Biomarkers for prediction of mortality in left-sided infective endocarditis

Abstract

Background: Evidence regarding biomarkers for risk prediction in patients with infective endocarditis (IE) is limited. We aimed to investigate the value of a panel of biomarkers for the prediction of in-hospital mortality in patients with IE. Methods: Between 2016 and 2018, consecutive IE patients admitted to the emergency department were prospectively included. Blood concentrations of nine biomarkers were measured at admission (D0) and on the seventh day (D7) of antibiotic therapy: C-reactive protein (CRP), sensitive troponin I (s-cTnI), procalcitonin, B-type natriuretic peptide (BNP), neutrophil gelatinase-associated lipocalin (NGAL), interleukin 6 (IL6), tumor necrosis fator α (TNF-α), proadrenomedullin, alpha-1-acid glycoprotein, and galectin 3. The primary endpoint was in-hospital mortality. Results: Among 97 patients, 56% underwent cardiac surgery, and in-hospital mortality was 27%. At admission, six biomarkers were independent predictors of in-hospital mortality: s-cTnI (OR 3.4; 95%CI 1.8-6.4; P < 0.001), BNP (OR 2.7; 95%CI 1.4-5.1; P = 0.002), IL-6 (OR 2.06; 95%CI 1.3-3.7; P = 0.019), procalcitonin (OR 1.9; 95%CI 1.1-3.2; P = 0.018), TNF-α (OR 1.8; 95%CI 1.1-2.9; P = 0.019), and CRP (OR 1.8; 95%CI 1.0-3.3; P = 0.037). At admission, S-cTnI provided the highest accuracy for predicting mortality (area under the ROC curve: s-cTnI 0.812, BNP 0.727, IL-6 0.734, procalcitonin 0.684, TNF-α 0.675, CRP 0.670). After 7 days of antibiotic therapy, BNP and inflammatory biomarkers improved their performance (s-cTnI 0.814, BNP 0.823, IL-6 0.695, procalcitonin 0.802, TNF-α 0.554, CRP 0.759). Conclusion: S-cTnI concentration measured at admission had the highest accuracy for mortality prediction in patients with IE.

Association of cardiac biomarkers and comorbidities with increased mortality, severity, and cardiac injury in COVID‐19 patients: A meta‐regression and decision tree analysis

“…Pairwise comparison meta‐analysis was conducted; 29 articles to compare between the severe and nonsevere presentation of COVID‐19 disease, seven records to compare between cohorts who developed cardiac injury and those who are not, six records to compare between patients who were admitted to the ICU and those admitted to the general hospital ward and 16 studies to compare between survivors and expired patients (Figure 1A). The study included a total of 56 studies (52 retrospective and 4 prospective studies) published from 24 January 2020 to 7 May 2020 1,13‐68 . These included 17 794 COVID‐19 patients from China (13 cities) and overseas (Figure 1B,C).…”

Troponin status predicts 30-day in-hospital mortality

“…Troponin has most obviously been shown to be a prognostic marker in myocardial infarction [44] . It is also a strong predictor in infective endocarditis with an OR of 3.4 [45] . In 105,338 hospitalized heart failure admissions, Peacock et al [46] determined troponin levels with 6.2% having positive troponin results; the adjusted OR for death with a positive troponin test was 2.55.…”

Association Between Elevated Cardiac Troponin Level and Clinical Outcomes in Patients with Infective Endocarditis: A Meta-Analysis

“…Of these, 458 were excluded after screening through the titles and abstracts, where the main reasons for exclusion were case or conference report, irrelevant to the objectives of our study, review articles, and animal experiments. A total of 13 studies were selected for full-text screening, following which 4 [15,[25][26][27] were excluded because of discrepancy in cardiac markers being used (not cardiac troponin) or target population being examined were of other cardiac diseases, 2 [28,29] were eliminated because the original data were not accessible. Ultimately, a total of 7 [30][31][32][33][34][35][36] studies were included for our meta-analysis (the PRISMA ow diagram was shown in Figure S1(Supplementary le 1)…”

“…There were 2 [30,35] studies assessing early surgery and in-hospital mortality together in 105 patients, showing that patients with elevated cardiac troponin were associated with higher mortality or incidence of early surgery during hospitalization [OR = 8.52, 95% CI (3.31,21.93)]. Of those excluded studies, 2 [28,29] that did not have accessible original data also reported a higher mortality rate among patients with a higher cardiac troponin level than those with a normal level, with an OR of 7.0 [95% CI (1.7,28.6)] and 3.4 [95% CI (1.8,6.4)] respectively.…”

“…studies assessing early surgery and in-hospital mortality together in 105 patients, showing that patients with elevated cardiac troponin were associated with higher mortality or incidence of early surgery during hospitalization [OR = 8.52, 95% CI (3.31,21.93)]. Of those excluded studies, 2[28,29] that did not have accessible original data also reported a higher mortality rate among patients with a higher cardiac troponin level than those with a Symptoms of the central nervous system were assessed in 3[31][32][33] studies. A signi cantly higher proportion of patients with an elevated cardiac troponin level (21.43,54/252) had symptoms of the central nervous system than those with a normal level (4.00%,3/75) [OR = 3.28, 95% CI (1.01,10.62)].…”