Direct comparison of three natriuretic peptides for prediction of short- and long-term mortality in patients with community-acquired pneumonia
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Direct comparison of three natriuretic peptides for prediction of short- and long-term mortality in patients with community-acquired pneumonia. / Nowak, Albina; Breidthardt, Tobias; Christ-Crain, Mirjam; Bingisser, Roland; Meune, Christophe; Tanglay, Yunus; Heinisch, Corinna; Reiter, Miriam; Drexler, Beatrice; Arenja, Nisha; Twerenbold, Raphael; Stolz, Daiana; Tamm, Michael; Müller, Beat; Müller, Christian.
In: CHEST, Vol. 141, No. 4, 04.2012, p. 974-982.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Direct comparison of three natriuretic peptides for prediction of short- and long-term mortality in patients with community-acquired pneumonia
AU - Nowak, Albina
AU - Breidthardt, Tobias
AU - Christ-Crain, Mirjam
AU - Bingisser, Roland
AU - Meune, Christophe
AU - Tanglay, Yunus
AU - Heinisch, Corinna
AU - Reiter, Miriam
AU - Drexler, Beatrice
AU - Arenja, Nisha
AU - Twerenbold, Raphael
AU - Stolz, Daiana
AU - Tamm, Michael
AU - Müller, Beat
AU - Müller, Christian
PY - 2012/4
Y1 - 2012/4
N2 - BACKGROUND: Early and accurate risk stratification for patients with community-acquired pneumonia (CAP) is an unmet clinical need.METHODS: We enrolled 341 unselected patients presenting to the ED with CAP in whom blinded measurements of N-terminal pro-B-type natriuretic peptide (NT-proBNP), midregional pro-atrial natriuretic peptide (MR-proANP), and B-type natriuretic peptide (BNP) were performed. The potential of these natriuretic peptides to predict short- (30-day) and long-term mortality was compared with the pneumonia severity index (PSI) and CURB-65 (confusion, urea plasma level, respiratory rate, BP, age over 65 years). The median follow-up was 942 days.RESULTS: NT-proBNP, MR-proANP, and BNP levels at presentation were higher in short-term (median 4,882 pg/mL vs 1,133 pg/mL; 426 pmol/L vs 178 pmol/L; 436 pg/mL vs 155 pg/mL, all P < .001) and long-term nonsurvivors (3,515 pg/mL vs 548 pg/mL; 283 pmol/L vs 136 pmol/L; 318 pg/mL vs 103 pg/mL, all P < .001) as compared with survivors. Receiver operating characteristics analysis to quantify the prognostic accuracy showed comparable areas under the curve for the three natriuretic peptides to PSI for short-term (PSI 0.76, 95% CI, 0.71-0.81; NT-proBNP 0.73, 95% CI, 0.67-0.77; MR-proANP 0.72, 95% CI, 0.67-0.77; BNP 0.68, 95% CI, 0.63-0.73) and long-term (PSI 0.72, 95% CI, 0.66-0.77; NT-proBNP 0.75, 95% CI, 0.70-0.80; MR-proANP 0.73, 95% CI, 0.67-0.77, BNP 0.70, 95% CI, 0.65-0.75) mortality. In multivariable Cox-regression analysis, NT-proBNP remained an independent mortality predictor (hazard ratio 1.004, 95% CI, 1.00-1.01, P = .02 for short-term; hazard ratio 1.004, 95% CI, 1.00-1.01, P = .001 for long-term, increase of 300 pg/mL). A categorical approach combining PSI point values and NT-pro-BNP levels adequately identified patients at low, medium, and high short- and long-term mortality risk.CONCLUSIONS: Natriuretic peptides are simple and powerful predictors of short- and long-term mortality for patients with CAP. Their prognostic accuracy is comparable to PSI.
AB - BACKGROUND: Early and accurate risk stratification for patients with community-acquired pneumonia (CAP) is an unmet clinical need.METHODS: We enrolled 341 unselected patients presenting to the ED with CAP in whom blinded measurements of N-terminal pro-B-type natriuretic peptide (NT-proBNP), midregional pro-atrial natriuretic peptide (MR-proANP), and B-type natriuretic peptide (BNP) were performed. The potential of these natriuretic peptides to predict short- (30-day) and long-term mortality was compared with the pneumonia severity index (PSI) and CURB-65 (confusion, urea plasma level, respiratory rate, BP, age over 65 years). The median follow-up was 942 days.RESULTS: NT-proBNP, MR-proANP, and BNP levels at presentation were higher in short-term (median 4,882 pg/mL vs 1,133 pg/mL; 426 pmol/L vs 178 pmol/L; 436 pg/mL vs 155 pg/mL, all P < .001) and long-term nonsurvivors (3,515 pg/mL vs 548 pg/mL; 283 pmol/L vs 136 pmol/L; 318 pg/mL vs 103 pg/mL, all P < .001) as compared with survivors. Receiver operating characteristics analysis to quantify the prognostic accuracy showed comparable areas under the curve for the three natriuretic peptides to PSI for short-term (PSI 0.76, 95% CI, 0.71-0.81; NT-proBNP 0.73, 95% CI, 0.67-0.77; MR-proANP 0.72, 95% CI, 0.67-0.77; BNP 0.68, 95% CI, 0.63-0.73) and long-term (PSI 0.72, 95% CI, 0.66-0.77; NT-proBNP 0.75, 95% CI, 0.70-0.80; MR-proANP 0.73, 95% CI, 0.67-0.77, BNP 0.70, 95% CI, 0.65-0.75) mortality. In multivariable Cox-regression analysis, NT-proBNP remained an independent mortality predictor (hazard ratio 1.004, 95% CI, 1.00-1.01, P = .02 for short-term; hazard ratio 1.004, 95% CI, 1.00-1.01, P = .001 for long-term, increase of 300 pg/mL). A categorical approach combining PSI point values and NT-pro-BNP levels adequately identified patients at low, medium, and high short- and long-term mortality risk.CONCLUSIONS: Natriuretic peptides are simple and powerful predictors of short- and long-term mortality for patients with CAP. Their prognostic accuracy is comparable to PSI.
KW - Aged
KW - Aged, 80 and over
KW - Atrial Natriuretic Factor/blood
KW - Biomarkers/blood
KW - Community-Acquired Infections/blood
KW - Female
KW - Follow-Up Studies
KW - Humans
KW - Male
KW - Middle Aged
KW - Natriuretic Peptide, Brain/blood
KW - Peptide Fragments/blood
KW - Pneumonia/blood
KW - Prognosis
KW - Regression Analysis
KW - Severity of Illness Index
U2 - 10.1378/chest.11-0824
DO - 10.1378/chest.11-0824
M3 - SCORING: Journal article
C2 - 22135381
VL - 141
SP - 974
EP - 982
JO - CHEST
JF - CHEST
SN - 0012-3692
IS - 4
ER -
