B-Type Natriuretic Peptides and High-Sensitive Troponin I as COVID-19 Survival Factors: Which One Is the Best Performer?

Renato De Falco,Giuliana Fortunato,Biagio Pinchera,Maria Vargas,Daniela Palma,Martina Vano,Marcella Savoia,Anna Miscioscia,Ivan Gentile,Giuseppe Servillo

doi:10.3390/jcm10122726

Abstract

Increased concentrations of B-type natriuretic peptide (BNP), N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity troponin I (HsTnI) in COVID-19 patients have already been reported. The aim of this study is to evaluate which of these common markers of cardiac disease is the most useful predictor of fatal outcome in COVID-19 patients. One hundred and seventy-four patients affected with COVID-19 were recruited, and markers of cardiac disease and the clinical history of the patients were collected at admission in the infectious disease unit or intensive care unit. NT-proBNP, BNP and HsTnI values were higher in in-hospital non-surviving patients. Receiver operating characteristic (ROC) curve analysis of NT-proBNP, BNP and HsTnI was performed, with NT-proBNP (AUC = 0.951) and HsTnI (AUC = 0.947) being better performers (p = 0.01) than BNP (AUC = 0.777). Logistic regression was performed assessing the relation of HsTnI and NT-proBNP to fatal outcome adjusting for age and gender, with only NT-proBNP being significant. The population was then divided into two groups, one with higher NT-proBNP values at admission than the cut-off resulted from the ROC curve (511 ng/L) and a second one with lower values. The Kaplan–Meier analysis showed an absence of fatal outcome in the group of patients with NT-proBNP values lower than the cut-off (p < 0.001). NT-proBNP proved to be the best prognostic tool for fatal outcome among markers of cardiac disease in COVID-19 patients.

Highlights

In the last days of December 2019, coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), broke out in the Huabei region (China)
Increased concentrations of markers for cardiac disease were detected early in patients suffering from COVID-19, and in particular high concentrations of high-sensitive cardiac troponin I (HsTnI) and
The aim of this study was to evaluate which of B-type natriuretic peptide (BNP), NT-proBNP and HsTnI could be considered the best prognostic predictor in COVID-19 patients

Summary

Introduction

In the last days of December 2019, coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), broke out in the Huabei region (China). SARS-CoV-2 has continued to spread worldwide leading the WHO, on March 11th, to declare COVID-19 a pandemic [1]. Patients affected by COVID-19 gave rise to high rates of hospitalization and intensive care unit (ICU). Admissions [2], with in-hospital mortality as high as 28% in severe COVID-19 [3]. Several studies investigated the possible correlation between markers of cardiac disease and the worsening of COVID-19 severity [4,5]. Increased concentrations of markers for cardiac disease were detected early in patients suffering from COVID-19, and in particular high concentrations of high-sensitive cardiac troponin I (HsTnI) and

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