Use of B-type natriuretic peptide in the risk stratification of community-acquired pneumonia

被引:89
作者
Christ-Crain, M. [1 ]
Breidthardt, T. [1 ]
Stolz, D. [1 ]
Zobrist, K. [1 ]
Bingisser, R. [1 ]
Miedinger, D. [1 ]
Leuppi, J. [1 ]
Tamm, M. [1 ]
Mueller, B. [1 ]
Mueller, C. [1 ]
机构
[1] Univ Basel Hosp, Dept Internal Med, CH-4031 Basel, Switzerland
关键词
biomarker; mortality; pneumonia;
D O I
10.1111/j.1365-2796.2008.01934.x
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Community-acquired pneumonia (CAP) is the leading infectious cause of death in developed countries. Risk stratification has previously been difficult. Methods: Markers of cardiac stress (B-type natriuretic peptide, BNP) and inflammation (C-reactive protein, white blood cell count, procalcitonin) as well as the pneumonia severity index (PSI) were determined in 302 consecutive patients presenting to the emergency department (ED) with CAP. The accuracy of these parameters to predict death was evaluated as the primary endpoint. Prediction of treatment failure was considered as the secondary endpoint. Results: B-type natriuretic peptide levels increased with rising disease severity as classified by the PSI (P = 0.015). BNP levels were significantly higher in nonsurvivors compared to survivors [median 439.2 (IQR 137.1-1384.6) vs. 114.3 (51.3-359.6) pg mL(-1), P < 0.001]. In a receiver operating characteristic analysis for the prediction of survival the area under the curve (AUC) for BNP was comparable to the AUC of the PSI (0.75 vs. 0.71, P = 0.52). Importantly, the combination of BNP and the PSI significantly improved the prognostic accuracy of the PSI alone (AUC 0.78 vs. 0.71; P = 0.02). The optimal cut-off for BNP was 279 pg mL(-1). The accuracy of BNP to predict treatment failure was identical to the accuracy to predict death (AUC 0.75). Conclusion: In patients with CAP, BNP levels are powerful and independent predictors of death and treatment failure. When used in conjunction with the PSI, BNP levels significantly improve the risk prediction when compared with the PSI alone.
引用
收藏
页码:166 / 176
页数:11
相关论文
共 35 条
[1]   Contribution of C-reactive protein to the diagnosis and assessment of severity of community-acquired pneumonia [J].
Almirall, J ;
Bolíbar, I ;
Toran, P ;
Pera, G ;
Boquet, X ;
Balanzó, X ;
Sauca, G .
CHEST, 2004, 125 (04) :1335-1342
[2]   Plasma concentrations of atrial, brain, and C-type natriuretic peptides and endothelin-1 in patients with chronic respiratory diseases [J].
Ando, T ;
Ogawa, K ;
Yamaki, K ;
Hara, M ;
Takagi, K .
CHEST, 1996, 110 (02) :462-468
[3]   Assessing the quality of clinical data in a computer-based record for calculating the Pneumonia Severity Index [J].
Aronsky, D ;
Haug, PJ .
JOURNAL OF THE AMERICAN MEDICAL INFORMATICS ASSOCIATION, 2000, 7 (01) :55-65
[4]   Natriuretic peptides, respiratory disease, and the right heart [J].
Bin Yap, L ;
Mukejee, D ;
Timms, PM ;
Ashrafian, H ;
Coghlan, JG .
CHEST, 2004, 126 (04) :1330-1336
[5]   Medical and economic long-term effects of B-type natriuretic peptide testing in patients with acute dyspnea [J].
Breidthardt, Tobias ;
Laule, Kirsten ;
Strohmeyer, Anne-Henny ;
Schindler, Christian ;
Meier, Sophie ;
Fischer, Michael ;
Scholer, Andre ;
Noveanu, Markus ;
Christ, Michael ;
Perruchoud, Andre P. ;
Mueller, Christian .
CLINICAL CHEMISTRY, 2007, 53 (08) :1415-1422
[6]   Prognostic value of plasma N-terminal pro-brain natriuretic peptide in patients with severe sepsis [J].
Brueckmann, M ;
Huhle, G ;
Lang, S ;
Haase, KK ;
Bertsch, T ;
Weiss, C ;
Kaden, JJ ;
Putensen, C ;
Borggrefe, M ;
Hoffmann, U .
CIRCULATION, 2005, 112 (04) :527-534
[7]   Brain natriuretic peptide blood levels in the differential diagnosis of dyspnea [J].
Cabanes, L ;
Richaud-Thiriez, B ;
Fulla, Y ;
Heloire, F ;
Vuillemard, C ;
Weber, S ;
Dusser, D .
CHEST, 2001, 120 (06) :2047-2050
[8]   A rapid bedside test for B-type peptide predicts treatment outcomes in patients admitted for decompensated heart failure: A pilot study [J].
Cheng, V ;
Kazanagra, R ;
Garcia, A ;
Lenert, L ;
Krishnaswamy, P ;
Gardetto, N ;
Clopton, P ;
Maisel, A .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2001, 37 (02) :386-391
[9]   Effect of procalcitonin-guided treatment on antibiotic use and outcome in lower respiratory tract infections:: cluster-randomised, single-blinded intervention trial [J].
Christ-Crain, M ;
Jaccard-Stolz, D ;
Bingisser, R ;
Gencay, MM ;
Huber, PR ;
Tamm, M ;
Müller, B .
LANCET, 2004, 363 (9409) :600-607
[10]   Procalcitonin guidance of antibiotic therapy in community-acquired pneumonia a Randomized trial [J].
Christ-Crain, Miriam ;
Stolz, Daiana ;
Bingisser, Roland ;
Muller, Christian ;
Miedinger, David ;
Huber, Peter R. ;
Zimmerli, Werner ;
Harbarth, Stephan ;
Tamm, Michael ;
Mueller, Beat .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2006, 174 (01) :84-93