Table_5_Cardiac Biomarker Levels and Their Prognostic Values in COVID-19 Patients With or Without Concomitant Cardiac Disease.DOCX

The coronavirus disease 2019 (COVID-19) pandemic has become a global threat. Increases in cardiac biomarkers are common and are associated with adverse outcomes in patients with COVID-19. Although these increases are more likely to occur in cases with concomitant cardiac disease, the differences in cardiac biomarker levels between patients with and without cardiac disease and their associations with in-hospital mortality are largely unknown. A consecutive serial of laboratory-confirmed COVID-19 cases was retrospectively enrolled. Clinical characteristics, laboratory results, and outcome data were collected. The levels of cardiac biomarkers were evaluated and compared by stratifying patients according to concomitant cardiac conditions and clinical classifications. The prognostic efficacy of cardiac biomarker levels on admission was also assessed. Among the overall study population and survived patients, the cardiac biomarker levels at both the early and late stages in cardiac patients were significantly higher than those in non-cardiac patients. However, their concentrations in cardiac patients were comparable to non-cardiac ones among non-survivors. The cardiac biomarker levels at the late stage of the disease were significantly decreased compared to those at the early stage among patients who were alive. Whereas, the late-stage biomarker levels were significantly increased in patients who ultimately died. Subgroup analysis illustrated that increases in cardiac biomarkers were closely related to the severity of the disease, and were prognostic for high risks of in-hospital mortality in non-cardiac, rather than in cardiac patients. Myo and NT-proBNP, rather than Hs-TnI and CK-MB, were independently associated with in-hospital mortality in the overall population and non-cardiac patients. However, these associations were not significant among cardiac patients. In conclusion, our results helped better understand the release pattern and prognostic performance of cardiac biomarkers in patients with COVID-19. Increased levels of Myo and NT-proBNP on admission could be useful markers for early identifying high-risk patients. However, special attention must be paid when implementing the prognostic function for cardiac patients.2019冠状病毒病（coronavirus disease 2019, COVID-19）大流行已成为全球性公共卫生威胁。新冠患者血清心脏生物标志物升高现象较为普遍，且与不良临床转归密切相关。尽管此类升高更易出现于合并心脏疾病的病例中，但伴与不伴心脏疾病的新冠患者之间的心脏生物标志物水平差异，及其与住院死亡率的关联，目前仍尚不明确。本研究回顾性纳入了一系列经实验室确诊的连续新型冠状病毒肺炎病例，收集其临床特征、实验室检测结果及临床转归数据。按患者合并心脏疾病情况与临床分型进行分层，对心脏生物标志物水平开展评估与对比，并分析入院时心脏生物标志物水平的预后效能。在全部研究人群及存活患者中，合并心脏疾病患者在疾病早期与晚期阶段的心脏生物标志物水平均显著高于非心脏疾病患者；但在非存活患者中，两类人群的生物标志物浓度无显著差异。在存活患者中，疾病晚期的心脏生物标志物水平较早期显著降低；而最终死亡的患者，其晚期生物标志物水平则显著升高。亚组分析结果显示，心脏生物标志物升高与疾病严重程度密切相关，且可预测非心脏疾病患者的住院死亡高风险，但对心脏疾病患者并无此类预测价值。肌红蛋白（Myo）和N末端B型利钠肽原（NT-proBNP），而非高敏肌钙蛋白I（Hs-TnI）与肌酸激酶同工酶MB（CK-MB），与全部研究人群及非心脏疾病患者的住院死亡率呈独立相关；但该关联在心脏疾病患者中并不显著。综上，本研究结果有助于更全面地理解新冠患者心脏生物标志物的释放模式与预后表现。入院时肌红蛋白与NT-proBNP水平升高，可作为早期识别高危患者的有效标志物；但在针对心脏疾病患者应用其预后评估功能时，需予以格外关注。