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

• Published in: Clinical research in cardiology Vol. 111; no. 3; pp. 343 - 354
• Main Authors: Kaufmann, Christoph C., Ahmed, Amro, Kassem, Mona, Freynhofer, Matthias K., Jäger, Bernhard, Aicher, Gabriele, Equiluz-Bruck, Susanne, Spiel, Alexander O., Vafai-Tabrizi, Florian, Gschwantler, Michael, Fasching, Peter, Wojta, Johann, Giannitsis, Evangelos, Huber, Kurt
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-03-2022; Springer Nature B.V
• Subjects: Aged; Biomarkers; Biomarkers - blood; Calcium-binding protein; Cardiology; Cardiovascular diseases; Coronaviruses; COVID-19; COVID-19 - blood; COVID-19 - mortality; Female; Glycopeptides - blood; Health risks; Heart; Hospital Mortality; Humans; Intensive Care Units; Male; Medicine; Medicine & Public Health; Middle Aged; Morbidity; Mortality; Original Paper; Patient Admission - statistics & numerical data; Patients; Predictive Value of Tests; Prognosis; Prospective Studies; Reclassification; Regression analysis; ROC Curve; SARS-CoV-2; Statistical analysis; Troponin; Troponin I; Troponin I - blood; Vasopressin; Viral diseases; COVID-19; Mortality; High-sensitive cardiac troponin I (hs-cTnI); Adverse outcome; Copeptin
• ISSN: 1861-0684; 1861-0692
• DOI: 10.1007/s00392-021-01970-4

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