Admission NT-proBNP and outcomes in patients without history of heart failure hospitalized with COVID-19.

AIMS: We examined the value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients admitted for coronavirus disease 2019 (COVID-19) without prior history of heart failure (HF) or cardiomyopathy. METHODS AND RESULTS: Retrospective cohort of consecutive adults (N = 679; median age 59 years; 38.7% women; 87.5% White; 7.1% Black; 5.4% Asian; 34.3% Hispanic) admitted with documented COVID-19 in an academic centre in Long Island, NY. Admission NT-proBNP was categorized using the European Society of Cardiology Heart Failure Association age-specific criteria for acute presentations. We examined (i) mortality and the composite of death or mechanical ventilation and (ii) out-of-hospital, intensive care unit (ICU)-free, and ventilator-free days at 28 days. Estimates were adjusted for confounders using a lasso selection process. Using age-specific criteria, 417 patients (61.4%) had low, 141 (20.8%) borderline, and 121 (17.8%) high NT-proBNP. Mortality was 5.8%, 20.6%, and 36.4% for patients with low, borderline, and high NT-proBNP, respectively. In lasso-adjusted models, high NT-proBNP was associated with higher mortality [hazard ratio (HR) 2.15; 95% confidence interval (CI) 1.06-4.39; P = 0.034] and composite endpoint rates (HR 1.66; 95%CI 1.04-2.66; P = 0.035). Patients with high NT-proBNP had 32%, 33%, and 33% fewer out-of-hospital, ICU-free, and ventilator-free days compared with low NT-proBNP counterparts. Results were consistent across age, sex, and race, and regardless of coronary artery disease or hypertension, except for stronger mortality signal with high NT-proBNP in women. CONCLUSIONS: In patients with COVID-19 and no HF history, high admission NT-proBNP is associated with higher mortality and healthcare resources utilization. Preventive strategies may be required for these patients.

Association of Proteinuria and Hematuria with Acute Kidney Injury and Mortality in Hospitalized Patients with COVID-19.

INTRODUCTION: Acute kidney injury (AKI) is strongly associated with poor outcomes in hospitalized patients with coronavirus disease 2019 (COVID-19), but data on the association of proteinuria and hematuria are limited to non-US populations. In addition, admission and in-hospital measures for kidney abnormalities have not been studied separately. METHODS: This retrospective cohort study aimed to analyze these associations in 321 patients sequentially admitted between March 7, 2020 and April 1, 2020 at Stony Brook University Medical Center, New York. We investigated the association of proteinuria, hematuria, and AKI with outcomes of inflammation, intensive care unit (ICU) admission, invasive mechanical ventilation (IMV), and in-hospital death. We used ANOVA, t test, χ2 test, and Fisher's exact test for bivariate analyses and logistic regression for multivariable analysis. RESULTS: Three hundred patients met the inclusion criteria for the study cohort. Multivariable analysis demonstrated that admission proteinuria was significantly associated with risk of in-hospital AKI (OR 4.71, 95% CI 1.28-17.38), while admission hematuria was associated with ICU admission (OR 4.56, 95% CI 1.12-18.64), IMV (OR 8.79, 95% CI 2.08-37.00), and death (OR 18.03, 95% CI 2.84-114.57). During hospitalization, de novo proteinuria was significantly associated with increased risk of death (OR 8.94, 95% CI 1.19-114.4, p = 0.04). In-hospital AKI increased (OR 27.14, 95% CI 4.44-240.17) while recovery from in-hospital AKI decreased the risk of death (OR 0.001, 95% CI 0.001-0.06). CONCLUSION: Proteinuria and hematuria both at the time of admission and during hospitalization are associated with adverse clinical outcomes in hospitalized patients with COVID-19.

N-Terminal Pro-B-Type Natriuretic Peptide and Mortality in Patients without Heart Failure Hospitalized with Severe Covid-19 Pneumonia

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been associated with myocardial damage. N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels have been reported to be elevated and to portend worse outcomes among patients hospitalized with coronavirus disease 2019 (COVID-19). The value of NT-proBNP in COVID-19 patients without heart failure (HF) is unclear, and data from the United States are limited. We reviewed the medical records of 304 adults without history of HF admitted to Stony Brook University Hospital, Long Island, NY, from March 1 to April 15, 2020 with documented severe COVID-19 pneumonia requiring high-flow oxygen therapy (non-rebreather mask, Venturi mask with FiO2 >50%, or high-flow nasal cannula). We excluded patients transferred already intubated from outside hospitals and those who were intubated or died within 24h of admission. NT-proBNP was measured with a standard Roche Diagnostics assay with a 5-ng/L limit of detection. Follow-up data were collected until death or hospital discharge or 30 days if still in the hospital by database lock (May 15, 2020). The primary endpoint was all-cause mortality and the secondary endpoint was death or need for intubation. The association of NT-proBNP with the endpoints was evaluated with multivariable Cox regression models. Mean age was 60±17 years;95 (31.2%) of patients were female;156 (51.3%) were White, 103 (33.9%) Hispanic, 22 (7.2%) Black, and 21 (6.9%) Asian;91 (29.9%) had diabetes, 39 (12.8%) coronary artery disease (CAD), and 27 (8.9%) atrial fibrillation (AF);mean body mass index (BMI) was 30.3±6.5 kg/m2. On admission, mean O2 saturation (O2SAT) was 89±8% and median NT-proBNP was 156 ng/L (44-729). After a median of 12 days (8-20), 74 patients (24.3%) died and 59 more (19.4%) were intubated and survived to hospital discharge. Baseline NT-proBNP was strongly associated with mortality. In models adjusting for age, sex, race, diabetes, CAD, AF, BMI, and baseline O2SAT, every log-2 (doubling) of NT-proBNP was associated with 29% higher risk (HR 1.29;95%CI: 1.17-1.43;P<0.001). The association of baseline NT-proBNP with the composite of death or intubation was weaker (HR 1.09;95%CI: 1.01-1.18;P = 025). Among patients hospitalized with severe COVID-19 pneumonia, admission NT-proBNP is a strong predictor of mortality. Elevated NT-proBNP levels may identify a subgroup of patients in need of cardioprotective therapy.