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Mid‐regional pro‐atrial natriuretic peptide independently predicts short‐term mortality in COVID‐19
Author(s) -
Kaufmann Christoph C.,
Ahmed Amro,
Kassem Mona,
Freynhofer Matthias K.,
Jäger Bernhard,
Aicher Gabriele,
EquiluzBruck Susanne,
Spiel Alexander O.,
Funk GeorgChristian,
Gschwantler Michael,
Fasching Peter,
Wojta Johann,
Huber Kurt
Publication year - 2021
Publication title -
european journal of clinical investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.164
H-Index - 107
eISSN - 1365-2362
pISSN - 0014-2972
DOI - 10.1111/eci.13531
Subject(s) - medicine , natriuretic peptide , cardiology , confounding , covid-19 , prospective cohort study , severity of illness , atrial natriuretic peptide , brain natriuretic peptide , heart failure , disease , infectious disease (medical specialty)
Background Mid‐regional pro‐atrial natriuretic peptide (MR‐proANP) is a strong prognostic marker in several inflammatory, respiratory and cardiovascular conditions, but has not been studied in COVID‐19 yet. Methods This prospective, observational study of patients with COVID‐19 infection was conducted from 6 June to 26 November 2020 in different wards of a tertiary hospital. MR‐proANP, N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) and high‐sensitive cardiac troponin I levels on admission were collected and tested for their association with disease severity and 28‐day mortality. Results A total of 213 eligible patients with COVID‐19 were included in the final analyses of whom 13.2% (n = 28) died within 28 days. Median levels of MR‐proANP at admission were significantly higher in nonsurvivors (307 pmol/L IQR, [161 ‐ 532] vs 75 pmol/L [IQR, 43 ‐ 153], P < .001) compared to survivors and increased with disease severity and level of hypoxaemia. The area under the ROC curve for MR‐proANP predicting 28‐day mortality was 0.832 (95% CI 0.753 ‐ 0.912, P < .001). An optimal cut‐off point of 160 pmol/L yielded a sensitivity of 82.1% and a specificity of 76.2%. MR‐proANP was a significant predictor of 28‐day mortality independent of clinical confounders, comorbidities and established prognostic markers of COVID‐19 (HR 2.77, 95% CI 1.21 ‐ 6.37; P = .016), while NT‐proBNP failed to independently predict 28‐day mortality and had a numerically lower AUC compared to MR‐proANP. Conclusion Higher levels of MR‐proANP at admission are associated with disease severity of COVID‐19 and act as a powerful and independent prognostic marker of 28‐day mortality.