scholarly journals High Levels of Pro B-Type Natriuretic Peptides Are Associated with Adverse Outcomes in COVID-19 Disease: A Single Center Experience

2020 ◽  
Vol 2 (5) ◽  
Author(s):  
Kashif Bin Naeem ◽  
Najiba Abdulrazzaq
Keyword(s):  
Cardiovascular Disease ◽  
Mechanical Ventilation ◽  
Critical Illness ◽  
Natriuretic Peptide ◽  
Cardiac Injury ◽  
Adverse Outcomes ◽  
Risk Of Death ◽  
Single Center Experience ◽  
Lower Egfr ◽  
History Of

Coronavirus disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome Coronavirus-2, has caused widespread morbidity and mortality worldwide. Cardiac injury is reported to be common in hospitalized patients. We evaluated whether Pro B-type Natriuretic Peptide (proBNP) levels measured on admission in COVID-19 patients were associated with worse outcomes. A retrospective analysis of laboratory-confirmed COVID-19 patients who were admitted between February 2020 and July 2020 to Al Kuwait Hospital, Dubai, UAE. Patients were divided into two groups: normal proBNP (≤125 ng/L) and high proBNP (>125 ng/L) upon admission. Clinical characteristics and outcomes were compared between the two groups. A total of 389 patients were studied. Overall, mean age was 50.2 years (range 16-94 years), 77.3% were males, 35.7% diabetics, 35.2% hypertensives and 5.6% had history of cardiovascular disease. Compared to the group with normal proBNP; patients with high proBNP on admission were: older, more diabetics and hypertensives, with more history of cardiovascular disease; they presented with abnormal chest radiograph; and had lower lymphocytes, higher neutrophils, lower eGFR, higher D-dimers, higher CRP and higher procalcitonin on admission laboratory tests. These patients had more risk of developing critical illness during the hospitalization, undergoing mechanical ventilation and risk of death. Elevated pro B-type natriuretic peptide levels on admission in COVID-19 patients may predict subsequent risk of developing critical illness, undergoing mechanical ventilation, and significant high risk of death.

scholarly journals Outcomes of COVID-19 in Patients With a History of Cancer and Comorbid Cardiovascular Disease

2020 ◽  
pp. 1-10
Author(s):  
Sarju Ganatra ◽  
Sourbha S. Dani ◽  
Robert Redd ◽  
Kimberly Rieger-Christ ◽  
Rushin Patel ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Mechanical Ventilation ◽  
Severe Disease ◽  
Multivariable Analysis ◽  
Supplemental Oxygen ◽  
Adverse Outcomes ◽  
Patients With Cancer ◽  
Vulnerable Patient ◽  
History Of ◽  
Secondary Endpoints

Background: Cancer and cardiovascular disease (CVD) are independently associated with adverse outcomes in patients with COVID-19. However, outcomes in patients with COVID-19 with both cancer and comorbid CVD are unknown. Methods: This retrospective study included 2,476 patients who tested positive for SARS-CoV-2 at 4 Massachusetts hospitals between March 11 and May 21, 2020. Patients were stratified by a history of either cancer (n=195) or CVD (n=414) and subsequently by the presence of both cancer and CVD (n=82). We compared outcomes between patients with and without cancer and patients with both cancer and CVD compared with patients with either condition alone. The primary endpoint was COVID-19–associated severe disease, defined as a composite of the need for mechanical ventilation, shock, or death. Secondary endpoints included death, shock, need for mechanical ventilation, need for supplemental oxygen, arrhythmia, venous thromboembolism, encephalopathy, abnormal troponin level, and length of stay. Results: Multivariable analysis identified cancer as an independent predictor of COVID-19–associated severe disease among all infected patients. Patients with cancer were more likely to develop COVID-19–associated severe disease than were those without cancer (hazard ratio [HR], 2.02; 95% CI, 1.53–2.68; P<.001). Furthermore, patients with both cancer and CVD had a higher likelihood of COVID-19–associated severe disease compared with those with either cancer (HR, 1.86; 95% CI, 1.11–3.10; P=.02) or CVD (HR, 1.79; 95% CI, 1.21–2.66; P=.004) alone. Patients died more frequently if they had both cancer and CVD compared with either cancer (35% vs 17%; P=.004) or CVD (35% vs 21%; P=.009) alone. Arrhythmias and encephalopathy were also more frequent in patients with both cancer and CVD compared with those with cancer alone. Conclusions: Patients with a history of both cancer and CVD are at significantly higher risk of experiencing COVID-19–associated adverse outcomes. Aggressive public health measures are needed to mitigate the risks of COVID-19 infection in this vulnerable patient population.

