Urinary N-Terminal Pro-Brain Natriuretic Peptide Predicts Acute Kidney Injury and Severe Disease in COVID-19.
Manuel Julian Vogel, Simon B Leininger, Stephan T Staudner, Ute Hubauer, Stefan Wallner, Julian Mustroph, Frank Hanses, Markus Zimmermann, Petra Lehn, Ralph Burkhardt, Lars S Maier, Julian Hupf, Carsten G Jungbauer
Author Information
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.
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.
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.
