Prognostic Value of Natriuretic Peptides and Cardiac Troponins in COVID-19
Jonathan W. Cunningham, Brian Claggett, Karola Jering, Muthiah Vaduganathan, Ankeet S. Bhatt, Ning Rosenthal, Scott D. Solomon
Abstract
iven the variable severity of coronavirus disease 2019 (COVID-19), clinicians need biomarkers that identify high-risk patients at the time of hospitalization.While elevated troponin is associated with greater mortality in COVID-19, 1,2 studies of natriuretic peptides (NPs) have been inconclusive. 2,3e investigated the independent prognostic value of NPs and troponin in COVID-19 inpatients discharged (alive or dead) between April 1 and November 30, 2020, with laboratory data in Premier Healthcare Database (n=48 510).COVID-19 infection, comorbidities and outcomes were defined using the International Classification of Diseases, Tenth Revision codes.Only biomarkers at admission (days 1 or 2) were considered.Associations between biomarkers and in-hospital death were assessed by logistic regression, adjusted for 18 covariates: age, sex, race/ethnicity, month, region, obesity, chronic renal/pulmonary disease, diabetes, hypertension, smoking, cancer, and 6 cardiovascular conditions (heart failure, myocardial infarction, peripheral vascular and cerebrovascular disease, valve disease, and atrial fibrillation).Supporting data are available to qualified researchers from Premier.The Mass General Brigham Institutional Review Board approved the study.NPs were available in 12 252 (25%) patients, and were analyzed in 4 groups: ≤35, 36 to 100, 101 to 400, and >400 pg/mL for BNP (B-type natriuretic peptide) and ≤100, 101 to 200, 201 to 1500, and >1500 pg/mL for NT-proBNP (N-terminal pro-B-type natriuretic peptide).Patients with higher NPs were older (mean, 74 years of age in the highest group vs 54 years of age in the lowest) and more likely to have heart failure (61% vs 5%) and atrial fibrillation (46% vs 5%).Adjusted risk of death was markedly greater in the highest versus lowest NP group