Chest
Original ResearchChest InfectionsDirect Comparison of Three Natriuretic Peptides for Prediction of Short- and Long-term Mortality in Patients With Community-Acquired Pneumonia
Section snippets
Setting and Study Population
We screened 421 unselected consecutive patients with suspected CAP presenting to the University Hospital of Basel from November 2003 to March 2007.11, 12 Due to logistic reasons, the recruitment was interrupted from February 2005 to April 2006. Patients' data were included into the analysis if values from all three NPs were obtained at presentation.
Patients were evaluated in the ED by at least two physicians, a resident in internal medicine and an internal medicine specialist. The decision for
Baseline Characteristics
A total of 421 patients were evaluated in this study. Baseline values from all three natriuretic peptides were available for 341 of the 421 (81%) consecutive patients. These 341 patients constituted the study population included into analysis. PSI was calculated in 320 patients of the study population. There was no difference in age, sex, and mortality between the cohort of the patients evaluated and patients included into analysis (Table 1).
The median follow-up time was 942 days (366-1626).
Discussion
In this prospective study of 341 patients presenting with CAP to the ED, we compared the potential of admission plasma NT-proBNP, MR-proANP, and BNP levels to predict unfavorable outcome for patients with CAP. We report six major findings. First, NP levels at presentation are significantly elevated in short- and long-term decedents. Second, NP levels predict short- and long-term mortality with comparable accuracy to PSI point values and exceed the predictive potential of CURB-65 and common
Conclusion
NPs are simple and powerful predictors of short- and long-term mortality. Their prognostic accuracy is comparable to PSI. Importantly, a combined assessment using PSI point values and NT-pro-BNP levels appears to provide additional risk stratification over a single marker approach.
Acknowledgments
Author contributions: All authors are fully responsible for the presented analysis and conclusions drawn in the manuscript.
Dr Nowak: conceived the idea, designed and initiated the study, performed statistical analyses, drafted the manuscript, amended and commented on the manuscript, and approved the final version.
Dr Breidthardt: conceived the idea, designed and initiated the study, performed statistical analyses, drafted the manuscript, amended and commented on the manuscript, and approved the
References (27)
- et al.
Mid-region pro-hormone markers for diagnosis and prognosis in acute dyspnea: results from the BACH (Biomarkers in Acute Heart Failure) trial
J Am Coll Cardiol
(2010) - et al.
B-type natriuretic peptide and renal function in the diagnosis of heart failure: an analysis from the Breathing Not Properly Multinational Study
Am J Kidney Dis
(2003) - et al.
Comparison of midregional pro-atrial and B-type natriuretic peptides in chronic heart failure: influencing factors, detection of left ventricular systolic dysfunction, and prediction of death
J Am Coll Cardiol
(2009) - et al.
Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care
Crit Care Med
(2001) - et al.
A prediction rule to identify low-risk patients with community-acquired pneumonia
N Engl J Med
(1997) - et al.
Assessing the quality of clinical data in a computer-based record for calculating the pneumonia severity index
J Am Med Inform Assoc
(2000) - et al.
B-type natriuretic peptide for risk stratification in community-acquired pneumonia
J Intern Med
(2005) - et al.
Use of B-type natriuretic peptide in the risk stratification of community-acquired pneumonia
J Intern Med
(2008) - et al.
Role of B-type natriuretic peptide (BNP) and NT-proBNP in clinical routine
Heart
(2006) - et al.
Immunoluminometric assay for the midregion of pro-atrial natriuretic peptide in human plasma
Clin Chem
(2004)
Comparison of midregional pro-atrial natriuretic peptide with N-terminal pro-B-type natriuretic peptide in the diagnosis of heart failure
J Intern Med
Pro-atrial natriuretic peptide and pro-vasopressin for predicting short-term and long-term survival in community-acquired pneumonia: results from the German Competence Network CAPNETZ
Thorax
Procalcitonin guidance of antibiotic therapy in community-acquired pneumonia: a randomized trial
Am J Respir Crit Care Med
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Drs Nowak and Breidthardt are coauthors of this article.
Funding/Support: Dr Meune was supported by a grant from the FAQ (Freie Akademische Gesellschaft), Basel, Switzerland.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).