Evaluation of B-type natriuretic peptide as prognostic marker in patients with pneumonia: A prospective cohort study
Abstract
Background: Pneumonia is the leading cause of death due to infection among the elderly in developed countries. We validated the usefulness of B-type natriuretic peptide (BNP) as a prognostic marker for pneumonia.
Methods: We carried out a prospective cohort study at Kanazawa Medical University Himi Municipal Hospital. We enrolled patients admitted between 1 January 2012 and 31 October 2016 with diagnoses of community-acquired pneumonia (CAP), non-CAP composed of aspiration pneumonia (AP) and healthcare-associated pneumonia (HCAP) whose BNP levels had been determined within the first 24 hours of admission. After enrollment, we collected baseline, demographic, clinical and laboratory characteristics, and outcome data. Primary outcome was defined as 30-day death. We applied univariate and multivariable Cox-regression analysis to each parameter to identify predictors of death for all included cases, CAP, and non-CAP.
Results: Of the 543 subjects included in the study, 205 were diagnosed with CAP and 338 with non-CAP. In the univariate analysis of the 543 subjects, mean BNP levels were associated with death (p = 0.0000); and in the multivariate analysis, BNP remained an independent predictor of mortality (cut-off points 220 pg/mL, hazard ratio (HR) 1.99, 95 % confidence interval (CI) 1.16-3.4, p = 0.01). A similar situation was found in univariate analysis of CAP and non-CAP (p = 0.0008, 0.0000, respectively), and in multivariable Cox-regression analysis of non-CAP (HR 2.27, 95 % CI 1.3-3.95, p = 0.004).
Conclusions: BNP level may be a useful single prognostic marker for AP or HCAP.
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Christ-Crain M, Breidthardt T, Stolz D, Zobrist K, Bingisser R, Miedinger D, Leuppi J, Tamm M, Mueller B, Mueller C. Use of B-type natriuretic peptide in the risk stratification of community-acquired pneumonia. J Intern Med. 2008 Aug;264(2):166-76. doi: 10.1111/j.1365-2796.2008.01934.x. Epub 2008 Feb 20.
Janssens JP, Krause KH. Pneumonia in the very old. Lancet Infect Dis. 2004 Feb;4(2):112-24.
Statistical database managed by the Statistics and Information Department, Ministry of Health, Labour and Welfare, Japan, http://www.mhlw.go.jp/toukei/saikin/hw/jinkou/kakutei15/dl/00_all.pdf (2015, accessed 10 February 2018).
Statistical database managed by the Statistics and Information Department, Ministry of Health, Labour and Welfare, Japan, http://www.e-stat.go.jp/SG1/estat/List.do?lid=000001158057 (2015, accessed 10 February 2018).
WHO methods and data sources for country-level causes of death 2000-2015. Global Health Estimates Technical Paper WHO/HIS/IER/GHE/2016.3, http://www.who.int/healthinfo/global_burden_disease/estimates/en/index1.html (2000-2015, accessed 10 February 2018).
Kohno S, Seki M, Watanabe A; CAP Study Group. Evaluation of an assessment system for the JRS 2005: A-DROP for the management of CAP in adults. Intern Med. 2011;50(11):1183-91. Epub 2011 Jun 1.
Gutiérrez F, Masiá M. Improving outcomes of elderly patients with community-acquired pneumonia. Drugs Aging. 2008;25(7):585-610.
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. Direct comparison of three natriuretic peptides for prediction of short- and long-term mortality in patients with community-acquired pneumonia. Chest. 2012 Apr;141(4):974-982. doi: 10.1378/chest.11-0824. Epub 2011 Dec 1.
Usuda D, Sangen R, Hashimoto Y, Muranaka E, Iinuma Y, Kanda T. Validation of a B-type natriuretic peptide as a prognostic marker in pneumonia patients: a prospective cohort study. BMJ Open. 2016 Feb 23;6(2):e010440. doi: 10.1136/bmjopen-2015-010440.
Vital Statistics of Toyama prefecture, Japan, http://www.pref.toyama.jp/sections/1015/lib/jinko/index.html (2016, accessed 10 February 2018).
Menéndez R, Martínez R, Reyes S, Mensa J, Filella X, Marcos MA, Martínez A, Esquinas C, Ramirez P, Torres A. Biomarkers improve mortality prediction by prognostic scales in community-acquired pneumonia. Thorax. 2009 Jul;64(7):587-91. doi: 10.1136/thx.2008.105312. Epub 2009 Jan 8.
