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Vogel MJ, Leininger SB, Staudner ST, Hubauer U, Wallner S, Mustroph J, Hanses F, Zimmermann M, Lehn P, Burkhardt R, Maier LS, Hupf J, Jungbauer CG. Urinary N-Terminal Pro-Brain Natriuretic Peptide Predicts Acute Kidney Injury and Severe Disease in COVID-19. Kidney Blood Press Res 2023; 48:424-435. [PMID: 37364545 PMCID: PMC10308530 DOI: 10.1159/000529690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 02/01/2023] [Indexed: 06/28/2023] Open
Abstract
INTRODUCTION The ongoing COVID-19 pandemic is placing an extraordinary burden on our health care system with its limited resources. Accurate triage of patients is necessary to ensure medical care for those most severely affected. In this regard, biomarkers could contribute to risk evaluation. The aim of this prospective observational clinical study was to assess the relationship between urinary N-terminal pro-brain natriuretic peptide (NT-proBNP) and acute kidney injury (AKI) as well as severe disease in patients with COVID-19. METHODS 125 patients treated with an acute respiratory infection in the emergency department of the University Hospital Regensburg were analyzed. These patients were divided into a COVID-19 cohort (n = 91) and a cohort with infections not caused by severe acute respiratory syndrome-coronavirus-2 (n = 34). NT-proBNP was determined from serum and fresh urine samples collected in the emergency department. Clinical endpoints were the development of AKI and a composite one consisting of AKI, intensive care unit admission, and in-hospital death. RESULTS 11 (12.1%) COVID-19 patients developed AKI during hospitalization, whereas 15 (16.5%) reached the composite endpoint. Urinary NT-proBNP was significantly elevated in COVID-19 patients who suffered AKI or reached the composite endpoint (each p < 0.005). In a multivariate regression analysis adjusted for age, chronic kidney disease, chronic heart failure, and arterial hypertension, urinary NT-proBNP was identified as independent predictor of AKI (p = 0.017, OR = 3.91 [CI: 1.28-11.97] per standard deviation [SD]), as well as of the composite endpoint (p = 0.026, OR 2.66 [CI: 1.13-6.28] per SD). CONCLUSION Urinary NT-proBNP might help identify patients at risk for AKI and severe disease progression in COVID-19.
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Affiliation(s)
- Manuel Julian Vogel
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Simon B Leininger
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Stephan T Staudner
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Ute Hubauer
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Stefan Wallner
- Department of Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Julian Mustroph
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Frank Hanses
- Emergency Department, University Hospital Regensburg, Regensburg, Germany
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - Markus Zimmermann
- Emergency Department, University Hospital Regensburg, Regensburg, Germany
| | - Petra Lehn
- Department of Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Ralph Burkhardt
- Department of Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Lars S Maier
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Julian Hupf
- Emergency Department, University Hospital Regensburg, Regensburg, Germany
| | - Carsten G Jungbauer
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
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Christou E, Iliodromiti Z, Pouliakis A, Loukatou E, Varela P, Panagoulia A, Chasiakou A, Zisimopoulos S, Iacovidou N, Boutsikou T. Urinary NT-proBNP: A Useful Biomarker for the Diagnosis of Respiratory Distress in the Neonatal Population. Cureus 2023; 15:e39019. [PMID: 37323310 PMCID: PMC10266900 DOI: 10.7759/cureus.39019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 06/17/2023] Open
Abstract
OBJECTIVE To determine the diagnostic accuracy of urinary NT-proBNP levels in the detection and classification of the severity of respiratory distress in neonates after birth. METHODS We compared the urinary NT- proBNP levels between the respiratory distress (RD) group and the control group on the 1st, 3rd, and 5th day of life (DOL). RESULTS The RD group (55 neonates) showed higher levels of NT-proBNP compared to the control group (63 neonates) on DOL1 (585.4 pg/ml vs 396.1 pg/ml (p=0.014)), DOL3 (805.1 pg/ml vs 271.9 pg/ml (p<0.001)) and DOL5 (409.7 pg/ml vs 94.4 pg/ml (p<0.001)). Especially, on DOL5, the area under the ROC curve was 0.884 and the NT-proBNP cut-off value (221.8 pg/ml) showed a sensitivity of 71% and specificity of 79%. The RD group was subclassified into neonates with mild (21 neonates), moderate (19 neonates), and severe (15 neonates) disease. NT-proBNP cut-off point of 668 pg/ml for DOL5 can safely differentiate neonates with severe disease from those with mild and moderate disease (combined subgroups) since the sensitivity was 80% and specificity was 77.5% for DOL5. CONCLUSION Urinary NT-proBNP levels are a useful biomarker in detecting clinical signs of respiratory distress in neonates that are born within the first week of life; they can also detect neonates that are vulnerable to severe forms of the disease.
