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

Pranata, Raymond; Huang, Ian; Lukito, Antonia Anna; Raharjo, Sunu Budhi

doi:10.1136/postgradmedj-2020-137884

Cited by 107 publications

(100 citation statements)

References 20 publications

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“…When compared to individuals with normal BMI, subjects with obesity have a greater risk of hypertension, dyslipidemia, insulin resistance, type 2 diabetes mellitus (T2DM), cardiovascular disease and cerebrovascular disease, all of which are recognized as comorbidities for poor outcomes in COVID-19 patients [21] , [22] , [24] , [25] . Excess BMI has been shown to increase susceptibility to infections, and obesity itself is an independent risk factor for severe COVID-19 [26] , [27] .…”

Section: Discussionmentioning

confidence: 99%

Body mass index and outcome in patients with COVID-19: A dose–response meta-analysis

Pranata

Lim

Yonas

et al. 2021

Diabetes & Metabolism

148

157

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Highlights Obesity was associated with mortality and severity in patients with COVID-19. Dose–response meta-analysis demonstrate an increase of 5% risk for poor outcome for every 5 kg/mg 2 increase in body mass index. The relationship departed from linearity and became steeper from 30–35 kg/mg 2 onwards.

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Section: Discussionmentioning

confidence: 99%

Body mass index and outcome in patients with COVID-19: A dose–response meta-analysis

Pranata

Lim

Yonas

et al. 2021

Diabetes & Metabolism

148

157

View full text Add to dashboard Cite

show abstract

“…While most patients with COVID-19 have mild influenza-like illness and may be asymptomatic, a minority of patients will develop severe pneumonia, acute respiratory distress syndrome (ARDS), multi-organ failure (MOF), and death [3]. Clinical and laboratory biomarkers [4] to predict the mortality and severity of COVID-19 are essential in this pandemic situation of which resource allocation must be urgently prepared especially in the context of respiratory support readiness.…”

Section: Introductionmentioning

confidence: 99%

Lymphopenia in severe coronavirus disease-2019 (COVID-19): systematic review and meta-analysis

2020

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Objective: Clinical and laboratory biomarkers to predict the severity of coronavirus disease 2019 (COVID-19) are essential in this pandemic situation of which resource allocation must be urgently prepared especially in the context of respiratory support readiness. Lymphocyte count has been a marker of interest since the first COVID-19 publication. We conducted a systematic review and meta-analysis in order to investigate the association of lymphocyte count on admission and the severity of COVID-19. We would also like to analyze whether patient characteristics such as age and comorbidities affect the relationship between lymphocyte count and COVID-19. Methods: Comprehensive and systematic literature search was performed from PubMed, SCOPUS, EuropePMC, ProQuest, Cochrane Central Databases, and Google Scholar. Research articles in adult patients diagnosed with COVID-19 with information on lymphocyte count and several outcomes of interest, including mortality, acute respiratory distress syndrome (ARDS), intensive care unit (ICU) care, and severe COVID-19, were included in the analysis. Inverse variance method was used to obtain mean differences and its standard deviations. Maentel-Haenszel formula was used to calculate dichotomous variables to obtain odds ratios (ORs) along with its 95% confidence intervals. Random-effect models were used for meta-analysis regardless of heterogeneity. Restrictedmaximum likelihood random-effects meta-regression was performed for age, gender, cardiac comorbidity, hypertension, diabetes mellitus, COPD, and smoking. Results: There were a total of 3099 patients from 24 studies. Meta-analysis showed that patients with poor outcome have a lower lymphocyte count (mean difference − 361.06 μL [− 439.18, − 282.95], p < 0.001; I 2 84%) compared to those with good outcome. Subgroup analysis showed lower lymphocyte count in patients who died (mean difference − 395.35 μL [− 165.64, − 625.07], p < 0.001; I 2 87%), experienced ARDS (mean difference − 377.56 μL [− 271.89, − 483.22], p < 0.001; I 2 0%), received ICU care (mean difference − 376.53 μL [− 682.84, − 70.22], p = 0.02; I 2 89%), and have severe COVID-19 (mean difference − 353.34 μL [− 250.94, − 455.73], p < 0.001; I 2 85%). Lymphopenia was associated with severe COVID-19 (OR 3.70 [2.44, 5.63], p < 0.001; I 2 40%). Meta-regression showed that the association between lymphocyte count and composite poor outcome was affected by age (p = 0.034). Conclusion: This meta-analysis showed that lymphopenia on admission was associated with poor outcome in patients with COVID-19.

