title: Midregional pro-A-type natriuretic peptide and carboxy-terminal provasopressin may predict prognosis in community-acquired pneumonia.
abstract: BACKGROUND
  Markers to better assess severity of disease in patients with community-acquired pneumonia (CAP) would help improve medical care of this condition. The hemodynamic biomarkers carboxy-terminal provasopressin (CT-proAVP; copeptin) and midregional proatrial natriuretic peptide (MR-proANP) are increased under septic conditions, in which MR-proANP has been described as a prognostic predictor. We aimed to explore the diagnostic accuracy of MR-proANP and CT-proAVP to predict mortality in patients with CAP.
  
  
  METHODS
  We conducted a prospective observational study of patients with CAP. We measured biomarkers in serum samples obtained at diagnosis and performed univariate and multivariate analyses to identify potential predictors of mortality.
  
  
  RESULTS
  CT-proAVP and MR-proANP concentrations were measured in 173 patients. We found a positive correlation between pneumonia severity index (PSI) and MR-proANP (r(s) = 0.68, P <0.0001) and between PSI and CT-proAVP (r(s) = 0.44, P <0.0001). Median (interquartile range) CT-proAVP and MR-proANP values were 8.2 (5.3-16.8) and 73.6 (44.6-144.0) pmol/L, respectively. Nonsurvivors had significantly higher MR-proANP and CT-proAVP than survivors (median 259.0 vs 71.8 pmol/L, P = 0.01, and 24.9 vs 8.1 pmol/L, P = 0.03, respectively). In multivariate analysis including PSI, procalcitonin, C-reactive protein, lipopolysaccharide-binding protein, CT-proAVP, and MR-proANP concentrations, only CT-proAVP remained an independent predictor of death (odds ratio 1.05, P = 0.007). Cutoff values of >18.9 pmol/L for CT-proAVP and >227 pmol/L for MR-proANP showed the highest diagnostic accuracy to predict mortality.
  
  
  CONCLUSIONS
  CT-proAVP and MR-proANP may be used to predict prognosis in patients with CAP.
authors.affiliation: Infectious Diseases Unit, Internal Medicine Department, Hospital General Universitario de Elche, Alicante, Spain. marmasia@ya.com
authors.forename: Mar
authors.initials: M
authors.lastname: Masiá
authors.forename: Jana
authors.initials: J
authors.lastname: Papassotiriou
authors.forename: Nils G
authors.initials: NG
authors.lastname: Morgenthaler
authors.forename: Ildefonso
authors.initials: I
authors.lastname: Hernández
authors.forename: Conrado
authors.initials: C
authors.lastname: Shum
authors.forename: Félix
authors.initials: F
authors.lastname: Gutiérrez
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D009320:Atrial Natriuretic Factor / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D017714:Community-Acquired Infections / Q000175:diagnosis; D005260:Female; D006020:Glycopeptides / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000175:diagnosis*; D011024:Pneumonia, Viral / Q000175:diagnosis*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D014667:Vasopressins / Q000097:blood*
chemical_list: D015415:Biomarkers; D006020:Glycopeptides; D011498:Protein Precursors; C048197:copeptins; D014667:Vasopressins; D009320:Atrial Natriuretic Factor