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Biomarkers of cardiac dysfunction and mortality from community-acquired pneumonia in adults.

Chang CL, Mills GD, Karalus NC, Jennings LC, Laing R, Murdoch DR, Chambers ST, Vettise D, Tuffery CM, Hancox RJ - PLoS ONE (2013)

Bottom Line: Cardiac dysfunction is common in acute respiratory diseases and may influence prognosis.Both NT-proBNP and Troponin T predicted 30-day mortality in age-adjusted analysis but after mutual adjustment for the other cardiac biomarker and the Pneumonia Severity Index, a raised N-terminal pro-brain natriuretic peptide remained a predictor of 30-day mortality (OR = 5.3, 95% CI 1.4-19.8, p = 0.013) but Troponin T did not (OR = 1.3, 95% CI 0.5-3.2, p = 0.630).In the meantime, measurement of B-type natriuretic peptides may help to assess prognosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Respiratory Medicine, Waikato Hospital, Hamilton, New Zealand.

ABSTRACT

Background: Cardiac dysfunction is common in acute respiratory diseases and may influence prognosis. We hypothesised that blood levels of N-terminal B-type natriuretic peptide (NT-proBNP) and high-sensitivity Troponin T would predict mortality in adults with community-acquired pneumonia.

Methods and findings: A prospective cohort of 474 consecutive patients admitted with community-acquired pneumonia to two New Zealand hospitals over one year. Blood taken on admission was available for 453 patients and was analysed for NT-proBNP and Troponin T. Elevated levels of NT-proBNP (>220 pmol/L) were present in 148 (33%) and 86 (19%) of these patients respectively. Among the 26 patients who died within 30 days of admission, 23 (89%) had a raised NT-proBNP and 14 (53%) had a raised Troponin T level on admission compared to 125 (29%) and 72 (17%) of the 427 who survived (p values<0.001). Both NT-proBNP and Troponin T predicted 30-day mortality in age-adjusted analysis but after mutual adjustment for the other cardiac biomarker and the Pneumonia Severity Index, a raised N-terminal pro-brain natriuretic peptide remained a predictor of 30-day mortality (OR = 5.3, 95% CI 1.4-19.8, p = 0.013) but Troponin T did not (OR = 1.3, 95% CI 0.5-3.2, p = 0.630). The areas under the receiver-operating curves to predict 30-day mortality were similar for NT-proBNP (0.88) and the Pneumonia Severity Index (0.87).

Conclusions: Elevated N-terminal B-type natriuretic peptide is a strong predictor of mortality from community-acquired pneumonia independent of clinical prognostic indicators. The pathophysiological basis for this is unknown but suggests that cardiac involvement may be an under-recognised determinant of outcome in pneumonia and may require a different approach to treatment. In the meantime, measurement of B-type natriuretic peptides may help to assess prognosis.

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Related in: MedlinePlus

1 year Kaplan-Meier survival curve for patients following community-acquired pneumonia stratified according to NT-proBNP level.Survival was worse in patients with high NT-proBNP levels (>220 pmol/L) compared to patients with normal NT-proBNP levels (≤220 pmol/L) (log-rank test, p<0.0001).
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pone-0062612-g002: 1 year Kaplan-Meier survival curve for patients following community-acquired pneumonia stratified according to NT-proBNP level.Survival was worse in patients with high NT-proBNP levels (>220 pmol/L) compared to patients with normal NT-proBNP levels (≤220 pmol/L) (log-rank test, p<0.0001).

Mentions: 27 patients who survived for more than one month died during the first year after admission. Neither elevated levels of NT-proBNP nor Troponin T predicted mortality between 1 month and 1 year after admission after adjusting for the Pneumonia Severity Index (OR = 1.1, 95% CI = 0.5 to 2.6, p = 0.826 and OR = 1.0, 95% CI = 0.4 to 2.6, p = 0.999 respectively) Figure 2. By contrast, the Pneumonia Severity Index was a significant predictor of mortality between 1 month and 1 year after admission (OR for each increment in category = 1.8, 95% CI 1.2 to 2.7, p = 0.004). 227/443 (51%) patients with follow-up data had died within 10 years of admission. Both NT-proBNP (OR = 2.3, 95% CI = 1.3 to 4.2, p = 0.003) and the Pneumonia Severity Index (OR 2.6, 95% CI = 2.1 to 3.3, p<0.001), but not Troponin T (OR = 1.4, 95% CI = 0.7 to 2.8, p = 0.339) predicted mortality between 1 month and 10 years after admission.


