AUTHOR=Zinellu Angelo , Sotgia Salvatore , Carru Ciriaco , Mangoni Arduino A. 

TITLE=B-Type Natriuretic Peptide Concentrations, COVID-19 Severity, and Mortality: A Systematic Review and Meta-Analysis With Meta-Regression

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=8

YEAR=2021

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2021.690790

DOI=10.3389/fcvm.2021.690790

ISSN=2297-055X

ABSTRACT=<p>Alterations in cardiac biomarkers have been reported in patients with coronavirus disease 2019 (COVID-19) in relation to disease severity and mortality. We conducted a systematic review and meta-analysis with meta-regression of studies reporting B-type natriuretic peptide (BNP) or N-terminal proBNP (NT-proBNP) plasma concentrations in COVID-19. We searched PubMed, Web of Science, and Scopus, between January 2020 and 2021, for studies reporting BNP/NT-proBNP concentrations, measures of COVID-19 severity, and survival status (PROSPERO registration number: CRD42021239190). Forty-four studies in 18,856 COVID-19 patients were included in the meta-analysis and meta-regression. In pooled results, BNP/NT-proBNP concentrations were significantly higher in patients with high severity or non-survivor status when compared to patients with low severity or survivor status during follow up (SMD = 1.07, 95% CI: 0.89–1.24, and <italic>p</italic> &lt; 0.001). We observed extreme between-study heterogeneity (<italic>I</italic><sup>2</sup> = 93.9%, <italic>p</italic> &lt; 0.001). In sensitivity analysis, the magnitude and the direction of the effect size were not substantially modified after sequentially removing individual studies and re-assessing the pooled estimates, (effect size range, 0.99 – 1.10). No publication bias was observed with the Begg's (<italic>p</italic> = 0.26) and Egger's (<italic>p</italic> = 0.40) <italic>t</italic>-tests. In meta-regression analysis, the SMD was significantly and positively associated with D-dimer (<italic>t</italic> = 2.22, <italic>p</italic> = 0.03), myoglobin (<italic>t</italic> = 2.40, <italic>p</italic> = 0.04), LDH (<italic>t</italic> = 2.38, <italic>p</italic> = 0.02), and procalcitonin (<italic>t</italic> = 2.56, <italic>p</italic> = 0.01) concentrations. Therefore, higher BNP/NT-proBNP plasma concentrations were significantly associated with severe disease and mortality in COVID-19 patients.</p>