Article Text
Abstract
Background Community-acquired pneumonia (CAP) is the most important clinical infection with a high long-term mortality rate. The aim of this study was to evaluate the value of biomarkers for the prediction of short-term and long-term mortality in CAP.
Methods A total of 1740 patients of mean±SD age 60±18 years (45% female) with proven CAP were enrolled in the study. Mid-regional pro-atrial natriuretic peptide (MR-proANP), C-terminal pro-atrial vasopressin (CT-proAVP), procalcitonin, C-reactive protein, leucocyte count (WBC) and CRB-65 score were determined on admission. Patients were followed up for 180 days.
Results MR-proANP and CT-proAVP levels increased with increasing severity of CAP, classified according to CRB-65 score. In patients who died within 28 and 180 days, median MR-proANP (313.9 vs 80.0 and 277.8 vs 76.0 pmol/l, each p<0.0001) and CT-proAVP (42.6 vs 11.2 and 33.2 vs 10.7 pmol/l, each p<0.0001) levels were significantly higher than the levels in survivors. In receiver operating characteristics analysis for survival at 28 and 180 days, the areas under the curves (AUCs) for CT-proAVP (0.84, 95% CI 0.82 to 0.86 and 0.78, 95% CI 0.76 to 0.80) and MR-proANP (0.81, 95% CI 0.79 to 0.83 and 0.81, 95% CI 0.79 to 0.83) were superior to the AUC of CRB-65 (0.74, 95% CI 0.71 to 0.76 and 0.71, 95% CI 0.69 to 0.74, p<0.05), procalcitonin, C-reactive protein and WBC. In multivariable Cox proportional hazards regression analyses adjusted for comorbidity and pneumonia severity, MR-proANP and CT-proAVP were independent and the strongest predictors of short-term and long-term mortality.
Conclusions MR-proANP and CT-proAVP are powerful tools for the prediction of short-term and long-term risk stratification of patients with CAP.
- community-acquired pneumonia
- atrial natriuretic peptide
- vasopressin
- procalcitonin
- mortality
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Footnotes
Funding This study was supported by the German Federal Ministry of Education and Research (Bundesministerium für Bildung und Forschung, BMBF) grants 01KI0103-105, Competence Network CAPNETZ.
Competing interests JK and OH are employees of BRAHMS AG, the manufacturer of the assays BRAHMS MR-proANP LIA and BRAHMS CT-proAVP LIA (Hennigsdorf, Germany). JK and OH do not own stock or options in the company. TW received funds for speaking at symposia organised on behalf of BRAHMS AG. All other authors have none to declare.
Ethics approval This study was conducted with the approval of the University of Magdeburg. Written informed consent was obtained from every patient prior to inclusion in the study. The study was approved by the local ethical committee.
Provenance and peer review Not commissioned; externally peer reviewed.