Abstract 4139661: Usefulness of High-sensitive Troponin I and N-terminal pro-B-type Natriuretic Peptide in Coronavirus Disease 2019 Risk Stratification on and after Omicron Variant Waves: COVID-MI Registry Cohort-2 Analysis

Introduction: Troponin-defined myocardial injury or N-terminal pro-B-type natriuretic peptide (NT-proBNP) elevation frequently coincides with coronavirus disease 2019 (COVID-19). Our prior study (COVID-MI Registry Cohort-1) confirmed that high-sensitive troponin I (HsTnI) and NT-proBNP effectively stratified mortality risk. However, variants of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) change rapidly, and it remains unclear whether these biomarkers are consistently effective in predicting prognosis of COVID-19 patients irrespective of epidemic periods. Research Questions: Can HsTnI or NT-proBNP stratify mortality risk in recent COVID-19 cohorts? Aims: To assess the potential of HsTnI and NT-proBNP levels for risk stratification in the recent COVID-19 waves. Methods: In the COVID-MI Registry Cohort-2, we enrolled 1115 consecutive COVID-19 patients admitted between October 2021 and October 2022, during the Omicron variant endemic. We collected data of HsTnI or NT-proBNP levels from hospital charts or using the samples in our hospital's serum/plasma bank if the data were not available. The primary outcome measure was all-cause mortality. Results: On admission, more than one-third of patients were classified as having severe COVID-19. HsTnI and NT-proBNP levels were available for 427 and 414 patients, respectively. The median HsTnI and NT-proBNP levels were 16 (interquartile range [IQR]: 5-57) ng/L and 524 (IQR: 140-2056) pg/mL, respectively. We stratified the patients into three groups by HsTnI level: <5.0 ng/L (95 patients), 5.0 ng/L to 99%ile URL (151 patients), and ≥99%ile URL (181 patients). For NT-proBNP, patients were grouped as follows: <125 pg/mL (95 patients), 125-900 pg/mL (161 patients), and ≥900 pg/mL (158 patients). The median follow-up duration was 25 days. Regarding cumulative 30-day incidence of mortality, higher HsTnI as well as higher NT-proBNP levels were associated with a higher risk. (HsTnI: < 5.0 ng/L group, 1.1%; 5.0 ng/L to 99%ile URL group, 3.0%; and ≥ 99%ile URL group, 21.7%; P <0.001. NT-proBNP: < 125 pg/mL group, 0%; 125-900 pg/mL group, 4.7%; and ≥ 900 pg/mL group, 17.1%; P <0.001). Conclusions: HsTnI and NT-proBNP levels on admission can stratify mortality risk in recent COVID-19 cohorts, which is consistent with previous studies on different SARS-CoV-2 variants.