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“…Comorbidities and laboratory markers have been proposed for risk stratification. 3 – 6 There is mounting evidence that in critically ill patients, there are characteristics of hyperinflammation, which consist of elevated serum C-reactive protein (CRP), procalcitonin (PCT), D-dimer, and hyperferritinemia. These findings suggest a possibly crucial role of a cytokine storm in COVID-19 pathophysiology.…”

Section: Introductionmentioning

confidence: 99%

C-reactive protein, procalcitonin, D-dimer, and ferritin in severe coronavirus disease-2019: a meta-analysis

Huang

Pranata

Lim

et al. 2020

Ther Adv Respir Dis

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519

438

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Background: Patients critically ill with coronavirus disease-2019 (COVID-19) feature hyperinflammation, and the associated biomarkers may be beneficial for risk stratification. We aimed to investigate the association between several biomarkers, including serum C-reactive protein (CRP), procalcitonin (PCT), D-dimer, and serum ferritin, and COVID-19 severity. Methods: We performed a comprehensive systematic literature search through electronic databases. The outcome of interest for this study was the composite poor outcome, which comprises mortality, acute respiratory distress syndrome, need for care in an intensive care unit, and severe COVID-19. Results: A total of 5350 patients were pooled from 25 studies. Elevated CRP was associated with an increased composite poor outcome [risk ratio (RR) 1.84 (1.45, 2.33), p < 0.001; I2: 96%] and its severe COVID-19 (RR 1.41; I2: 93%) subgroup. A CRP ⩾10 mg/L has a 51% sensitivity, 88% specificity, likelihood ratio (LR) + of 4.1, LR- of 0.5, and an area under curve (AUC) of 0.84. An elevated PCT was associated with an increased composite poor outcome [RR 3.92 (2.42, 6.35), p < 0.001; I2: 85%] and its mortality (RR 6.26; I2: 96%) and severe COVID-19 (RR 3.93; I2: 63%) subgroups. A PCT ⩾0.5 ng/ml has an 88% sensitivity, 68% specificity, LR+ of 2.7, LR- of 0.2, and an AUC of 0.88. An elevated D-dimer was associated with an increased composite poor outcome [RR 2.93 (2.14, 4.01), p < 0.001; I2: 77%], including its mortality (RR 4.15; I2: 83%) and severe COVID-19 (RR 2.42; I2: 58%) subgroups. A D-dimer >0.5 mg/L has a 58% sensitivity, 69% specificity, LR+ of 1.8, LR- of 0.6, and an AUC of 0.69. Patients with a composite poor outcome had a higher serum ferritin with a standardized mean difference of 0.90 (0.64, 1.15), p < 0.0001; I2: 76%. Conclusion: This meta-analysis showed that an elevated serum CRP, PCT, D-dimer, and ferritin were associated with a poor outcome in COVID-19. The reviews of this paper are available via the supplemental material section.

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

Cited by 107 publications

References 20 publications

Body mass index and outcome in patients with COVID-19: A dose–response meta-analysis

Body mass index and outcome in patients with COVID-19: A dose–response meta-analysis

Lymphopenia in severe coronavirus disease-2019 (COVID-19): systematic review and meta-analysis

C-reactive protein, procalcitonin, D-dimer, and ferritin in severe coronavirus disease-2019: a meta-analysis

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