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Endothelin-1 precursor peptides correlate with severity of disease and outcome in patients with community acquired pneumonia.

Schuetz P, Stolz D, Mueller B, Morgenthaler NG, Struck J, Mueller C, Bingisser R, Tamm M, Christ-Crain M - BMC Infect. Dis. (2008)

Bottom Line: The diagnostic accuracy to predict bacteraemia of procalcitonin (AUC 0.84 [95% 0.74-0.93]) was superior than C-reactive protein (AUC 0.67 [95%CI 0.56-0.78]) and leukocyte count (AUC 0.66 [95%CI 0.55-0.78]) and in the range of proET-1(AUC of 0.77 [95%CI 0.67-0.86]).ProET-1 determination improved significantly the prognostic accuracy of the CURB65 score (AUC of the combined model 0.69 [95%CI 0.59-0.79]).ISRCTN04176397.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Internal Medicine, University Hospital Basel, Switzerland. SchuetzP@uhbs.ch

ABSTRACT

Background: Circulating levels of endothelin-1 are increased in sepsis and correlate with severity of disease. A rapid and easy immunoassay has been developed to measure the more stable ET-1 precursor peptides proET-1. The objective of this study was to assess the diagnostic and prognostic value of proET-1 in a prospective cohort of mainly septic patients with community-acquired pneumonia.

Methods: We evaluated 281 consecutive patients with community acquired pneumonia. Serum proET-1 plasma levels were measured using a new sandwich immunoassay.

Results: ProET-1 levels exhibited a gradual increase depending on the clinical severity of pneumonia as assessed by the pneumonia severity index (PSI) and the CURB65 scores (p < 0.001 and p < 0.01). The diagnostic accuracy to predict bacteraemia of procalcitonin (AUC 0.84 [95% 0.74-0.93]) was superior than C-reactive protein (AUC 0.67 [95%CI 0.56-0.78]) and leukocyte count (AUC 0.66 [95%CI 0.55-0.78]) and in the range of proET-1(AUC of 0.77 [95%CI 0.67-0.86]). ProET-1 levels on admission were increased in patients with adverse medical outcomes including death and need for ICU admission. ROC curve analysis to predict the risk for mortality showed a prognostic accuracy of proET-1 (AUC 0.64 [95%CI 0.53-0.74]), which was higher than C-reactive protein (AUC 0.51 [95%CI 0.41-0.61]) and leukocyte count (AUC 0.55 [95%CI 0.44-0.65]) and within the range of the clinical severity scores (PSI AUC 0.69 [95%CI 0.61-0.76] and CURB65 0.67 [95%CI 0.57-0.77]) and procalcitonin (AUC 0.59 [95% 0.51-0.67]). ProET-1 determination improved significantly the prognostic accuracy of the CURB65 score (AUC of the combined model 0.69 [95%CI 0.59-0.79]). In a multivariate logistic regression model, only proET1 and the clinical severity scores were independent predictors for death and for the need for ICU admission.

Conclusion: In community-acquired pneumonia, ET-1 precursor peptides correlate with disease severity and are independent predictors for mortality and ICU admission. If confirmed in future studies, proET-1 levels may become another helpful tool for risk stratification and management of patients with community-acquired pneumonia.

Trial registration: ISRCTN04176397.

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Related in: MedlinePlus

ProET-1 levels increase according to disease severity as represented by the PSI (Pneumonia Severity Index).
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Figure 2: ProET-1 levels increase according to disease severity as represented by the PSI (Pneumonia Severity Index).

Mentions: ProET1 (pmol/L) levels were significantly higher at hospital admission as compared to recovery (108.1 [IQR 99.3–117.0] vs 70.1 [IQR 64.6–71.5], p < 0.0001 (Figure 1). On admission, pro-ET1 levels significantly increased with increasing severity of CAP as determined by the PSI scores (Figure 2) and the CURB65 (Figure 3) score (p < 0.001 and p < 0.01). Median proET1 levels showed an about 2-fold increase from patients with PSI class 1 to PSI class 5, and a 0.4-fold increase from CURB65 class 0 to class 4, respectively. This gradual increase was also present for procalcitonin levels (p < 0.01, p < 0.01) and total leukocyte count (p = 0.03, p = 0.004), but not for C-reactive protein (p = 0.12, p = 0.61) and body temperature (p = 0.59, p = 0.42).