Biomarkers of cardiac dysfunction and mortality from community-acquired pneumonia in adults.

Chang CL, Mills GD, Karalus NC, Jennings LC, Laing R, Murdoch DR, Chambers ST, Vettise D, Tuffery CM, Hancox RJ - PLoS ONE (2013)

1 year Kaplan-Meier survival curve for patients following community-acquired pneumonia stratified according to NT-proBNP level.Survival was worse in patients with high NT-proBNP levels (>220 pmol/L) compared to patients with normal NT-proBNP levels (≤220 pmol/L) (log-rank test, p<0.0001).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3646835&req=5

pone-0062612-g002: 1 year Kaplan-Meier survival curve for patients following community-acquired pneumonia stratified according to NT-proBNP level.Survival was worse in patients with high NT-proBNP levels (>220 pmol/L) compared to patients with normal NT-proBNP levels (≤220 pmol/L) (log-rank test, p<0.0001).
Mentions: 27 patients who survived for more than one month died during the first year after admission. Neither elevated levels of NT-proBNP nor Troponin T predicted mortality between 1 month and 1 year after admission after adjusting for the Pneumonia Severity Index (OR = 1.1, 95% CI = 0.5 to 2.6, p = 0.826 and OR = 1.0, 95% CI = 0.4 to 2.6, p = 0.999 respectively) Figure 2. By contrast, the Pneumonia Severity Index was a significant predictor of mortality between 1 month and 1 year after admission (OR for each increment in category = 1.8, 95% CI 1.2 to 2.7, p = 0.004). 227/443 (51%) patients with follow-up data had died within 10 years of admission. Both NT-proBNP (OR = 2.3, 95% CI = 1.3 to 4.2, p = 0.003) and the Pneumonia Severity Index (OR 2.6, 95% CI = 2.1 to 3.3, p<0.001), but not Troponin T (OR = 1.4, 95% CI = 0.7 to 2.8, p = 0.339) predicted mortality between 1 month and 10 years after admission.

Bottom Line: Cardiac dysfunction is common in acute respiratory diseases and may influence prognosis.Both NT-proBNP and Troponin T predicted 30-day mortality in age-adjusted analysis but after mutual adjustment for the other cardiac biomarker and the Pneumonia Severity Index, a raised N-terminal pro-brain natriuretic peptide remained a predictor of 30-day mortality (OR = 5.3, 95% CI 1.4-19.8, p = 0.013) but Troponin T did not (OR = 1.3, 95% CI 0.5-3.2, p = 0.630).In the meantime, measurement of B-type natriuretic peptides may help to assess prognosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Respiratory Medicine, Waikato Hospital, Hamilton, New Zealand.

ABSTRACT

Background: Cardiac dysfunction is common in acute respiratory diseases and may influence prognosis. We hypothesised that blood levels of N-terminal B-type natriuretic peptide (NT-proBNP) and high-sensitivity Troponin T would predict mortality in adults with community-acquired pneumonia.

Methods and findings: A prospective cohort of 474 consecutive patients admitted with community-acquired pneumonia to two New Zealand hospitals over one year. Blood taken on admission was available for 453 patients and was analysed for NT-proBNP and Troponin T. Elevated levels of NT-proBNP (>220 pmol/L) were present in 148 (33%) and 86 (19%) of these patients respectively. Among the 26 patients who died within 30 days of admission, 23 (89%) had a raised NT-proBNP and 14 (53%) had a raised Troponin T level on admission compared to 125 (29%) and 72 (17%) of the 427 who survived (p values<0.001). Both NT-proBNP and Troponin T predicted 30-day mortality in age-adjusted analysis but after mutual adjustment for the other cardiac biomarker and the Pneumonia Severity Index, a raised N-terminal pro-brain natriuretic peptide remained a predictor of 30-day mortality (OR = 5.3, 95% CI 1.4-19.8, p = 0.013) but Troponin T did not (OR = 1.3, 95% CI 0.5-3.2, p = 0.630). The areas under the receiver-operating curves to predict 30-day mortality were similar for NT-proBNP (0.88) and the Pneumonia Severity Index (0.87).

Conclusions: Elevated N-terminal B-type natriuretic peptide is a strong predictor of mortality from community-acquired pneumonia independent of clinical prognostic indicators. The pathophysiological basis for this is unknown but suggests that cardiac involvement may be an under-recognised determinant of outcome in pneumonia and may require a different approach to treatment. In the meantime, measurement of B-type natriuretic peptides may help to assess prognosis.

Show MeSH
Related in: MedlinePlus