Cardiac biomarkers in acute respiratory distress syndrome: a systematic review and meta-analysis

Abstract

Background Acute respiratory distress syndrome (ARDS) is a leading cause of morbidity and mortality in the intensive care unit. Biochemical markers of cardiac dysfunction are associated with high mortality in many respiratory conditions. The aim of this systematic review is to examine the link between elevated biomarkers of cardiac dysfunction in ARDS and mortality. Methods A systematic review of MEDLINE, EMBASE, Web of Science and CENTRAL databases was performed. We included studies of adult intensive care patients with ARDS that reported the risk of death in relation to a measured biomarker of cardiac dysfunction. The primary outcome of interest was mortality up to 60 days. A random-effects model was used for pooled estimates. Funnel-plot inspection was done to evaluate publication bias; Cochrane chi-square tests and I2 tests were used to assess heterogeneity. Results Twenty-two studies were included in the systematic review and 18 in the meta-analysis. Biomarkers of cardiac stretch included NT-ProBNP (nine studies) and BNP (six studies). Biomarkers of cardiac injury included Troponin-T (two studies), Troponin-I (one study) and High-Sensitivity-Troponin-I (three studies). Three studies assessed multiple cardiac biomarkers. High levels of NT-proBNP and BNP were associated with a higher risk of death up to 60 days (unadjusted OR 8.98; CI 4.15-19.43; p<0.00001). This association persisted after adjustment for age and illness severity. Biomarkers of cardiac injury were also associated with higher mortality, but this association was not statistically significant (unadjusted OR 2.21; CI 0.94-5.16; p= 0.07). Conclusion Biomarkers of cardiac stretch are associated with increased mortality in ARDS.

Right Ventricular Dysfunction in Ventilated Patients with COVID-19 (COVID-RV)

“…Cardiomyocyte injury, quantified by elevated troponin levels, and haemodynamic cardiac stress, as quantified by increased natriuretic peptide concentrations have been previously described both in COVID-19 and ARDS [32][33][34]. The association of NT-proBNP and abnormal troponin levels with RVD in this cohort suggests a potential role of direct myocardial injury in the aetiology of myocardial dysfunction in patients with COVID-19.…”

Snakebites in Pediatric Patients in Kahramanmaraş: Is Pro-brain Natriuretic Peptide a Prognostic Biomarker for Snakebites?

“…In animal and human studies, it has been stated that when hypoxic pulmonary vasoconstriction is created, BNP increases and causes pulmonary vasodilation. It has been reported that high BNP is associated with an increased risk of death in patients with acute respiratory distress syndrome (ARDS) [ 24 ]. Güllü et al studied cases of envenomation due to scorpion bites and showed proBNP to have a good predictive value for a poor outcome [ 7 ].…”

Analytical validation of a novel point‐of‐care immunoassay for canine N‐terminal pro‐brain natriuretic peptide analysis

“…NT‐proBNP is currently used as a prognostic indicator in human patients and appears to predict adverse outcomes better than other cardiac biomarkers upon patient follow‐up, suggesting the ability to aid in risk stratification 4 . Additionally, a metanalysis of 18 research studies revealed that high NT‐proBNP concentrations, indicating cardiac stretch, were associated with a higher risk of death due to acute respiratory distress syndrome for up to 60 days 5 . Thus, NT‐proBNP is an important prognosticator for both left heart and right heart overload, which includes either cardiogenic or pulmonogenic etiologies.…”

“…4 Additionally, a metanalysis of 18 research studies revealed that high NT-proBNP concentrations, indicating cardiac stretch, were associated with a higher risk of death due to acute respiratory distress syndrome for up to 60 days. 5 Thus, NT-proBNP is an important prognosticator for both left heart and right heart overload, which includes either cardiogenic or pulmonogenic etiologies.…”