Prognostic value of brain natriuretic peptide in COVID-19 with or without acute heart failure
Date Issued
2022-10-01
Author(s)
Bergami, M
Manfrini, O
Cenko, E
Dorobantu, M
Fronea, O
Mjehovic, P
Pasalic, M
Poposka, L
Milicic, D
Zdravkovic, M
Bugiardini, R
DOI
10.1093/eurheartj/ehac544.922
Abstract
Background: Although Brain Natriuretic Peptide (BNP) provides strong
prognostic information of an unfavorable outcome in patients with acute
heart failure (AHF), there is little information of its relevance as a biomarker
for outcomes in COVID-19 and its complications
Purpose: To evaluate the association of increased BNP levels with complications
and in-hospital mortality in a cohort of hospitalized COVID-19
patients.
Methods: The study included COVID-19 patients with data on BNP levels
included in the ISACS COVID-19 registry. The population was categorized
according to the presence of peak BNP levels ≥100 pg/mL during
hospitalization. Primary outcomes included in-hospital mortality, AHF
or acute respiratory failure (ARF, defined as PiO2/FiO2<300 mmHg or
need for mechanical ventilation). Calculations were conducted using age
and sex-adjusted multivariable logistic regression analyses. Results were
also stratified according to presence or absence of cardiovascular disease
(CVD) history. Differences between subgroups were verified for statistical
significance using test for interaction.
Results: Of the 1152 patients included in the study, 615 (53.4%) had elevated
BNP levels. These subjects were older (69.9±13.8 vs 59.1±16.8,
p-value<0.001), had higher rates of cardiovascular risk factors (82.9% vs
57.7%, p-value<0.001) and presented more frequently with a prior history
of CVD (either ischemic heart disease, cerebrovascular disease, venous
thromboembolism, atrial fibrillation or a history of revascularization) (50.1%
vs 27.5%, p-value<0.001). No sex differences were observed. When considering
outcomes, BNP levels ≥100 pg/mL were associated with increased
rates of in-hospital mortality (32.9% vs 4.9%, p-value<0.001),
even after adjustment for demographic characteristics (OR: 7.35; 95%
CI: 4.75–11.40; p-value<0.001). High BNP levels were also strongly associated
with an increased risk of AHF (OR 19.9; 95% CI 8.6–45.9; pvalue<
0.001), a correlation that persisted both in patients with and without
a prior CVD history (p for interaction=0.29). Of note, patients with elevated
BNP also had a higher likelihood of developing ARF (OR 2.7; 95% CI 2.1–
3.6; p-value<0.001), even in absence of AHF (OR 3.00; 95% CI 2.20–4.1;
p-value<0.001).
Conclusions: In COVID-19, blood BNP level not only appears to be a predictor
of in-hospital mortality and AHF but was also independently associated
with an increased risk of ARF. This finding supports the routine use of
BNP in all patients admitted to the hospital for COVID-19, regardless of a prior
history of CVD.
prognostic information of an unfavorable outcome in patients with acute
heart failure (AHF), there is little information of its relevance as a biomarker
for outcomes in COVID-19 and its complications
Purpose: To evaluate the association of increased BNP levels with complications
and in-hospital mortality in a cohort of hospitalized COVID-19
patients.
Methods: The study included COVID-19 patients with data on BNP levels
included in the ISACS COVID-19 registry. The population was categorized
according to the presence of peak BNP levels ≥100 pg/mL during
hospitalization. Primary outcomes included in-hospital mortality, AHF
or acute respiratory failure (ARF, defined as PiO2/FiO2<300 mmHg or
need for mechanical ventilation). Calculations were conducted using age
and sex-adjusted multivariable logistic regression analyses. Results were
also stratified according to presence or absence of cardiovascular disease
(CVD) history. Differences between subgroups were verified for statistical
significance using test for interaction.
Results: Of the 1152 patients included in the study, 615 (53.4%) had elevated
BNP levels. These subjects were older (69.9±13.8 vs 59.1±16.8,
p-value<0.001), had higher rates of cardiovascular risk factors (82.9% vs
57.7%, p-value<0.001) and presented more frequently with a prior history
of CVD (either ischemic heart disease, cerebrovascular disease, venous
thromboembolism, atrial fibrillation or a history of revascularization) (50.1%
vs 27.5%, p-value<0.001). No sex differences were observed. When considering
outcomes, BNP levels ≥100 pg/mL were associated with increased
rates of in-hospital mortality (32.9% vs 4.9%, p-value<0.001),
even after adjustment for demographic characteristics (OR: 7.35; 95%
CI: 4.75–11.40; p-value<0.001). High BNP levels were also strongly associated
with an increased risk of AHF (OR 19.9; 95% CI 8.6–45.9; pvalue<
0.001), a correlation that persisted both in patients with and without
a prior CVD history (p for interaction=0.29). Of note, patients with elevated
BNP also had a higher likelihood of developing ARF (OR 2.7; 95% CI 2.1–
3.6; p-value<0.001), even in absence of AHF (OR 3.00; 95% CI 2.20–4.1;
p-value<0.001).
Conclusions: In COVID-19, blood BNP level not only appears to be a predictor
of in-hospital mortality and AHF but was also independently associated
with an increased risk of ARF. This finding supports the routine use of
BNP in all patients admitted to the hospital for COVID-19, regardless of a prior
history of CVD.
File(s)![Thumbnail Image]()
Loading...
Name
Prognostic value of brain natriuretic peptide in COVID-19 with or without acute heart failure.pdf
Size
88.95 KB
Format
Adobe PDF
Checksum
(MD5):e066dd62c708731d19bbfb969bf00ea1