Endothelin-1 precursor peptides correlate with severity of disease and outcome in patients with community acquired pneumonia.

Schuetz P, Stolz D, Mueller B, Morgenthaler NG, Struck J, Mueller C, Bingisser R, Tamm M, Christ-Crain M - BMC Infect. Dis. (2008)

ProET-1 levels increase according to disease severity as represented by the PSI (Pneumonia Severity Index).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2335111&req=5

Figure 2: ProET-1 levels increase according to disease severity as represented by the PSI (Pneumonia Severity Index).
Mentions: ProET1 (pmol/L) levels were significantly higher at hospital admission as compared to recovery (108.1 [IQR 99.3–117.0] vs 70.1 [IQR 64.6–71.5], p < 0.0001 (Figure 1). On admission, pro-ET1 levels significantly increased with increasing severity of CAP as determined by the PSI scores (Figure 2) and the CURB65 (Figure 3) score (p < 0.001 and p < 0.01). Median proET1 levels showed an about 2-fold increase from patients with PSI class 1 to PSI class 5, and a 0.4-fold increase from CURB65 class 0 to class 4, respectively. This gradual increase was also present for procalcitonin levels (p < 0.01, p < 0.01) and total leukocyte count (p = 0.03, p = 0.004), but not for C-reactive protein (p = 0.12, p = 0.61) and body temperature (p = 0.59, p = 0.42).

Bottom Line: The diagnostic accuracy to predict bacteraemia of procalcitonin (AUC 0.84 [95% 0.74-0.93]) was superior than C-reactive protein (AUC 0.67 [95%CI 0.56-0.78]) and leukocyte count (AUC 0.66 [95%CI 0.55-0.78]) and in the range of proET-1(AUC of 0.77 [95%CI 0.67-0.86]).ProET-1 determination improved significantly the prognostic accuracy of the CURB65 score (AUC of the combined model 0.69 [95%CI 0.59-0.79]).ISRCTN04176397.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Internal Medicine, University Hospital Basel, Switzerland. SchuetzP@uhbs.ch

ABSTRACT

Background: Circulating levels of endothelin-1 are increased in sepsis and correlate with severity of disease. A rapid and easy immunoassay has been developed to measure the more stable ET-1 precursor peptides proET-1. The objective of this study was to assess the diagnostic and prognostic value of proET-1 in a prospective cohort of mainly septic patients with community-acquired pneumonia.

Methods: We evaluated 281 consecutive patients with community acquired pneumonia. Serum proET-1 plasma levels were measured using a new sandwich immunoassay.

Results: ProET-1 levels exhibited a gradual increase depending on the clinical severity of pneumonia as assessed by the pneumonia severity index (PSI) and the CURB65 scores (p < 0.001 and p < 0.01). The diagnostic accuracy to predict bacteraemia of procalcitonin (AUC 0.84 [95% 0.74-0.93]) was superior than C-reactive protein (AUC 0.67 [95%CI 0.56-0.78]) and leukocyte count (AUC 0.66 [95%CI 0.55-0.78]) and in the range of proET-1(AUC of 0.77 [95%CI 0.67-0.86]). ProET-1 levels on admission were increased in patients with adverse medical outcomes including death and need for ICU admission. ROC curve analysis to predict the risk for mortality showed a prognostic accuracy of proET-1 (AUC 0.64 [95%CI 0.53-0.74]), which was higher than C-reactive protein (AUC 0.51 [95%CI 0.41-0.61]) and leukocyte count (AUC 0.55 [95%CI 0.44-0.65]) and within the range of the clinical severity scores (PSI AUC 0.69 [95%CI 0.61-0.76] and CURB65 0.67 [95%CI 0.57-0.77]) and procalcitonin (AUC 0.59 [95% 0.51-0.67]). ProET-1 determination improved significantly the prognostic accuracy of the CURB65 score (AUC of the combined model 0.69 [95%CI 0.59-0.79]). In a multivariate logistic regression model, only proET1 and the clinical severity scores were independent predictors for death and for the need for ICU admission.

Conclusion: In community-acquired pneumonia, ET-1 precursor peptides correlate with disease severity and are independent predictors for mortality and ICU admission. If confirmed in future studies, proET-1 levels may become another helpful tool for risk stratification and management of patients with community-acquired pneumonia.

Trial registration: ISRCTN04176397.

Show MeSH
Related in: MedlinePlus