Abstract 14697: Nt-probnp and Outcomes in Patients With and Without Heart Failure Hospitalized With Severe Covid-19 Pneumonia

Abstract

Introduction: The value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in hospitalized patients with severe coronavirus disease 2019 (COVID-19) is unclear. Hypothesis: Elevated NT-proBNP is associated with worse prognosis in hospitalized COVID-19 patients regardless of history of HF. Methods: We evaluated the in-hospital course of 469 adults admitted to Stony Brook University Hospital, NY, from March 1 to April 15, 2020 with severe COVID-19 pneumonia (need for high-flow O 2 ). We excluded patients who required mechanical ventilation (MV) or died within 24h of admission. We used Cox regression models to examine the association of admission NT-proBNP with mortality and the composite of death or MV. Results: Admission NT-proBNP was available in 399 patients (85.1%) of this cohort. Table 1 summarizes the patient characteristics according to history of HF (41/399 [10.3%]). After a median of 13 days (8-22), 107 patients (26.8%) died and 86 additional patients (21.6%) required MV and survived. Both HF (HR 3.65; 95%CI 2.32-5.77; P<0.001) and admission NT-proBNP (HR per log-2 [doubling] 1.35; 95%CI 1.27-1.44; P<0.001) were strongly associated with mortality. In models adjusting for age, sex, race, body mass index, hypertension, diabetes, coronary artery disease, atrial fibrillation, chronic lung disease, chronic kidney disease, and baseline 0 2 saturation, every log-2 higher admission NT-proBNP was associated with 28% higher mortality in patients with HF (HR 1.28; 95%CI 1.02-1.61; P=0.037) and 26% higher mortality in patients without HF (HR 1.26; 95%CI 1.14-1.40; P<0.001), P for interaction 0.92. Admission NT-proBNP was also associated with the composite of death or MV in the entire cohort (adjusted HR per log-2 1.09; 95%CI 1.02-1.17; P=0.017). Conclusions: In these high-risk COVID-19 patients, admission NT-proBNP was strongly predictive of mortality regardless of HF. Elevated NT-proBNP may thus identify patients in need of cardioprotective measures.