TY - JOUR T1 - Markers of neutrophil extracellular traps predict adverse outcome in community-acquired pneumonia: secondary analysis of a randomised controlled trial JF - European Respiratory Journal JO - Eur Respir J DO - 10.1183/13993003.01389-2017 VL - 51 IS - 4 SP - 1701389 AU - Fahim Ebrahimi AU - Stavros Giaglis AU - Sinuhe Hahn AU - Claudine A. Blum AU - Christine Baumgartner AU - Alexander Kutz AU - Shane Vontelin van Breda AU - Beat Mueller AU - Philipp Schuetz AU - Mirjam Christ-Crain AU - Paul Hasler Y1 - 2018/04/01 UR - http://erj.ersjournals.com/content/51/4/1701389.abstract N2 - Neutrophil extracellular traps (NETs) are a hallmark of the immune response in inflammatory diseases. However, the role of NETs in community-acquired pneumonia (CAP) is unknown. This study aims to characterise the impact of NETs on clinical outcomes in pneumonia.This is a secondary analysis of a randomised controlled, multicentre trial. Patients with CAP were randomly assigned to either 50 mg prednisone or placebo for 7 days. The primary end-point was time to clinical stability; main secondary end-points 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 multivariate 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.CAP 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.Neutrophil extracellular traps predict higher risk for clinical instability and 30-day mortality in pneumonia http://ow.ly/Gxbh30iqbom ER -