scholarly journals Adaptive metabolic and inflammatory responses identified using accelerated aging metrics are linked to adverse outcomes in severe SARS-CoV-2 infection

2021 ◽  
Author(s):  
Alejandro Márquez-Salinas ◽  
Carlos A Fermín-Martínez ◽  
Neftalí Eduardo Antonio-Villa ◽  
Arsenio Vargas-Vázquez ◽  
Enrique C. Guerra ◽  
...  
Keyword(s):  
Critical Illness ◽  
Proportional Hazards ◽  
Inflammatory Responses ◽  
Age Groups ◽  
Accelerated Aging ◽  
Cox Proportional Hazards ◽  
Adverse Outcomes ◽  
Adaptive Responses ◽  
Predictive Capacity ◽  
Risk Of Death

Abstract Background Chronological age (CA) is a predictor of adverse COVID-19 outcomes; however, CA alone does not capture individual responses to SARS-CoV-2 infection. Here, we evaluated the influence of aging metrics PhenoAge and PhenoAgeAccel to predict adverse COVID-19 outcomes. Furthermore, we sought to model adaptive metabolic and inflammatory responses to severe SARS-CoV-2 infection using individual PhenoAge components. Methods In this retrospective cohort study, we assessed cases admitted to a COVID-19 reference center in Mexico City. PhenoAge and PhenoAgeAccel were estimated using laboratory values at admission. Cox proportional hazards models were fitted to estimate risk for COVID-19 lethality and adverse outcomes (ICU admission, intubation, or death). To explore reproducible patterns which model adaptive responses to SARS-CoV-2 infection, we used k-means clustering using PhenoAge components. Results We included 1068 subjects of whom 222 presented critical illness and 218 died. PhenoAge was a better predictor of adverse outcomes and lethality compared to CA and SpO2 and its predictive capacity was sustained for all age groups. Patients with responses associated to PhenoAgeAccel&gt;0 had higher risk of death and critical illness compared to those with lower values (log-rank p&lt;0.001). Using unsupervised clustering we identified four adaptive responses to SARS-CoV-2 infection: 1) Inflammaging associated with CA, 2) metabolic dysfunction associated with cardio-metabolic comorbidities, 3) unfavorable hematological response, and 4) response associated with favorable outcomes. Conclusions Adaptive responses related to accelerated aging metrics are linked to adverse COVID-19 outcomes and have unique and distinguishable features. PhenoAge is a better predictor of adverse outcomes compared to CA.

scholarly journals Association between the level of plasma B-type natriuretic peptide and in-hospital mortality in patients with acute exacerbation of COPD without a history of coronary ischemic heart disease: a retrospective study

2021 ◽  
Author(s):  
Jiyun Cui ◽  
Jie Liu ◽  
Jing Wang ◽  
Meng Lv ◽  
Chunyan Xing ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Heart Disease ◽  
Hospital Mortality ◽  
Ischemic Heart Disease ◽  
Natriuretic Peptide ◽  
Invasive Mechanical Ventilation ◽  
Ischemic Heart ◽  
Composite Outcome ◽  
History Of ◽  
Secondary Outcomes