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Affiliation(s)
- Evangelos Christou
- Department of Pediatrics, Panagiotis & Aglaia Kyriakou Children's Hospital, Athens, GRC
- Department of Neonatology, Aretaieion University Hospital, Athens, GRC
| | - Zoi Iliodromiti
- Department of Neonatology, Aretaieion University Hospital, Athens, GRC
| | - Abraham Pouliakis
- Epidemiology and Public Health, 2nd Department of Pathology, National and Kapodistrian University of Athens, Athens, GRC
| | - Eirini Loukatou
- Department of Pediatrics, Alexandra General Hospital, Athens, GRC
| | - Pinelopi Varela
- Department of Pediatrics, Alexandra General Hospital, Athens, GRC
| | - Adamantia Panagoulia
- Department of Biochemistry, Panagiotis & Aglaia Kyriakou Children's Hospital, Athens, GRC
| | - Anthia Chasiakou
- Department of Biopathology, Aretaieion University Hospital, Athens, GRC
| | - Spyridon Zisimopoulos
- Department of Pediatrics, Elena Venizelou General and Maternity Hospital, Athens, GRC
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Reynen S, Schlossbauer M, Hubauer U, Hupf J, Mohr A, Orso E, Zimmermann M, Luchner A, Maier LS, Wallner S, Jungbauer CG. Urinary N-terminal pro-brain natriuretic peptide: prognostic value in patients with acute chest pain. ESC Heart Fail 2021; 8:2293-2305. [PMID: 33822463 PMCID: PMC8120380 DOI: 10.1002/ehf2.13332] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 03/02/2021] [Accepted: 03/12/2021] [Indexed: 11/10/2022] Open
Abstract
AIMS The objective of this study was to investigate the prognostic value of urinary N-terminal pro-brain natriuretic peptide (NT-proBNP) compared with plasma NT-proBNP in patients presenting with acute chest pain in the emergency department. METHODS AND RESULTS We measured simultaneously plasma and urinary NT-proBNP at admission in 301 patients with acute chest pain. In our cohort, 174 patients suffered from acute coronary syndrome (ACS). A follow-up (median of 55 months) was performed regarding the endpoints all-cause mortality and major adverse cardiac events (mortality, congestive heart failure, ACS with the necessity of a coronary intervention, and stroke). Fifty-four patients died during follow-up; 98 suffered from the combined endpoint. A significant and positive correlation of urinary and plasma NT-proBNP was found (r = 0.87, P < 0.05). Patients with troponin positive ACS had significantly elevated levels of plasma and urinary NT-proBNP compared with those with unstable angina pectoris or chest wall syndrome (each P < 0.05). The highest levels of both biomarkers were found in patients with congestive heart failure (each P < 0.05). According to Kaplan-Meier analysis, plasma and urinary NT-proBNP were significant predictors for mortality and the combined endpoint in the whole study cohort and in the subgroup of patients with ACS (each P < 0.05). Regarding Cox regression analysis, plasma and urinary NT-proBNP were independent predictors for mortality and the combined endpoint (each P < 0.05). CONCLUSIONS Urinary NT-proBNP seems to provide a significant predictive value regarding the endpoints all-cause mortality and major adverse cardiac events in patients with acute chest pain and those with ACS.
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Affiliation(s)
- Stefanie Reynen
- Department of Internal Medicine II (Cardiology), University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, Regensburg, 93053, Germany
| | - Michael Schlossbauer
- Department of Internal Medicine II (Cardiology), University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, Regensburg, 93053, Germany.,Department of Anesthesiology, Hospital Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Ute Hubauer
- Department of Internal Medicine II (Cardiology), University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, Regensburg, 93053, Germany
| | - Julian Hupf
- Emergency Department, University Hospital Regensburg, Regensburg, Germany
| | - Arno Mohr
- Department of Internal Medicine II (Cardiology), University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, Regensburg, 93053, Germany.,Department of Pneumology, Donaustauf Hospital, Donaustauf, Germany
| | - Evelyn Orso
- Department of Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Markus Zimmermann
- Emergency Department, University Hospital Regensburg, Regensburg, Germany
| | - Andreas Luchner
- Department of Cardiology, Hospital Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Lars S Maier
- Department of Internal Medicine II (Cardiology), University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, Regensburg, 93053, Germany
| | - Stefan Wallner
- Department of Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Carsten G Jungbauer
- Department of Internal Medicine II (Cardiology), University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, Regensburg, 93053, Germany
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