Abstract
Neutrophil extracellular traps (NETs) are a hallmark of the immune response in inflammatory diseases. However, the role of NETs in community-acquired pneumonia is unknown. This study aims to characterise the impact of NETs on clinical outcomes in pneumonia.
This is a secondary analysis of a randomized-controlled, multicentre trial. Patients with community-acquired pneumonia were randomly assigned to either prednisone 50 mg or placebo for 7 days. The primary endpoint was time to clinical stability; main secondary endpoints were length of hospital stay and mortality.
In total 310 patients were included in the analysis. Levels of cell-free nucleosomes as surrogate markers of NETosis were significantly increased at admission and declined over 7 days. NETs were significantly associated with reduced hazards of clinical stability and hospital discharge in multivariable adjusted analyses. Moreover, NETs were associated with a 3.8-fold increased adjusted odds ratio of 30-day mortality. Prednisone treatment modified circulatory NET levels and was associated with beneficial outcome.
Community-acquired pneumonia is accompanied by pronounced NET formation. Patients with elevated serum NET markers were at higher risk for clinical instability, prolonged length of hospital stay and 30-day all-cause mortality. NETs represent a novel marker for outcome and a possible target for adjunct treatments of pneumonia.
Abstract
Neutrophil extracellular traps predict higher risk for clinical instability and 30-day mortality in pneumonia
Footnotes
This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.
Conflict of interest: Dr. Ebrahimi reports grants from Research Council Kantonsspital Aarau, during the conduct of the study.
Conflict of interest: Dr. Giaglis reports grants from KSA RESEARCH COUNCIL, during the conduct of the study; In addition, Dr. Giaglis has a patent US 20160061824 A1 pending.
Conflict of interest: Dr. Hahn has nothing to disclose.
Conflict of interest: Dr. Blum reports grants from Research Funds Endocrinology Kantonsspital Aarau, during the conduct of the study.
Conflict of interest: Dr. Baumgartner has nothing to disclose.
Conflict of interest: Dr. Kutz has nothing to disclose.
Conflict of interest: Dr. Mueller has nothing to disclose.
Conflict of interest: Dr. Schuetz has nothing to disclose.
Conflict of interest: Dr. Christ-Crain reports grants from Swiss National Science Foundation, grants from Gottfried & Julia Bangerter-Rhyner Stiftung, grants from Nora van Meeuwen Häfliger Stiftung, during the conduct of the study.
Conflict of interest: Dr. Hasler has a patent pending on the use of nucleosome assay for diagnosis of rheumatoid arthritis.
Conflict of interest: Dr. van Breda has nothing to disclose.
- Copyright ©ERS 2018