Cardiac biomarkers and mortality in COVID-19 infection: A review

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Submitted: March 27, 2022
Accepted: June 16, 2022
Published: June 23, 2022
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Lots of meta-analysis emphasize that a great number of hospitalized patients with moderate and severe forms of COVID-19 developed acute myocardial damage, defined as an increase of cardiac biomarkers, such N-terminal pro–B-type natriuretic peptide (NT-pro-BNP), creatine kinase-myocardial band (CK-MB) and of all type of troponins. The highest mortality rate is related with progressively increasing biomarkers levels and with a history of cardiovascular disease. In fact, the biomarkers dosage should be considered as a prognostic marker in all patients with COVID-19 disease at admission, during hospitalization and in the case of clinical deterioration. The purpose of this review is to evaluate cardiovascular prognostic factors in COVID-19 disease throughout the analysis of cardiac biomarkers to early identify the most serious patients and to optimize their outcomes.



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Su S, Wong G, Shi W, et al. Epidemiology, Genetic recombination, and pathogenesis of coronaviruses. Trends Microbiol 2016;24:490-502. DOI:
World Health Organization. Coronavirus disease 2019 (COVID-19), Situation Report 32. 2020. Available from:
Aboughdir M, Kirwin T, Khader AA, et al. Prognostic value of cardiovascular biomarkers in COVID-19: A review. Viruses 2020;12:527. DOI:
Danwang C, Endomba FT, Nkeck JR, et al. A meta-analysis of potential biomarkers associated with severity of coronavirus disease 2019 (COVID-19). Biomark Res 2020;8:37. DOI:
Nguyen JL, Yang W, Ito K, et al. Seasonal influenza infections and cardiovascular disease mortality. JAMA Cardiol 2016;1:274-81. DOI:
Corrales-Medina VF, Suh KN, Rose G, et al. Cardiac complications in patients with community-acquired pneumonia: a systematic review and meta-analysis of observational studies. PLoS Med 2011;8:e1001048. DOI:
Alhogbani T. Acute myocarditis associated with novel Middle East respiratory syndrome coronavirus. Ann Saudi Med 2016;36.78. DOI:
Guo T, Fan Y, Chen M, et al. Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19). JAMA Cardiol 2020;5:811-8. Erratum in: JAMA Cardi. 2020;5:848. DOI:
Chen T, Wu D, Chen H, et al. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study. BMJ 2020 26;368:m1091. Erratum in: BMJ 2020;368:m1295. DOI:
Yang C, Liu F, Liu W, et al. Myocardial injury and risk factors for mortality in patients with COVID-19 pneumonia. Int J Cardiol 2021;326:230-6. DOI:
Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020;395:1054-1062.. Erratum in: Lancet 2020;395:1038. DOI:
Han H, Xie L, Liu R, et al. Analysis of heart injury laboratory parameters in 273 COVID-19 patients in one hospital in Wuhan, China. J Med Virol 2020;92:819-23. DOI:
Inciardi RM, Adamo M, Lupi L, et al. Characteristics and outcomes of patients hospitalized for COVID-19 and cardiac disease in Northern Italy. Eur Heart J 2020;41:1821-9. Erratum in: Eur Heart J 2020;41:4591. DOI:
Lombardi CM, Carubelli V, Iorio A, et al. Association of troponin levels with mortality in italian patients hospitalized with coronavirus disease 2019: Results of a multicenter study. JAMA Cardiol 2020;5:1274-80. DOI:
Stefanini GG, Chiarito M, Ferrante G, et al. Early detection of elevated cardiac biomarkers to optimise risk stratification in patients with COVID-19. Heart 2020;106:1512-8. DOI:
Poterucha TJ, Elias P, Jain SS, et al. Admission cardiac diagnostic testing with electrocardiography and troponin measurement prognosticates increased 30-day mortality in COVID-19. J Am Heart Assoc 2021;10:e018476. DOI:
Aggarwal S, Garcia-Telles N, Aggarwal G, et al. Clinical features, laboratory characteristics, and outcomes of patients hospitalized with coronavirus disease 2019 (COVID-19): Early report from the United States. Diagnosis (Berl) 2020;7:91-6. DOI:
Nathisuwan S, Talbert RL. A review of vasopeptidase inhibitors: A new modality in the treatment of hypertension and chronic heart failure. Pharmacotherapy 2002;22:27-42. DOI:
Levin ER, Frank HJL. Natriuretic peptides inhibit rat astroglial proliferation: Mediation by C receptor. Am J Physiol 1991;261:R453-7. DOI:
Marcus LS, Hart D, Packer M, et al. Hemodynamic and renal excretory effects of human brain natriuretic peptide infusion in patients with congestive heart failure. A double-blind, placebo-controlled, randomized crossover trial. Circulation 1996;94:3184-9. DOI:
