eligible patients with COVID-19 were included of whom 55 (25.8%) reached the primary endpoint. Median levels of copeptin and hs-cTnI at admission were significantly higher in patients with an adverse outcome (Copeptin 29.6 pmol/L, [IQR, 16.2–77.8] vs 17.2 pmol/L [IQR, 7.4–41.0] and hs-cTnI 22.8 ng/L [IQR, 11.5–97.5] vs 10.2 ng/L [5.5–23.1], P < 0.001 respectively). ROC analysis demonstrated an optimal cut-off of 19.3 pmol/L for copeptin and 16.8 ng/L for hs-cTnI and an increase of either biomarker was significantly associated with the primary endpoint. The combination of raised hs-cTnI and copeptin yielded a superior prognostic value to individual measurement of biomarkers and was a strong prognostic marker upon multivariable logistic regression analysis (OR 4.274 [95% CI, 1.995–9.154], P < 0.001). Addition of copeptin and hs-cTnI to established risk models improved C-statistics and net reclassification indices.

Conclusion

The combination of raised copeptin and hs-cTnI upon admission is an independent predictor of ICU admission or 28-day mortality in hospitalized patients with COVID-19.

Graphical abstract

中文翻译：

通过使用高敏心肌肌钙蛋白 I 和和肽素的双标记策略改善 COVID-19 住院患者的预后预测

背景

COVID-19 与心肌损伤的高发病率和心血管发病率增加有关。和肽素是一种血管加压素释放的标志物，之前已被确定为传染病和心血管疾病的风险标志物。

方法

这项针对实验室确诊的 COVID-19 感染患者的前瞻性观察性研究于 2020 年 6 月 6 日至 11 月 26 日在一家三级医院进行。收集入院时的和肽素和高敏心肌肌钙蛋白 I (hs-cTnI) 水平，并测试它们与 ICU 入院或 28 天死亡率等主要复合终点的关联。

结果

共纳入了 213 名符合条件的 COVID-19 患者，其中 55 名（25.8%）达到了主要终点。有不良结局的患者入院时和肽素和 hs-cTnI 的中位数水平显着更高（和肽素 29.6 pmol/L，[IQR, 16.2–77.8] vs 17.2 pmol/L [IQR, 7.4–41.0] 和 hs-cTnI 22.8 ng/L [IQR，11.5–97.5] 与 10.2 ng/L [5.5–23.1]，分别为P < 0.001）。ROC 分析表明和肽素的最佳截止值为 19.3 pmol/L，hs-cTnI 为 16.8 ng/L，任一生物标志物的增加与主要终点显着相关。升高的 hs-cTnI 和和肽素的组合产生了优于个体生物标志物测量的预后价值，并且在多变量逻辑回归分析中是一个强有力的预后标志物（OR 4.274 [95% CI, 1.995–9.154]，P < 0.001)。将和肽素和 hs-cTnI 添加到已建立的风险模型中改善了 C 统计量和净重分类指数。