Nowak, A; Breidthardt, T; Christ-Crain, M; Bingisser, R; Meune, C; Tanglay, Y; Heinisch, C; Reiter, M; Drexler, B; Arenja, N; Twerenbold, R; Stolz, D; Tamm, M; Müller, B; Müller, C (2012). Direct comparison of three natriuretic peptides for prediction of short- and long-term mortality in community acquired pneumonia. Chest, 141(4):974-982.
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AbstractBackgroundEarly and accurate risk stratification in community-acquired pneumonia is an unmet clinical need.MethodsWe enrolled 341 unselected patients presenting to the Emergency Department (ED) with CAP in whom blinded measurements of NT-proBNP, MR-proANP and 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. The median follow-up was 942 days.ResultsNT-proBNP, MR-proANP and BNP levels at presentation were higher in short- (median 4882 vs. 1133 pg/ml; 426 vs. 178 pmol/l; 436 vs. 155 pg/ml, all P<0.001) and long-term non-survivors (3515 vs. 548 pg/ml; 283 vs. 136 pmol/l; 103 vs. 318 pg/ml, all P<0.001) as compared to survivors. Receiver-operating characteristics analysis to quantify the prognostic accuracy showed comparable areas under the curve (AUC) 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 (HR 1.004, 95%CI 1.00-1.01, P=0.02 for short-term; HR 1.004, 95%CI 1.00-1.01, P=0.001 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.ConclusionNatriuretic peptides are simple and powerful predictors of short- and long-term mortality in CAP. Their prognostic accuracy is comparable to PSI.
|Item Type:||Journal Article, refereed, original work|
|Communities & Collections:||04 Faculty of Medicine > University Hospital Zurich > Clinic and Policlinic for Internal Medicine|
|DDC:||610 Medicine & health|
|Deposited On:||31 Jan 2012 19:58|
|Last Modified:||23 Nov 2012 16:46|
|Publisher:||American College of Chest Physicians|
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