Troponin, natriuretic peptide levels may help assess prognosis for COVID-19
In patients hospitalized for COVID-19, those with elevated natriuretic peptide and troponin levels were at greater risk for mortality compared with those who did not, according to data published in the American Journal of Cardiology.
Annamaria Iorio, MD, cardiologist at Papa Giovanni XXIII Hospital in Bergamo, Italy, and colleagues analyzed 341 patients (mean age, 68 years; 72% men) from the Cardio-COVID-Italy multicenter study who were hospitalized for COVID-19 from March 1 to April 9, 2020, and had cardiac biomarker data available to determine the prognostic role of natriuretic peptide and troponin.
The researchers excluded patients admitted with ACS and defined troponin levels as elevated if they exceeded the 99th percentile of normal values and natriuretic peptide levels as elevated if they exceeded the limit for ruling in acute HF.
At 14 days, 24% of patients died.
Compared with those with normal levels of natriuretic peptide and troponin, those with elevated levels of both had nearly threefold increased risk for mortality (HR = 2.94; 95% CI, 1.31-6.64; P = .009), according to the researchers.
Adjusting for age, gender, oxygen saturation, HF history and chronic kidney disease did not change the results.
In patients with normal troponin values, those with elevated natriuretic peptide levels had increased risk for mortality (HR = 2.86; 95% CI, 1.21-6.72; P = .016), Iorio and colleagues wrote.
“In our study, we showed that in patients with COVID-19 infection, early assessment of natriuretic peptides and troponin may better identify those patients with higher risk of in-hospital mortality,” Iorio and colleagues wrote. “Specifically, natriuretic peptides showed prognostic role in identifying patients with poor outcome in those with normal troponin value. Importantly, this occurred irrespective of age and history of HF and chronic renal disease. Thus, the same natriuretic peptides cutpoint usually used for acute HF diagnosis may be used in identifying the need for aggressive management and hemodynamic monitoring. As such, cardiac biomarkers information, which can be measured at admission, may have a prognostic role in identifying different risk profiles.”