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Direct Comparison of Three Natriuretic Peptides for prediction of short- and long-term mortality in community acquired pneumonia.

Type of publication Peer-reviewed
Publikationsform Original article (peer-reviewed)
Author 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,
Project Preventing viral exacerbation of chronic obstructive pulmonary disease in upper respiratory tract infection - The PREVENT study
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Original article (peer-reviewed)

Journal Chest
Title of proceedings Chest
DOI 10.1378/chest.11-0824

Abstract

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.
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