Mid‐regional pro‐atrial natriuretic peptide independently predicts short‐term mortality in COVID‐19

Abstract

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

Improvement of outcome prediction of hospitalized patients with COVID-19 by a dual marker strategy using high-sensitive cardiac troponin I and copeptin

“…We have previously published data from the same study population and reported on the prognostic impact of Mid-regional pro-atrial natriuretic peptide among other biomarkers (creatinine, blood urea nitrogen, LDH, hs-cTnI, NT-proBNP) on 28-day mortality [ 16 ].…”

Effectiveness of Copeptin, MR-proADM and MR-proANP in Predicting Adverse Outcomes, Alone and in Combination with Traditional Severity Scores, a Secondary Analysis in COVID-19 Patients Requiring Intensive Care Admission

“…In our population 43 subjects were obese (63.2%), 12 subjects were affected by diabetes mellitus (17.6%) and 45 subjects were affected by arterial hypertension (66.2%). The median length of stay (LOS) in ICU was 13 [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] days, while the median LOS in hospital was 20 [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] days. Demographic, clinical and biochemical characteristics of the enrolled patients are listed in Table 1.…”

“…The attempt to find a possible correlation between some endocrinological markers and COVID-19 severity has already been investigated in the literature with encouraging results [11][12][13][14][15]. For sure, in light of the longer half-life and stability of mid-regional pro-adrenomedullin (MR-proADM), copeptin and mid-regional pro-atrial natriuretic peptide (MR-proANP), with respect to their biologically active counterpart (namely ADM, AVP-arginine vasopressin-and ANP), the research focus has been shifted especially to these three markers.…”

Biomarkers Associated with Cardiovascular Disease in COVID-19

“…There are several pathophysiological links that may contribute to the association of MR-proANP with COVID-19. Most of these mechanisms are closely linked to pathophysiological considerations with NT-proBNP, since both biomarkers are secreted upon volume overload, one primarily by ventricular and the other by atrial myocytes [85].…”