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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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Receiver operating characteristic (ROC) curve for NT-proBNP and Pneumonia Severity Index class in 30-day mortality prediction.The area under the ROC curve = 0.8803 for NT-proBNP and 0.8701 for Pneumonia Severity Index class respectively.
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pone-0062612-g003: Receiver operating characteristic (ROC) curve for NT-proBNP and Pneumonia Severity Index class in 30-day mortality prediction.The area under the ROC curve = 0.8803 for NT-proBNP and 0.8701 for Pneumonia Severity Index class respectively.

Mentions: ROC analyses of the sensitivity and specificity to predict 30-day mortality showed areas under the curve of 0.88 (95% CI = 0.82 to 0.94) for NT-proBNP, 0.79 (95% CI = 0.71 to 0.87) for Troponin T, and 0.87 (95% CI = 0.83 to 0.91) for the Pneumonia Severity Index (Figure 3). Our pre-specified cut point for a raised NT-proBNP of >220 pmol/L had a sensitivity of 88% and a specificity of 71% for 30-day mortality.


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)

Receiver operating characteristic (ROC) curve for NT-proBNP and Pneumonia Severity Index class in 30-day mortality prediction.The area under the ROC curve = 0.8803 for NT-proBNP and 0.8701 for Pneumonia Severity Index class respectively.
© Copyright Policy
Related In: Results  -  Collection

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

pone-0062612-g003: Receiver operating characteristic (ROC) curve for NT-proBNP and Pneumonia Severity Index class in 30-day mortality prediction.The area under the ROC curve = 0.8803 for NT-proBNP and 0.8701 for Pneumonia Severity Index class respectively.
Mentions: ROC analyses of the sensitivity and specificity to predict 30-day mortality showed areas under the curve of 0.88 (95% CI = 0.82 to 0.94) for NT-proBNP, 0.79 (95% CI = 0.71 to 0.87) for Troponin T, and 0.87 (95% CI = 0.83 to 0.91) for the Pneumonia Severity Index (Figure 3). Our pre-specified cut point for a raised NT-proBNP of >220 pmol/L had a sensitivity of 88% and a specificity of 71% for 30-day mortality.

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