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Meta-Analysis
. 2020 Jul;96(1137):387-391.
doi: 10.1136/postgradmedj-2020-137884. Epub 2020 May 20.

Elevated N-terminal pro-brain natriuretic peptide is associated with increased mortality in patients with COVID-19: systematic review and meta-analysis

Raymond Pranata  1 , Ian Huang  2   3 , Antonia Anna Lukito  2   4 , Sunu Budhi Raharjo  5
Affiliations
Meta-Analysis

Elevated N-terminal pro-brain natriuretic peptide is associated with increased mortality in patients with COVID-19: systematic review and meta-analysis

Raymond Pranata et al. Postgrad Med J. 2020 Jul.

Abstract

Objectives: This systematic review and meta-analysis aimed to assess the association between N-terminal pro-brain natriuretic peptide (NT-proBNP) and mortality in patients with COVID-19.

Methods: Systematic literature search from several electronic databases were performed. The outcome was mortality (non-survivor) in patients with COVID-19 pneumonia. NT-proBNP data were in continuous variable (pg/mL), dichotomous data (elevated/non-elevated) and effect estimate adjusted to cardiac injury/elevated biomarkers of cardiac injury.

Results: A total of 967 patients from six studies were included in this analysis. NT-proBNP was higher in non-survivor group (standardised mean difference 0.75 (0.44, 1.07), p<0.001; I2: 61%). Elevated NT-proBNP was associated with increased mortality (RR 3.63 (92.21, 5.95), p<0.001; I2: 60%). Sensitivity analysis by removing a study reduces heterogeneity (risk ratio 3.47 (2.36, 5.11), p<0.001; I2: 49%). Pooled adjusted HR (adjusted to cardiac injury/elevated biomarkers of cardiac injury) showed that elevated NT-proBNP was independently associated with mortality (HR 1.37 (1.19, 1.57), p<0.001; I2: 0%, p=0.77). Pooled analysis of multiple cut-off point resulted in a sensitivity of 76% (46%-92%) and specificity of 88% (71%-96%). Summary receiver operating characteristic curve analysis demonstrates an area under curve of 0.90 (0.87-0.93). Elevated NT-proBNP has a likelihood ratio (LR) +6.4 and LR -0.3.

Conclusion: Elevated NT-proBNP level was associated with increased mortality in COVID-19 pneumonia.

Keywords: infectious diseases; intensive & critical care; respiratory infections.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses study flow diagram. NT-proBNP, N-terminal pro-brain natriuretic peptide.
Figure 2
Figure 2
NT-proBNP concentration and mortality. Non-survivors have a higher concentration of NT-proBNP compared with survivors. NT-proBNP, N-terminal pro-brain natriuretic peptide.
Figure 3
Figure 3
Elevated NT-proBNP and mortality. Elevated NT-proBNP was associated with increased mortality. NT-proBNP, N-terminal pro-brain natriuretic peptide.
Figure 4
Figure 4
SROC curve for elevated NT-proBNP and mortality. SROC curve for pooled analysis of elevated NT-proBNP at multiple cut-off points. NT-proBNP, N-terminal pro-brain natriuretic peptide. SROC: Summary receiver operating characteristic
Figure 5
Figure 5
Funnel-plot analysis. Funnel-plot analysis showing asymmetrical funnel plot indicating possible risk of publication bias. SMD, standardised mean difference.
See this image and copyright information in PMC

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