Abstract
Background: The association of B-type natriuretic peptide (BNP) and in-hospital outcomes of Coronavirus disease 2019 (COVID-19) remains unknown. Our aim of this study was to investigate the independent predictors for mortality, especially cardiac history and serial assessment of cardiac markers (B-type natriuretic peptide [BNP] and troponin I). Methods: We obtained the medical records for hospitalized patients with laboratory confirmed COVID-19 from the Mount Sinai Health System. 929 patients with BNP data were divided into 3 groups, BNP ≤ 20 pg/mL, 20 pg/mL < BNP ≤ 100, and 100 pg/mL < BNP. The Cox proportional hazard model was constructed with the three BNP groups and troponin-I, d-dimer and C-reactive protein at admission and peak level. Results: Each BNP category was divided almost equally (BNP ≤ 20 pg/mL (29.9%, N=278), 20 < BNP ≤ 100 pg/mL (35.5%, N= 330), 100 < BNP pg/mL (34.6%, N=321). Patients with high BNP are older and have more co-morbidity including cardiac disease and chronic kidney disease. Patients with high BNP had higher d-dimer, troponin-I than control group. At 4 weeks, death rates were significantly different among the 3 groups (BNP ≤ 20 pg/mL versus 20 < BNP ≤ 100 pg/mL versus 100 < BNP pg/mL: 4.7% versus 13.6% versus 18.4%, P<0.0001). After the Cox model adjustments were done with the initial lab, troponin-I (>0.030 ng/mL) and d-dimer were found to be independent predictors for in-hospital mortality (troponin-I: HR [95%CI]: 1.72 [1.23-2.41], P=0.002), d-dimer: 1.03 [1.00-1.05], P=0.025), but not BNP. Notably, the Cox model with peak lab had better predictability of in-hospital mortality than those with lab at admission. Conclusions: Although higher BNP showed higher in-hospital mortality with unadjusted data with hospitalized COVID-19, BNP was not an independent predictor for in-hospital mortality after adjustment. Serial lab measurements could provide better predictability for in-hospital mortality.
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