n-terminal pro b-type natriuretic peptide and vitamin d levels as prognostic markers in covid-19 pneumonia

Conditions: COVID19 Pneumonia

Summary: this study is designed to assess the difference between level of nt-pro-bnp, and vitmin d in moderate cases who progressed to severe or critically ill category compared to those who did not. assessment of any possible correlation between nt-pro-bnp and vitamin d and the need for mechanical ventilation or mortality in covid-19 infection.

on 30 january 2020, world health organization (who) officially declared the covid-19 epidemic as a public health emergency of international concern. an acute respiratory disease, caused by a novel coronavirus (sars-cov-2, previously known as 2019-ncov), the coronavirus disease 2019 (covid-19) has spread throughout china and received worldwide attention (guo et al., 2020). as an emerging acute respiratory infectious disease, covid-19 primarily spreads through the respiratory tract, by droplets, respiratory secretions, and direct contact (li et al., 2020). based on current epidemiological investigation, the incubation period is 1-14 days, mostly 3-7 days and the covid-19 is contagious during the latency period (jin et al., 2020). the common clinical manifestations included fever (88.7%), cough (67.8%), fatigue (38.1%), sputum production (33.4%), shortness of breath (18.6%), sore throat (13.9%), and headache (13.6%) \[16\]. in addition, a part of patients manifested gastrointestinal symptoms, with diarrhea (3.8%) and vomiting (5.0%) (guan et al., 2020). b-type natriuretic peptide (bnp) is mainly synthesized and secreted by myocytes in the left ventricle (lv) as a response to myocytes stretched by pressure overload or volume expansion of the ventricle (cao et al., 2019). in patients with community acquired peumonia (cap), nt-pro bnp levels are powerful predictors of adverse cardiac events. for patients with systemic inflammatory response syndrome (sirs), chen et al found that compared with non-sirs patients, subjects with sirs had a markedly higher level of b-type natriuretic peptide (bnp). additionally, bnp level of more than 113 pg/ml was independent predictor of all-cause mortality in septic patients. additionally, in 302 cap patients, christ-crain et al confirmed that bnp levels increased with rising disease severity as classified by the pulmonary severity index (psi) (p=0.01). li et al confirmed that bnp could be used as a biomarker for evaluating the severity of cap. they recommended bnp level of 299.0 pg/ml in predicting in-hospital mortality (sensitivity 67.5%, specificity 81.6%) (zhang et al., 2016). in respiratory system conditions, such as influenza, vitamin d has wide-ranging and fundamental roles, including through: gene transcription via covid-19 relevant vdr (vitamin d receptor) pathways; wider immune function; and airway epithelial cell tight-junction function and integrity. further, studies suggest vitamin d supplementation may be protective in respiratory conditions, the effect being highly significant in 'd' deficient persons. it is hypothesized by watkins, 2020 and grant et al., 2020 that vitamin d insufficiency may significantly compromise, respiratory immune response function, greatly increasing risk of covid-19 severity and mortality (brown and sarkar, 2020). primary outcomes: this study is designed to assess the difference between level of nt-pro-bnp, and vitmin d in moderate cases who progressed to severe or critically ill category compared to those who did not. secondary outcomes: assessment of any possible correlation between nt-pro-bnp and vitamin d and the need for mechanical ventilation or mortality in covid-19 infection. the study will be conducted on 100 covid-19 confirmed patients group (1): 50 mild to moderate cases (lung shadows without hypoxia and oxygen saturation \>92%) who progressed to severe illness characterized by hypoxia necessitating oxygen therapy, or critical illness characterized by respiratory failure necessitating mechanical ventilation either invasive or non-invasive within their hospital stay. group (2): 50 mild to moderate cases who did not show clinical progression and were discharged.

Eligibility criteria:
inclusion criteria: * all cases will be diagnosed with covid-19 by rt-pcr • group (1) critically ill patients: respiratory rate \> 30/min sao2 \< 92% at room temperature chest radiology showing more than 50% lesion or progressive lesion within 24 to 48 hours • group (2) moderate cases: patients has pneumonia manifestations on radiology associated with symptoms \&/or leucopenia or lymphopenia. exclusion criteria: * other causes of pneumonia other than infection with sars-cov-2. * concomitant heart failure. * hypoxic patients on hospital admission. * arrhythmia.

Keywords: nt-pro-bnp vitamin d covid-19 pneumonia hplc/uv diode array