Wang LJ, Mu SC, Lin CH, Lin MI, Sung TC. Fatal community-acquired pneumonia: 18 years in a medical center. Pediatr Neonatol. 2013 Feb;54(1):22-7. doi: 10.1016/j.pedneo.2012.11.003. Epub 2013 Jan 8.
Riquelme R, Torres A, El-Ebiary M, de la Bellacasa JP, Estruch R, Mensa J, Fernández-Solá J, Hernández C, Rodriguez-Roisin R. Community-acquired pneumonia in the elderly: A multivariate analysis of risk and prognostic factors. Am J Respir Crit Care Med. 1996 Nov;154(5):1450-5.
Molinos L, Clemente MG, Miranda B, Alvarez C, del Busto B, Cocina BR, Alvarez F, Gorostidi J, Orejas C; ASTURPAR Group. Community-acquired pneumonia in patients with and without chronic obstructive pulmonary disease. J Infect. 2009 Jun;58(6):417-24. doi: 10.1016/j.jinf.2009.03.003. Epub 2009 Mar 14.
Kothe H, Bauer T, Marre R, Suttorp N, Welte T, Dalhoff K; Competence Network for Community-Acquired Pneumonia study group. Outcome of community-acquired pneumonia: influence of age, residence status and antimicrobial treatment. Eur Respir J. 2008 Jul;32(1):139-46. doi: 10.1183/09031936.00092507. Epub 2008 Feb 20.
Clemente MG, Budiño TG, Seco GA, Santiago M, Gutiérrez M, Romero P. Community-acquired pneumonia in the elderly: prognostic factors. Arch Bronconeumol. 2002 Feb;38(2):67-71.
Wu CL, Lin FJ, Lee SY, Lee CH, Peng MJ, Chen PJ, Kuo HT. Early evolution of arterial oxygenation in severe community-acquired pneumonia: a prospective observational study. J Crit Care. 2007 Jun;22(2):129-36. Epub 2007 Jan 31.
Fukuyama H, Yamashiro S, Tamaki H, Kishaba T. A prospective comparison of nursing- and healthcare-associated pneumonia (NHCAP) with community-acquired pneumonia (CAP). J Infect Chemother. 2013 Aug;19(4):719-26. doi: 10.1007/s10156-013-0557-1. Epub 2013 Jan 25.
Committee for the Japanese Respiratory Society Guidelines in Management of Respiratory. Aspiration pneumonia. Respirology. 2004 Mar;9 Suppl 1:S35-7.
Kohno S, Imamura Y, Shindo Y, Seki M, Ishida T, Teramoto S, Kadota J, Tomono K, Watanabe A. Clinical practice guidelines for nursing- and healthcare-associated pneumonia (NHCAP) [complete translation]. Respir Investig. 2013 Jun;51(2):103-26. doi: 10.1016/j.resinv.2012.11.001.
González-González AI, Lobos-Bejarano J, Horrillo-García C, Castellanos-Maroto J, Díaz-Sánchez S, Castellanos-Rodríguez A, Martínez-Carrasco J, Taboada-Tabeada M, Miraflores-Carpio J. Brain natriuretic peptide in primary care: diagnostic value in heart failure. Aten Primaria. 2005 Nov 30;36(9):510-4.
Li J, Ye H, Zhao L. B-type natriuretic peptide in predicting the severity of community-acquired pneumonia. World J Emerg Med. 2015;6(2):131-6. doi: 10.5847/wjem.j.1920-8642.2015.02.008.
Yetkin O, Hacievliyagil SS, Gunen H. Assessment of B-type natriuretic peptide in patients with pneumonia. Int J Clin Pract. 2008 Mar;62(3):488-91. Epub 2007 Oct 3.
Scali MC, Simioniuc A, Dini FL, Marzilli M. The potential value of integrated natriuretic peptide and echo-guided heart failure management. Cardiovasc Ultrasound. 2014 Jul 18;12:27. doi: 10.1186/1476-7120-12-27.
Leli C. Utility of brain natriuretic peptide as prognostic marker in community-acquired pneumonia and chronic obstructive pulmonary disease exacerbation patients presenting to the emergency department. Infez Med. 2011 Dec;19(4):235-40.
DOI: http://dx.doi.org/10.18103/imr.v4i3.690
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