Key result
Higher BNP and NT-proBNP strongly linked to severe disease and mortality in COVID-19.
Why the study?
Alterations in cardiac biomarkers have been reported in patients with COVID-19 in relation to disease severity and mortality, prompting a systematic assessment of BNP and NT-proBNP concentrations.
Are higher BNP/NT-proBNP plasma concentrations associated with increased disease severity and mortality in COVID-19 patients?
Meta-Analysis (n=18,856)
Are higher BNP/NT-proBNP plasma concentrations associated with increased disease severity and mortality in COVID-19 patients?
Effect estimate: SMD 1.07 (95% CI 0.89-1.24)
p-value: p=<0.001
Elevated plasma concentrations of BNP or NT-proBNP on admission are significantly associated with higher disease severity and increased mortality in patients with COVID-19.
May aid COVID-19 risk stratification on admission; confirms association but leaves causal impact open.
Alterations in cardiac biomarkers have been reported in patients with coronavirus disease 2019 (COVID-19) in relation to disease severity and mortality. We conducted a systematic review and meta-analysis with meta-regression of studies reporting B-type natriuretic peptide (BNP) or N-terminal proBNP (NT-proBNP) plasma concentrations in COVID-19. We searched PubMed, Web of Science, and Scopus, between January 2020 and 2021, for studies reporting BNP/NT-proBNP concentrations, measures of COVID-19 severity, and survival status (PROSPERO registration number: CRD42021239190). Forty-four studies in 18,856 COVID-19 patients were included in the meta-analysis and meta-regression. In pooled results, BNP/NT-proBNP concentrations were significantly higher in patients with high severity or non-survivor status when compared to patients with low severity or survivor status during follow up (SMD = 1.07, 95% CI: 0.89–1.24, and p < 0.001). We observed extreme between-study heterogeneity ( I 2 = 93.9%, p < 0.001). In sensitivity analysis, the magnitude and the direction of the effect size were not substantially modified after sequentially removing individual studies and re-assessing the pooled estimates, (effect size range, 0.99 – 1.10). No publication bias was observed with the Begg's ( p = 0.26) and Egger's ( p = 0.40) t -tests. In meta-regression analysis, the SMD was significantly and positively associated with D-dimer ( t = 2.22, p = 0.03), myoglobin ( t = 2.40, p = 0.04), LDH ( t = 2.38, p = 0.02), and procalcitonin ( t = 2.56, p = 0.01) concentrations. Therefore, higher BNP/NT-proBNP plasma concentrations were significantly associated with severe disease and mortality in COVID-19 patients.
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Zinellu et al. (2021) conducted a meta-analysis in COVID-19 (n=18,856). BNP or NT-proBNP vs. Low severity or survivor status was evaluated on BNP/NT-proBNP concentrations in high severity or non-survivor status vs low severity or survivor status (SMD 1.07, 95% CI 0.89-1.24, p=<0.001). Higher BNP and NT-proBNP plasma concentrations were significantly associated with severe disease and mortality in patients with COVID-19 (SMD 1.07).
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