TY - JOUR
T1 - N-Terminal Pro-B-Type Natriuretic Peptide as a Biomarker for the Severity and Outcomes With COVID-19 in a Nationwide Hospitalized Cohort
AU - O’donnell, Christian
AU - Ashland, Melanie D.
AU - Vasti, Elena C.
AU - Lu, Ying
AU - Chang, Andrew Y.
AU - Wang, Paul
AU - Daniels, Lori B.
AU - de Lemos, James A.
AU - Morrow, David A.
AU - Rodriguez, Fatima
AU - O’brien, Connor G.
N1 - Funding Information:
American Heart Association (AHA) Rapid Response Grant COVID-19 and Its Cardiovascular Impact: AHA’s suite of registries is funded by multiple industry sponsors. AHA’s COVID-19 CVD Registry is partially supported by the Gordon and Betty Moore Foundation. Dr Lu is funded by the Stanford Center for Clinical & Translational Education and Research (Spectrum) from the National Health Institutions, 3UL1TR003142-02S2. Dr Wang is funded by American Heart Association: 20SFRN35360189; 18SFRN34120036; Stanford University co–principal investigator of BAROS (Bariatric Atrial Restoration of Sinus Rhythm), NCT04050969, the John R. and Ai Giak L. Singleton co-director of the Stanford Center for Arrhythmia Research. Dr Rodriguez is funded by a career development award from the National Heart, Lung, and Blood Institute (K01 HL 144607) and the American Heart Association/Robert Wood Johnson Harold Amos Medical Faculty Development Program.
Funding Information:
Dr Lu reports grant support from Merck Sharp & Dohme Corp. and Abeona Therapeutics Inc., has served on clinical trial data monitoring committees for Nektar and Gilead, and has received consulting income from United Health Care. Dr Wang is on the Varian Medical Systems Advisory Board (unpaid) and is a EndoEpiAF cofounder. Dr Daniels reports consulting income from Quidel, Roche, and Siemens; and has served on a clinical end points adjudication committee for Abbott and Siemens. Dr de Lemos reports grant support from Roche Diagnostics and Abbott Diagnostics, and consulting income from Siemen’s Health Care Diagnostics, Ortho Clinical Diagnostics, and Quidel, Inc. Dr Morrow is a member of the TIMI Study group, which has received institutional research grant support through Brigham and Women’s Hospital from Abbott Laboratories, Amgen, Anthos Therapeutics, Arca Biopharma, AstraZeneca, Bayer HealthCare Pharmaceuticals, Inc., Daiichi-Sankyo, Eisai, Intarcia, Janssen, Merck, Novartis, Pfizer, Quark Pharmaceuticals, Regeneron, Roche, Siemens, The Medicines Company, and Zora Biosciences. Dr Morrow has received consulting fees from Bayer Pharma, InCarda, Merck, Novartis, and Roche Diagnostics. The remaining authors have no disclosures to report.
Publisher Copyright:
© 2021 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
PY - 2021/12/21
Y1 - 2021/12/21
N2 - 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.
AB - 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.
KW - Biomarker
KW - COVID-19
KW - Critical care
KW - Mortality/survival
KW - NT-proBNP
UR - http://www.scopus.com/inward/record.url?scp=85122904128&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85122904128&partnerID=8YFLogxK
U2 - 10.1161/JAHA.121.022913
DO - 10.1161/JAHA.121.022913
M3 - Article
C2 - 34889112
AN - SCOPUS:85122904128
VL - 10
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
SN - 2047-9980
IS - 24
M1 - e022913
ER -