Elevated Natriuretic Peptides in Patients With Severe or Critical COVID-19: A Meta-Analysis

Background: The worldwide COVID-19 pandemic caused by SARS-CoV-2 has resulted in an extraordinary increase in the number of patients who are severely critically ill. For many of these patients, cardiovascular risk factors are key contributors to the development of severe illness. Laboratory markers for cardiac damage and failure, such as natriuretic peptides, are reported to be elevated in patients with severe COVID-19.Methods: We conducted a systematic review and meta-analysis to compare natriuretic peptide levels in patients with severe COVID-19 vs those with nonsevere COVID-19. PubMed and medRxiv were searched through April 7, 2020. The outcome of interest was the difference in B-type natriuretic peptide (BNP) or N-terminal-proBNP levels in patients with severe vs nonsevere COVID-19.Results: We identified 9 retrospective cohort studies that had a total of 1,575 patients with COVID-19 who had their natriuretic peptides measured and were classified by disease severity. All studies were conducted in China. Patients with severe COVID-19 had significantly higher BNP levels than patients with nonsevere COVID-19 (mean difference, 69.56 pg/mL; 95% CI, 1.77-137.35 pg/mL; P=.04, I-2=83%). Similarly, patients with severe COVID-19 had significantly higher N-terminal-proBNP levels than patients with nonsevere COVID-19 (mean difference, 518.65 pg/mL; 95% CI, 152.40-884.90 pg/mL; P=.006, I-2=86%).Conclusions: In this study, Chinese patients with severe COVID-19 had higher natriuretic peptide levels than those with nonsevere COVID-19. Studies from all countries affected by the virus will help to further delineate whether the cause is directly or indirectly of cardiac origin and whether preexisting heart failure has an influence on this disparity.

背景：由严重急性呼吸综合征冠状病毒2（SARS - CoV - 2）引发的全球新型冠状病毒肺炎（COVID - 19）大流行导致重症患者数量大幅增加。对于许多此类患者，心血管危险因素是病情加重的关键因素。据报道，严重COVID - 19患者中心脏损伤和衰竭的实验室标志物，如利钠肽，会升高。 方法：我们进行了一项系统综述和荟萃分析，以比较重症COVID - 19患者和非重症COVID - 19患者的利钠肽水平。我们检索了截至2020年4月7日的PubMed和medRxiv数据库。关注的结果是重症与非重症COVID - 19患者B型利钠肽（BNP）或N末端 - 前体BNP水平的差异。 结果：我们确定了9项回顾性队列研究，共有1575例COVID - 19患者测量了利钠肽并按疾病严重程度分类。所有研究均在中国进行。重症COVID - 19患者的BNP水平显著高于非重症COVID - 19患者（平均差异为69.56皮克/毫升；95%置信区间为1.77 - 137.35皮克/毫升；P = 0.04，I² = 83%）。同样，重症COVID - 19患者的N末端 - 前体BNP水平也显著高于非重症COVID - 19患者（平均差异为518.65皮克/毫升；95%置信区间为152.40 - 884.90皮克/毫升；P = 0.006，I² = 86%）。 结论：在本研究中，中国重症COVID - 19患者的利钠肽水平高于非重症患者。来自所有受该病毒影响国家的研究将有助于进一步明确其原因是直接或间接源于心脏，以及既往存在的心力衰竭是否对这种差异有影响。