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Elevated Natriuretic Peptides in Patients With Severe or Critical COVID-19: A Meta-Analysis
Benjamin Benhuri1, Tadao Aikawa2, Hisato Takagi3
1Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, New York.
Insights
Patients with severe COVID-19 show elevated natriuretic peptide levels, including B-type natriuretic peptide (BNP) and N-terminal-proBNP, compared to those with nonsevere illness. This finding highlights potential cardiac involvement in severe COVID-19 cases.
Area of Science:
- Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- The COVID-19 pandemic has led to a surge in critically ill patients.
- Cardiovascular risk factors are significant contributors to severe COVID-19 illness.
- Elevated cardiac damage markers, like natriuretic peptides, are observed in severe COVID-19.
Purpose of the Study:
- To systematically review and meta-analyze natriuretic peptide levels in severe versus nonsevere COVID-19 patients.
- To compare B-type natriuretic peptide (BNP) and N-terminal-proBNP levels based on COVID-19 disease severity.
Main Methods:
- Systematic review and meta-analysis of published studies.
- Searched PubMed and medRxiv for relevant literature up to April 7, 2020.
- Included 9 retrospective cohort studies with 1,575 COVID-19 patients.
Main Results:
- Severe COVID-19 patients had significantly higher BNP levels (mean difference: 69.56 pg/mL, P = .04).
- Severe COVID-19 patients also showed significantly higher N-terminal-proBNP levels (mean difference: 518.65 pg/mL, P = .006).
- All included studies were conducted in China.
Conclusions:
- Chinese patients with severe COVID-19 exhibited elevated natriuretic peptide levels compared to nonsevere cases.
- Further international studies are needed to determine the cardiac origin and influence of heart failure on these disparities.
Background:
The worldwide COVID-19 pandemic caused by SARS-CoV-2 has resulted in an extraordinary increase in the number of patients who are severely critically ill. For many of these patients, cardiovascular risk factors are key contributors to the development of severe illness. Laboratory markers for cardiac damage and failure, such as natriuretic peptides, are reported to be elevated in patients with severe COVID-19.
Methods:
We conducted a systematic review and meta-analysis to compare natriuretic peptide levels in patients with severe COVID-19 vs those with nonsevere COVID-19. PubMed and medRxiv were searched through April 7, 2020. The outcome of interest was the difference in B-type natriuretic peptide (BNP) or N-terminal-proBNP levels in patients with severe vs nonsevere COVID-19.
Results:
We identified 9 retrospective cohort studies that had a total of 1,575 patients with COVID-19 who had their natriuretic peptides measured and were classified by disease severity. All studies were conducted in China. Patients with severe COVID-19 had significantly higher BNP levels than patients with nonsevere COVID-19 (mean difference, 69.56 pg/mL; 95% CI, 1.77-137.35 pg/mL; P = .04, I2 = 83%). Similarly, patients with severe COVID-19 had significantly higher N-terminal-proBNP levels than patients with nonsevere COVID-19 (mean difference, 518.65 pg/mL; 95% CI, 152.40-884.90 pg/mL; P = .006, I2 = 86%).
Conclusions:
In this study, Chinese patients with severe COVID-19 had higher natriuretic peptide levels than those with nonsevere COVID-19. Studies from all countries affected by the virus will help to further delineate whether the cause is directly or indirectly of cardiac origin and whether preexisting heart failure has an influence on this disparity.
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