Established Cardiovascular Biomarkers Provide Limited Prognostic Information in Unselected Patients Hospitalized With COVID-19
Torbjørn Omland, Christian Prebensen, Ragnhild Røysland, Signe Søvik, Vibecke Sørensen, Helge Røsjø, My Svensson, Jan Erik Berdal, Peder L. Myhre
Abstract
orbidity and mortality associated with Coronavirus disease 2019 (CO-VID-19) is substantial, and underlying cardiovascular disease (CVD) is a risk factor for severe disease. 1,22][3][4] These studies identified C-reactive protein, lactate dehydrogenase, ferritin, cardiac troponins, N-terminal pro-B-type natriuretic peptide, and D-dimer as markers of increased risk.Retrospective studies carry significant risk of selection bias, because the indication for measurements is at the discretion of the treating physician.We aimed to overcome such limitations by prospectively investigating associations between CVD and inflammatory biomarkers and COVID-19.COVID-MECH (COVID-19 Mechanisms Study; NCT04314232) was a prospective, observational study enrolling consecutive adult patients hospitalized with laboratory-confirmed COVID-19 at Akershus University Hospital (Norway) March 18 to May 4, 2020.Study-specific consent forms were signed by participants or nextof-kin for patients unable to consent.The study was approved by local regulatory authorities.Study data are not publicly available because of Norwegian General Data Protection Regulation.The primary end point in COVID-MECH was the composite of hospital mortality or admission to the intensive care unit prompted by need for mechanical ventilation and lasting >24 hours.Follow-up to 30 days or discharge or death was complete.Clinical information was extracted from electronic medical records by the investigators.Blood samples were drawn by venipuncture at admission in the emergency department and analyzed immediately at the central laboratory.The association between log-transformed admission biomarker concentrations and the primary end point was examined in univariable and multivariable logistic regression models adjusting for age, sex, and race (model 1).Model 2 additionally adjusted for CVD, body mass index, estimated glomerular filtration rate, and symptom duration.Model 3 additionally adjusted for National Early Warning Scores (NEWS), calculated from admission respiratory rate, oxygen saturation, supplemental oxygen, systolic blood pressure, pulse rate, temperature, and level of consciousness. 5 Discrimination for the primary end point was assessed using area under the receiver operating curve.Reclassification was calculated using the Net Reclassification Index.In total, 131 of 135 patients included in COVID MECH had blood samples available for this analysis.Mean (SD) age was 59.6±14.1 (range 25-86) years; 80 (61%) patients were men; and 79 (60%) had ≥1 comorbidity: 39 (30%) hypertension, 37 (29%) obesity, 17 (13%) CVD, 22 (17%) diabetes, 8 (6%) chronic kidney disease, and 6 (5%) chronic obstructive pulmonary disease.Seventy (53%) patients were White; these were older (mean 65.4±13.4versus 53.1±11.8years; P<0.