Abstract Background: Previous studies suggested that plasma B-type natriuretic peptide (BNP) level was often elevated in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and was associated with increased mortality. However, most studies did not consider the fact that conditions such as coronary ischemic heart disease can also increase BNP level. Therefore, we aimed to explore the association between BNP level and in-hospital mortality in patients with AECOPD without a history of coronary ischemic heart disease.Methods: In this retrospective cohort study, patients who were diagnosed with AECOPD using International Statistical Classification of Diseases and Related Health Problems, Nineth Revision (ICD-9 codes) between January 2017 and December 2019. All data were obtained from electronic patient files and medical data intelligence platform of Jinan Central Hospital. BNP level was determined within 24 hours after admission, and the value was log2 transformed. The primary outcome was in-hospital mortality, and the secondary outcome was a composite outcome of in-hospital mortality or invasive mechanical ventilation.Results: A total of 300 patients were included in this study. Univariate cox regression analysis showed that the unadjusted HRs of the primary and secondary outcomes were 1.85 (95% CI, 1.39-2.47) and 1.45 (95% CI, 1.20-1.75), respectively. After adjustment for age, sex, past medical history, smoking status, drinking status, CURB65 (Confusion, Urea > 7mmol/L, Respiratory rate≥30/min, Blood pressure systolic < 90 mmHg or diastolic <60 mmHg and age > 65 years), arterial partial pressure of O2(PaO2), the adjusted HRs of the primary and secondary outcomes were 3.65 (95% CI, 2.54-5.26) and 1.43 (95% CI, 1.14-1.97), respectively. The results of subgroup analysis by age, sex, and lung function were robust. This study was retrospective, so there was no clinical trial registration.Conclusions: The plasma log2BNP level was significantly associated with in-hospital mortality and a composite outcome of in-hospital mortality or invasive mechanical ventilation.

scholarly journals Prognostic Significance of B Type Natriuretic Peptide in Acute Coronary Syndrome

2014 ◽  
Vol 13 (2) ◽  
pp. 78-88 ◽  
Author(s):  
Nasreen Chowdhury ◽  
Md. Aminul Haque Khan ◽  
Md Mozammel Hoque
Keyword(s):  
Heart Failure ◽  
Acute Coronary Syndrome ◽  
Risk Stratification ◽  
Natriuretic Peptide ◽  
Prognostic Significance ◽  
Left Ventricular ◽  
Adverse Outcomes ◽  
Risk Of Death ◽  
Coronary Syndrome ◽  
Early Risk

Acute Coronary syndrome (ACS) is the most common cause of admission to the coronary care unit with highest risk of death and adverse outcomes. ACS accounts for 60–70% of all admissions in the hospital. Patients with ACS encompass a heterogeneous group that varies widely regarding severity of the underlying coronary artery disease, prognosis and response to treatment. Patients with the highest risk of subsequent events usually have the largest benefit of an intensified pharmacological treatment and early mechanical intervention. The prognosis for low-risk patients, on the other hand, is often difficult to improve further and these patients usually benefit more from a conservative management with a lower risk of side effects. Therefore, risk stratification is essential and should be initiated early and updated continuously throughout the hospital stay. Early risk stratification is usually performed by the use of clinical background factors, clinical presentation, electrocardiography and biochemical markers of myocardial damage. Levels of natriuretic peptides have been shown to reflect cardiac performance. The aim of this study was to review elaborately on B type Natriuretic Peptide (BNP) and its prognostic value in patient with ACS. This review focuses on the emerging role of these peptides in the early risk stratification of ACS patients. Elevation of BNP levels in acute MI and UA is predictive of a greater risk of death, post infarction heart failure, or  reinfarction. Post infarction studies demonstrate that elevated plasma BNP levels are associated with larger infarct size, increased probability of ventricular remodeling, lower ejection fraction, higher risk of heart failure, and increased mortality. This cardiac marker is a potent predictor of mortality in patients with all forms ACS. BNP measurements serve as an index of severity of the ischemic injury, as well as the degree of impairment in left ventricular function.DOI: http://dx.doi.org/10.3329/cmoshmcj.v13i2.21079

scholarly journals Acute cardiac injury is associated with adverse outcomes, including mortality in COVID-19 patients. A single-center experience

