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N-Terminal Pro-B-Type Natriuretic Peptide and Mortality in Patients without Heart Failure Hospitalized with Severe Covid-19 Pneumonia
Severe acute respiratory syndrome coronavirus 2 (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 coronavirus disease 2019 (C...
Autores principales: | , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Published by Elsevier Inc.
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7527191/ http://dx.doi.org/10.1016/j.cardfail.2020.09.213 |
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author | Yoo, Jeanwoo Papamanoli, Aikaterini Grewal, Prabhjot Nakamura, Jacquelyn Dhaliwal, Simrat Fung, Jenny Jacob, Robin Abata, Joshua Hotelling, Jessica Karkala, Nikitha Rawal, Sahil Coritsidis, Alexandra Tsui, To Skopicki, Hal Marcos, Luis A. Kalogeropoulos, Andreas |
author_facet | Yoo, Jeanwoo Papamanoli, Aikaterini Grewal, Prabhjot Nakamura, Jacquelyn Dhaliwal, Simrat Fung, Jenny Jacob, Robin Abata, Joshua Hotelling, Jessica Karkala, Nikitha Rawal, Sahil Coritsidis, Alexandra Tsui, To Skopicki, Hal Marcos, Luis A. Kalogeropoulos, Andreas |
author_sort | Yoo, Jeanwoo |
collection | PubMed |
description | Severe acute respiratory syndrome coronavirus 2 (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 coronavirus disease 2019 (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. We reviewed the medical records of 304 adults without history of HF admitted to Stony Brook University Hospital, Long Island, NY, from March 1 to April 15, 2020 with documented severe COVID-19 pneumonia requiring high-flow oxygen therapy (non-rebreather mask, Venturi mask with FiO2 >50%, or high-flow nasal cannula). We 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 body mass index (BMI) was 30.3±6.5 kg/m(2). 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 (HR 1.29; 95%CI: 1.17-1.43; P<0.001). The association of baseline NT-proBNP with the composite of death or intubation was weaker (HR 1.09; 95%CI: 1.01-1.18; P = 025). 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. |
format | Online Article Text |
id | pubmed-7527191 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Published by Elsevier Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-75271912020-10-01 N-Terminal Pro-B-Type Natriuretic Peptide and Mortality in Patients without Heart Failure Hospitalized with Severe Covid-19 Pneumonia Yoo, Jeanwoo Papamanoli, Aikaterini Grewal, Prabhjot Nakamura, Jacquelyn Dhaliwal, Simrat Fung, Jenny Jacob, Robin Abata, Joshua Hotelling, Jessica Karkala, Nikitha Rawal, Sahil Coritsidis, Alexandra Tsui, To Skopicki, Hal Marcos, Luis A. Kalogeropoulos, Andreas J Card Fail 202 Severe acute respiratory syndrome coronavirus 2 (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 coronavirus disease 2019 (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. We reviewed the medical records of 304 adults without history of HF admitted to Stony Brook University Hospital, Long Island, NY, from March 1 to April 15, 2020 with documented severe COVID-19 pneumonia requiring high-flow oxygen therapy (non-rebreather mask, Venturi mask with FiO2 >50%, or high-flow nasal cannula). We 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 body mass index (BMI) was 30.3±6.5 kg/m(2). 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 (HR 1.29; 95%CI: 1.17-1.43; P<0.001). The association of baseline NT-proBNP with the composite of death or intubation was weaker (HR 1.09; 95%CI: 1.01-1.18; P = 025). 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. Published by Elsevier Inc. 2020-10 2020-09-30 /pmc/articles/PMC7527191/ http://dx.doi.org/10.1016/j.cardfail.2020.09.213 Text en Copyright © 2020 Published by Elsevier Inc. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. |
spellingShingle | 202 Yoo, Jeanwoo Papamanoli, Aikaterini Grewal, Prabhjot Nakamura, Jacquelyn Dhaliwal, Simrat Fung, Jenny Jacob, Robin Abata, Joshua Hotelling, Jessica Karkala, Nikitha Rawal, Sahil Coritsidis, Alexandra Tsui, To Skopicki, Hal Marcos, Luis A. Kalogeropoulos, Andreas N-Terminal Pro-B-Type Natriuretic Peptide and Mortality in Patients without Heart Failure Hospitalized with Severe Covid-19 Pneumonia |
title | N-Terminal Pro-B-Type Natriuretic Peptide and Mortality in Patients without Heart Failure Hospitalized with Severe Covid-19 Pneumonia |
title_full | N-Terminal Pro-B-Type Natriuretic Peptide and Mortality in Patients without Heart Failure Hospitalized with Severe Covid-19 Pneumonia |
title_fullStr | N-Terminal Pro-B-Type Natriuretic Peptide and Mortality in Patients without Heart Failure Hospitalized with Severe Covid-19 Pneumonia |
title_full_unstemmed | N-Terminal Pro-B-Type Natriuretic Peptide and Mortality in Patients without Heart Failure Hospitalized with Severe Covid-19 Pneumonia |
title_short | N-Terminal Pro-B-Type Natriuretic Peptide and Mortality in Patients without Heart Failure Hospitalized with Severe Covid-19 Pneumonia |
title_sort | n-terminal pro-b-type natriuretic peptide and mortality in patients without heart failure hospitalized with severe covid-19 pneumonia |
topic | 202 |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7527191/ http://dx.doi.org/10.1016/j.cardfail.2020.09.213 |
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