N‐Terminal Pro‐B‐Type Natriuretic Peptide as a Biomarker for the Severity and Outcomes With COVID‐19 in a Nationwide Hospitalized Cohort
Open accessAbstract
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.
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In patients with severe COVID-19, elevated biomarkers of cardiac damage that predict heart failure including troponins and NT-proBNP were strongly and independently associated with in-hospital mortality.
“In patients with severe COVID-19, elevated biomarkers of cardiac damage that predict heart failure including troponins and NT-proBNP (N-terminal pro-B-type natriuretic peptide) were strongly and independently associated with in-hospital mortality.”
From COVID-19, Myocarditis and Pericarditis (2023) · cites this paper as [71]
The Multivariable Analysis of In-Hospital Mortality section reports that elevated NT-proBNP was associated with higher adjusted odds of death in hospitalized COVID-19 patients, including after adjustment for other biomarkers. The paper mentions an association between elevated troponin and mortality, but the passages do not establish that troponin was independently associated with mortality. Page numbers are unavailable in our copy. (LLM, conf=0.87)
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References 28 · Cited by 27
Research works printed but not linked: 3
- Bibbins-Domingo K, Ansari M, Schiller NB, Massie B, Whooley MA. B-type natriuretic peptide and ischemia in patients with stable cor- onary disease: data from the Heart and Soul study. Circulation. 2003;108:2987-2992. doi: 10.1161/01.CIR.00001 03681.04726.9C · DOI
- Januzzi JL, van Kimmenade R, Lainchbury J, Bayes-Genis A, Ordonez- Llanos J, Santalo-Bel M, Pinto YM, Richards M. NT-proBNP testing for diagnosis and short-term prognosis in acute destabilized heart failure: an international pooled analysis of 1256 patients: the international col- laborative of NT-proBNP study. Eur Heart J. 2006;27:330-337. doi: 10.1093/eurhe artj/ehi631 · DOI
- Rudiger A, Gasser S, Fischler M, Hornemann T, Von Eckardstein A, Maggiorini M. Comparable increase of B-type natriuretic peptide and amino-terminal pro-B-type natriuretic peptide levels in patients with severe sepsis, septic shock, and acute heart failure. Crit Care Med. 2006;34:2140-2144. doi: 10.1097/01.CCM.00002 29144.97624. · DOI
- Authors
- O’Donnell, C., Ashland, M. D., Vasti, E. C., Lu, Y., Chang, A. Y., Wang, P., Daniels, L. B., de Lemos, J. A., Morrow, D. A., Rodriguez, F., & O’Brien, C. G.
- Affiliations
- Stanford Medicine (US)
- Stanford Cancer Institute Stanford University School of Medicine Stanford CA
- University of California San Diego (US)
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX
- Brigham and Women's Hospital (US)
- Division of Cardiovascular Medicine The Stanford Prevention Research Center The Cardiovascular Institute Stanford University School of Medicine Stanford CA
- University of California, San Francisco (US)
- Corresponding author
- O’Brien, Connor G.
- ORCID
- Venue
- Journal of the American Heart Association
- Published
- 2021-12-21
- Volume
- 10
- Issue
- 24
- Pages
- e022913-e022913
- ISSN
- 2047-9980 (ISSN-L)
- PMC
- PMC9075235
- OpenAlex
- W4200015943
- Cited by
- 27
- References
- 28
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 6 · 2023: 11 · 2022: 5
- FWCI
- 1.74
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc-nd
- Locations
- Journal of the American Heart Association (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- eScholarship (California Digital Library) (submittedVersion, cc-by-nc-nd)
- Funders
- National Institutes of Health (UL1TR003142)
- National Heart, Lung, and Blood Institute (K01HL144607)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Keywords
- NT-proBNP, COVID-19 pandemic, prognostic factors, in-hospital mortality, heart failure, major adverse cardiac events, intensive care unit admission, intubation, cardiac arrest, shock, hospitalized patients
- MeSH terms
- COVID-19, Heart Failure, Humans, Peptide Fragments, Prognosis, Prospective Studies, Biomarkers, Hospital Mortality, Natriuretic Peptide, Brain
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