In COVID-19 Without HF, High NT-proBNP Predicts Mortality
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Mortality goes up in tandem with admission natriuretic peptide levels in patients with severe COVID-19 pneumonia but no history of heart failure (HF), perhaps signaling a need for careful fluid management and other cardioprotective measures, researchers propose, on the basis of their single-center study.

SARS-CoV-2 infection has been associated with myocardial damage. N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels have been reported to be elevated and to portend worse outcomes among patients hospitalized with COVID-19. The value of NT-proBNP in COVID-19 patients without heart failure (HF) is unclear, and data from the United States are limited.

Researchers reviewed the medical records of 304 adults without history of HF with documented severe COVID-19 pneumonia requiring high-flow oxygen therapy. They excluded patients transferred already intubated from outside hospitals and those who were intubated or died within 24h of admission. NT-proBNP was measured with a standard Roche Diagnostics assay with a 5-ng/L limit of detection.

Follow-up data were collected until death or hospital discharge or 30 days if still in the hospital by database lock (May 15, 2020). The primary endpoint was all-cause mortality and the secondary endpoint was death or need for intubation. The association of NT-proBNP with the endpoints was evaluated with multivariable Cox regression models.

Mean age was 60±17 years; 95 (31.2%) of patients were female; 156 (51.3%) were White, 103 (33.9%) Hispanic, 22 (7.2%) Black, and 21 (6.9%) Asian; 91 (29.9%) had diabetes, 39 (12.8%) coronary artery disease (CAD), and 27 (8.9%) atrial fibrillation (AF); mean BMI was 30.3±6.5 kg/m2. On admission, mean O2 saturation (O2SAT) was 89±8% and median NT-proBNP was 156 ng/L (44-729). After a median of 12 days (8-20), 74 patients (24.3%) died and 59 more (19.4%) were intubated and survived to hospital discharge.

Baseline NT-proBNP was strongly associated with mortality. In models adjusting for age, sex, race, diabetes, CAD, AF, BMI, and baseline O2SAT, every log-2 (doubling) of NT-proBNP was associated with 29% higher risk. The association of baseline NT-proBNP with the composite of death or intubation was weaker.

Among patients hospitalized with severe COVID-19 pneumonia, admission NT-proBNP is a strong predictor of mortality. Elevated NT-proBNP levels may identify a subgroup of patients in need of cardioprotective therapy.