Omland T. Clinical and laboratory diagnostics of cardiovascular disease: focus on natriuretic peptides and cardiac ischemia. Scand J Clin Lab Invest Suppl 2005;240:18-24. DOI:
Caro-Codón J, Rey JR, Buño A, et al. Characterization of NT-proBNP in a large cohort of COVID-19 patients. Eur J Heart Fail 2021;23:456-64. DOI:
Sorrentino S, Cacia M, Leo I, et al. B-type natriuretic peptide as biomarker of COVID-19 disease severity-A meta-analysis. J Clin Med 2020;9:2957. DOI:
Gao L, Jiang D, Wen XS, et al. Prognostic value of NT-proBNP in patients with severe COVID-19. Respir Res 2020;21:83. DOI:
Park DW, Kim YH, Yun SC, et al. Frequency, causes, predictors, and clinical significance of peri-procedural myocardial infarction following percutaneous coronary intervention. Eur Heart J 2013;34:1662-9. DOI:
Bao J, Li C, Zhang K, et al. Comparative analysis of laboratory indexes of severe and non-severe patients infected with COVID-19. Clin Chim Acta 2020;509:180-94. DOI:
Shi L, Wang Y, Wang Y, et al. Meta-analysis of relation of creatine kinase-MB to risk of mortality in coronavirus disease 2019 patients. Am J Cardiol 2020;130:163-5. DOI:
Babapoor-Farrokhran S, Gill D, Walker J, et al. Myocardial injury and COVID-19: Possible mechanisms. Life Sci 2020;253:117723. DOI:
Boukhris M, Hillani A, Moroni F, et al. Cardiovascular implications of the COVID-19 pandemic: A global perspective. Can J Cardiol 2020;36:1068-80. DOI:
Li JW, Han TW, Woodward M, et al. The impact of 2019 novel coronavirus on heart injury: A systematic review and meta-analysis. Prog Cardiovasc Dis 2020;63:518-24. DOI:
Shi S, Qin M, Shen B, et al. Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China. JAMA Cardiol 2020;5:802-10. DOI:
Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020;323:1061-9. Erratum in: JAMA 2021;325:1113. DOI:
Xu Z, Shi L, Wang Y, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med 2020;8:420-2. Erratum in: Lancet Respir Med 2020;8:420-2. DOI:
Bonow RO, Fonarow GC, O’Gara PT, et al. Association of coronavirus disease 2019 (COVID-19) with myocardial injury and mortality. JAMA Cardiol 2020;5:751-3. DOI:
Kwong JC, Schwartz KL, Campitelli MA, et al. Acute myocardial infarction after laboratory-confirmed influenza infection. N Engl J Med 2018;378:345-53. DOI:
Madjid M, Miller CC, Zarubaev VV, et al. Influenza epidemics and acute respiratory disease activity are associated with a surge in autopsy-confirmed coronary heart disease death: results from 8 years of autopsies in 34,892 subjects. Eur Heart J 2007;28:1205-10. DOI:
Inciardi RM, Lupi L, Zaccone G, et al. Cardiac involvement in a patient with coronavirus disease 2019 (COVID-19). JAMA Cardiol 2020;5:819-24. DOI:
Fajgenbaum DC, June CH. Cytokine storm. N Engl J Med 2020;383:2255-73. DOI:
Lippi G, Lavie CJ, Sanchis-Gomar F. Cardiac troponin I in patients with coronavirus disease 2019 (COVID-19): Evidence from a meta-analysis. Prog Cardiovasc Dis 2020;63:390-1. DOI:
Pranata R, Huang I, Lukito AA, et al. Elevated N-terminal pro-brain natriuretic peptide is associated with increased mortality in patients with COVID-19: Systematic review and meta-analysis. Postgrad Med J 2020;96:387-91. DOI:
Dalia T, Lahan S, Ranka S, et al. Impact of congestive heart failure and role of cardiac biomarkers in COVID-19 patients: A systematic review and meta-analysis. Indian Heart J 2021;73:91-8. DOI:
Wan S, Xiang Y, Fang W, et al. Clinical features and treatment of COVID-19 patients in northeast Chongqing. J Med Virol 2020;92:797-806. DOI:
Liu C, Wang Y. [Discussion on the application of febrile disease theory to the diagnosis and treatment of novel coronavirus pneumonia].[Article in Chinese with English Abstract]. Lanzhou University 2020. Available from:
Wei JF, Huang FY, Xiong TY, et al. Acute myocardial injury is common in patients with COVID-19 and impairs their prognosis. Heart 2020;106:1154-9. DOI:
Ghio S, Baldi E, Vicentini A, et al. Cardiac involvement at presentation in patients hospitalized with COVID-19 and their outcome in a tertiary referral hospital in Northern Italy. Intern Emerg Med 2020;15:1457-65. Erratum in: Intern Emerg Med 2021;16:807. DOI:

How to Cite

Cersosimo, Angelica, Giuliana Cimino, Ludovica Amore, Emiliano Calvi, Greta Pascariello, Riccardo Maria Inciardi, Carlo Mario Lombardi, Enrico Vizzardi, and Marco Metra. 2022. “Cardiac Biomarkers and Mortality in COVID-19 Infection: A Review”. Monaldi Archives for Chest Disease 93 (1).