2020 ◽  
Vol 41 (11) ◽  
pp. 1204-1210
Author(s):  
Kashif Naeem ◽  
Mahmood Hachim ◽  
Ibrahim Hachim ◽  
Ayman Chkhis ◽  
Rajesh Quadros ◽  
...  
Keyword(s):  
Cardiac Injury ◽  
Adverse Outcomes ◽  
Single Center ◽  
Single Center Experience

Mortality after Critical Illness

2014 ◽  
Author(s):  
Matthew Baldwin ◽  
Hannah Wunsch
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Critical Illness ◽  
Prolonged Mechanical Ventilation ◽  
Risk Of Death ◽  
Increased Risk ◽  
Poor Nutrition ◽  
Long Term Mortality

Many critically ill patients now survive what were previously fatal illnesses, but long-term mortality after critical illness remains high. While study populations vary by country, age, intervention, or specific diagnosis, investigations demonstrate that the majority of additional deaths occur in the first 6 to 12 months after hospital discharge. Patients with diagnoses of cancer, respiratory failure, and neurological disorders leading to the need for intensive care have the highest long-term mortality, while those with trauma and cardiovascular diseases have much lower long-term mortality. Use of mechanical ventilation, older age, and a need for care in a facility after the acute hospitalization are associated with particularly high 1-year mortality among survivors of critical illnesses. Due to challenges of follow-up, less is known about causes of delayed mortality following critical illness. Longitudinal studies of survivors of pneumonia, stroke, and patients who require prolonged mechanical ventilation suggest that most debilitated survivors die from recurrent infections and sepsis. Potential biologic mechanisms for increased risk of death after a critical illness include sepsis-induced immunoparalysis, intensive care unit-acquired weakness, neuroendocrine changes, poor nutrition, and genetic variance. Studies are needed to fully understand how the severity of the acute critical illness interacts with comorbid disease, pre-illness disability, and pre-existing and acquired frailty to affect long-term mortality. Such studies will be fundamental to improve targeting of rehabilitative, therapeutic, and palliative interventions to improve both survival and quality of life after critical illness.

409Cardiovascular risk profiles and outcomes in patients with type 2 diabetes - Implications for choice of new diabetes therapies

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M E Malik ◽  
C A Andersson ◽  
P B Blanche ◽  
C M R Rasmussen ◽  
B Z Zareini ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Ischemic Stroke ◽  
Sglt2 Inhibitors ◽  
Low Risk ◽  
Receptor Agonists ◽  
Risk Of Death ◽  
History Of ◽  
New Onset

Abstract Background Reflecting recent clinical trial findings, updated type 2 diabetes (T2D) guidelines recommend targeting SGLT2 inhibitors at patients at risk of heart failure (HF)-related events and GLP-1 receptor agonists at those at greater risk of atherosclerotic events. However, which cardiovascular disease phenotype in patients with T2D is more predictive of one or other type of these events is unclear. Purpose To estimate the risk of HF-related events and atherosclerotic events, according to background cardiovascular phenotype, in patients with T2D. Methods Patients with T2D and new-onset cardiovascular disease were identified using Danish health care registers (period 1995 to 2015). Patients were divided in four groups based on the primary type of cardiovascular disease: 1) HF, 2) ischemic heart disease (IHD), 3) ischemic stroke, and 4) peripheral artery disease (PAD). The absolute 5-year risks of the subsequent event, either a HF-related event or an atherosclerotic event (IHD, ischemic stroke and PAD), and the associated risk of death, were compared across the four groups. The Aalen-Johansen estimator was used to account for censoring, the competing risk of HF and atherosclerotic events, respectively, and death. Results We included 37,850 patients with T2D and new-onset cardiovascular disease. Median age was 70 years and 40% were female. Patients with HF were at higher risk of readmission for HF (18.1%; 95% confidence interval (CI): 17.2–19.0) than of an atherosclerotic event (14.2%; 13.4–15.0) (Figure). Patients with IHD were at higher risk of a new atherosclerotic event (23.5%; 22.8.-24.2) than of developing HF (9.3%; 8.9–9.8), although the risk of HF was still substantial. Conversely, patients with ischemic stroke were at low risk of HF (3.3%; 2.9–3.8) and higher risk of an atherosclerotic event (16.9%; 95% CI: 16.0–17.7). Patients with PAD had the lowest risk of HF (3.1%; 95% CI: 2.8–3.4) and the highest risk of an atherosclerotic event (35.0%; 95% CI: 33.4–36.7). Compared to a new atherosclerotic event, developing HF was associated with a higher 1-year risk of death (16.0%; 95% CI: 14.7–17.3 versus 33.0%; 95% CI: 31.8–34.2) amongst all patients. Cumulative incidence of first new event Conclusions In T2D, a patient's history of cardiovascular disease was predictive of type of subsequent cardiovascular event. While history of ischemic stroke and PAD were associated with a high risk of future atherosclerotic events, and low risk of HF, patients with IHD were at substantial risk of both types of event. Conversely, while history of HF was most predictive of future HF events, the risk of atherosclerotic events in patients with HF was also high. Our findings may help determine which type of therapy T2D patients with a particular cardiovascular disease history might benefit from – SGLT2 inhibitors, GLP-1 receptor agonists or potentially both. Acknowledgement/Funding Mariam Elmegaard Malik was funded by a research grant from Department of Cardiology, Herlev and Gentofte Hospital.

