Plasma brain natriuretic peptide, D-Dimer, and serum troponin-I as predictors for in-hospital death in patients with COVID-19 |
The Egyptian Journal of Immunology Volume 30 (3), July, 2023 Pages: 32 – 43. www.Ejimmunology.org https://doi.org/10.55133/eji.300304 |
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Amal A. Mahmoud1, Heba A. Abd El-Hafeez1, Areej O. Ali1, Ayman K. M. Hassan2, and Mohamed I. Seddik1 |
1Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt.
2Department of Cardiology, Faculty of Medicine, Assiut University, Assiut, Egypt.
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Corresponding author: Areej O. Ali, Department of Clinical Pathology, Faculty of Medicine, Assiut University., Assiut, Egypt. Email: areejosama@aun.edu.eg. |
Abstract
The severe acute respiratory syndrome coronavirus 2, first appeared in Wuhan, China, in December 2019. Since then, a variety of strains of the virus were spread throughout the world, prompting the World Health Organization to declare a pandemic in March 2020. Additionally, Coronavirus disease 2019 (COVID-19) can cause a variety of symptoms, ranging from fatigue and fever to severe respiratory and cardiovascular complications. This study evaluated the role of brain natriuretic peptide (BNP), troponin-I and D-dimer as biomarkers for death prediction in hospitalized patients with COVID-19. The study included 90 patients with COVID -19 diagnosed with PCR-RNA testing. They were divided into survivors and non-survivors. Also, 20 apparently healthy individuals age and sex matched were included as a control group. Plasma BNP and serum troponin-I were measured by enzyme linked immune-sorbent assay (ELISA) technique. D-dimer was measured by a turbidimetric technique. Patients with COVID-19 had significantly elevated levels of serum Troponin-I and plasma BNP in comparison to controls (p< 0.0001, for both). D-dimer, troponin–I and BNP levels were significantly higher in the non-survivors group when compared to the survivors group. Troponin-1 can predict COVID-19 severity with sensitivity, specificity, and accuracy of 55.1%, 66.7%, and 57.8%, respectively at a cutoff value of 0.075 (ng /ml); and area under the receiver operating characteristic (AUC) curve of 0.670 (95% CI: 0.551 – 0.790, p=0.018). BNP can predict COVID-19 severity with sensitivity, specificity, and accuracy of 98.6%, 71.4%, 92.2%, respectively at a cutoff value of 16.02 (Pg /ml) and AUC of 0.872 (95% CI: 0.778 – 0.965, p<0.001). Univariate and multivariate logistic regression analysis showed that only BNP level can significantly predict death among COVID-19 infected patients. In conclusion, plasma BNP and serum troponin-I could be used as prognostic biomarkers for determination of the severity of COVID-19 and BNP could predict mortality.
Keywords:
COVID-19, BNP, Troponin-I, D-dimer
Date received:
20 January 2022; accepted: 19 April 2023
PMID:
37439528
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