Abstract
Background Currently, there is limited research on the prognostic value of NT-proBNP (N-terminal pro-B-type natriuretic peptide) as a biomarker in COVID-19. We proposed the a priori hypothesis that an elevated NT-proBNP concentration at admission is associated with increased in-hospital mortality. Methods and Results In this prospective, observational cohort study of the American Heart Association’s COVID-19 Cardiovascular Disease Registry, 4675 patients hospitalized with COVID-19 were divided into normal and elevated NT-proBNP cohorts by standard age-adjusted heart failure thresholds, as well as separated by quintiles. Patients with elevated NT-proBNP (n=1344; 28.7%) were older, with more cardiovascular risk factors, and had a significantly higher rate of in-hospital mortality (37% versus 16%; P <0.001) and shorter median time to death (7 versus 9 days; P <0.001) than those with normal values. Analysis by quintile of NT-proBNP revealed a steep graded relationship with mortality (7.1%-40.2%; P <0.001). NT-proBNP was also associated with major adverse cardiac events, intensive care unit admission, intubation, shock, and cardiac arrest ( P <0.001 for each). In subgroup analyses, NT-proBNP, but not prior heart failure, was associated with increased risk of in-hospital mortality. Adjusting for cardiovascular risk factors with presenting vital signs, an elevated NT-proBNP was associated with 2-fold higher adjusted odds of death (adjusted odds ratio [OR], 2.23; 95% CI, 1.80-2.76), and the log-transformed NT-proBNP with other biomarkers projected a 21% increased risk of death for each 2-fold increase (adjusted OR, 1.21; 95% CI, 1.08-1.34). Conclusions Elevated NT-proBNP levels on admission for COVID-19 are associated with an increased risk of in-hospital mortality and other complications in patients with and without heart failure.
Keywords: COVID‐19; NT‐proBNP; biomarker; critical care; mortality/survival.
【저자키워드】 Biomarker, Critical care, COVID‐19, NT‐proBNP, mortality/survival., 【초록키워드】 COVID-19, Biomarker, Critical care, Mortality, intensive care, peptide, intubation, cardiovascular disease, Cardiac arrest, cardiovascular, heart failure, Cohort, Shock, Research, Patient, cardiovascular risk factors, death, Complication, vital signs, registry, NT-proBNP, Admission, Critical, in-hospital mortality, NT‐proBNP, intensive care unit admission, Hypothesis, Concentration, on admission, normal values, Subgroup analyses, Observational cohort study, Prognostic value, Older, adjusted odds ratio, cardiac events, Disease Registry, 95% CI, increased risk, median time, N-terminal pro-B-type natriuretic peptide, thresholds, N-terminal, American Heart Association, Result, elevated, events, adjusted, significantly higher, presenting, analyses, separated, Adjusting, cardiovascular risk factor, log-transformed, patients hospitalized, pro-B-type natriuretic peptide, with COVID-19, 【제목키워드】 COVID-19, Natriuretic,