scholarly journals Impact of cardiovascular disease on clinical outcomes in hospitalized patients with Covid-19: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Ernesto Maddaloni ◽  
Luca D’Onofrio ◽  
Antonio Siena ◽  
Cecilia Luordi ◽  
Carmen Mignogna ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Mechanical Ventilation ◽  
Meta Analysis ◽  
Random Effect ◽  
Pooled Analysis ◽  
Prevention Strategies ◽  
Risk Of Death ◽  
Independent Association ◽  
The Impact ◽  
Random Effect Models

AbstractContrasting data have been published about the impact of cardiovascular disease on Covid-19. A comprehensive synthesis and pooled analysis of the available evidence is needed to guide prioritization of prevention strategies. To clarify the association of cardiovascular disease with Covid-19 outcomes, we searched PubMed up to 26 October 2020, for studies reporting the prevalence of cardiovascular disease among inpatients with Covid-19 in relation to their outcomes. Pooled odds-ratios (OR) for death, for mechanical ventilation or admission in an intensive care unit (ICU) and for composite outcomes were calculated using random effect models overall and in the subgroup of people with comorbid diabetes. Thirty-three studies enrolling 52,857 inpatients were included. Cardiovascular disease was associated with a higher risk of death both overall (OR 2.58, 95% confidence intervals, CI 2.12–3.14, p < 0.001, number of studies 24) and in the subgroup of people with diabetes (OR 2.91, 95% CI 2.13–3.97, p < 0.001, number of studies 4), but not with higher risk of ICU admission or mechanical ventilation (OR 1.35, 95% CI 0.73–2.50, p = 0.34, number of studies 4). Four out of five studies reporting OR adjusted for confounders failed to show independent association of cardiovascular disease with Covid-19 deaths. Accordingly, the adjusted-OR for Covid-19 death in people with cardiovascular disease dropped to 1.31 (95% CI 1.01–1.70, p = 0.041). Among patients hospitalized for Covid-19, cardiovascular disease confers higher risk of death, which was highly mitigated when adjusting the association for confounders.

scholarly journals Factors associated with hospitalization and critical illness among 4,103 patients with Covid-19 disease in New York City

2020 ◽  
Author(s):  
Christopher M. Petrilli ◽  
Simon A. Jones ◽  
Jie Yang ◽  
Harish Rajagopalan ◽  
Luke O’Donnell ◽  
...  
Keyword(s):  
New York ◽  
Mechanical Ventilation ◽  
New York City ◽  
Critical Illness ◽  
Decision Tree ◽  
York City ◽  
Adverse Outcomes ◽  
Maximum Information ◽  
Factors Associated ◽  
Markers Of Inflammation

AbstractBackgroundLittle is known about factors associated with hospitalization and critical illness in Covid-19 positive patients.MethodsWe conducted a cross-sectional analysis of all patients with laboratory-confirmed Covid-19 treated at an academic health system in New York City between March 1, 2020 and April 2, 2020, with follow up through April 7, 2020. Primary outcomes were hospitalization and critical illness (intensive care, mechanical ventilation, hospice and/or death). We conducted multivariable logistic regression to identify risk factors for adverse outcomes, and maximum information gain decision tree classifications to identify key splitters.ResultsAmong 4,103 Covid-19 patients, 1,999 (48.7%) were hospitalized, of whom 981/1,999 (49.1%) have been discharged, and 292/1,999 (14.6%) have died or been discharged to hospice. Of 445 patients requiring mechanical ventilation, 162/445 (36.4%) have died. Strongest hospitalization risks were age ≥75 years (OR 66.8, 95% CI, 44.7-102.6), age 65-74 (OR 10.9, 95% CI, 8.35-14.34), BMI>40 (OR 6.2, 95% CI, 4.2-9.3), and heart failure (OR 4.3 95% CI, 1.9-11.2). Strongest critical illness risks were admission oxygen saturation <88% (OR 6.99, 95% CI 4.5-11.0), d-dimer>2500 (OR 6.9, 95% CI, 3.2-15.2), ferritin >2500 (OR 6.9, 95% CI, 3.2-15.2), and C-reactive protein (CRP) >200 (OR 5.78, 95% CI, 2.6-13.8). In the decision tree for admission, the most important features were age >65 and obesity; for critical illness, the most important was SpO2<88, followed by procalcitonin >0.5, troponin <0.1 (protective), age >64 and CRP>200.ConclusionsAge and comorbidities are powerful predictors of hospitalization; however, admission oxygen impairment and markers of inflammation are most strongly associated with critical illness.

scholarly journals The impact of previous history of bariatric surgery on outcome of Covid-19: A nationwide medico-administrative French study.

2020 ◽  
Author(s):  
Antonio Iannelli ◽  
Samir Bouam ◽  
Anne-Sophie Schneck ◽  
Sébastien Frey ◽  
Jean Gugenheim ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Mechanical Ventilation ◽  
Protective Effect ◽  
Invasive Mechanical Ventilation ◽  
Male Gender ◽  
Secondary Outcome ◽  
Risk Of Death ◽  
Surgery Group ◽  
History Of ◽  
The Impact

Abstract Purpose: To determine the risk of invasive mechanical ventilation and death in obese individuals with history of bariatric surgery compared to standard ones admitted for Covid-19 infection.Methods: Nationwide retrospective observational study based on electronic health data. 4 248 253 individuals aged 15 to 75 years with a diagnosis of obesity were included. All obese inpatients, undergoing bariatric surgery or not, recorded during a hospital stay by the French National Health Insurance were followed, during a mean observation time of 5.43 ± 2.93 years. This exposition was bariatric surgery (n=389,671) including adjustable gastric banding, sleeve gastrectomy, gastric bypass versus no bariatric surgery (n=3,858,582). The primary outcome was Covid-19 related death and the secondary outcome was the need for invasive mechanical ventilation.Results: 8 286 (0.2%) obese individuals were admitted for Covid-19 infection between January 1st and May 15th 2020 with a diagnosis of Covid-19 infection. 541 (0.14%) had a history of bariatric surgery and 7,745 (0.2%) did not. Invasive mechanical ventilation was necessary in 14.54% of patients and death occurred in 13.58% of cases. The need for an invasive mechanical ventilation and death occurred in 7% and 3.5% in the bariatric surgery group versus 15% and 14.2% in the non-bariatric surgery group, respectively (both p<0.0001). After a logistic regression, the risk of invasive mechanical ventilation significantly increased with age being higher in the age class 61-75, male gender, and hypertension, whereas bariatric surgery showed an independent protective effect. Mortality was independently associated with increasing age, male gender, known history of heart failure, cancer, and diabetes, whereas BS was in favor with a protective effect. Conclusion: This nationwide administrative study showed that bariatric surgery is independently associated with a reduced risk of death and invasive mechanical ventilation in obese individuals with Covid-19 infection.

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