Cardiovascular and inflammatory biomarkers to predict short- and long-term survival in community-acquired pneumonia: Results from the German Competence Network, CAPNETZ.
BACKGROUND
Several new biomarkers are related to mortality in community-acquired pneumonia (CAP).


OBJECTIVE
Aim of this study was to compare new biomarkers for the prediction of short- and long-term all-cause mortality in CAP.


METHODS
We enrolled 728 patients (59.0 ± 18.2 yr) with CAP. Midregional proadrenomedullin (MR-proADM), midregional proatrial natriuretic peptide (MR-proANP), proarginin-vasopressin (copeptin), proendothelin-1 (CT-proET-1), procalcitonin (PCT), C-reactive protein, white blood cell (WBC) count, and clinical confusion, respiratory rate, blood pressure, and age over 65 years (CRB-65) score were determined on admission. Patients were followed up for 180 days.


RESULTS
In patients who died of any cause within 28 and 180 days (2.5 and 5.1%, respectively), MR-proADM, MR-proANP, copeptin, CT-proET-1 and PCT as well as CRB-65 were significantly higher compared with survivors. MR-proADM had the best performance for 28 days (HR 3.67) and 180 days (HR 2.84) survival. The C index of MR-proADM for 28-day survival (0.85) was superior to MR-proANP (0.81), copeptin (0.78), CT-proET-1 (0.79), and CRB-65 (0.72) for the prediction of mortality. For prediction of mortality at 180 days, the C index of MR-proADM (0.78) was higher than that for MR-proANP (0.74), copeptin (0.73), CT-proET-1 (0.76), PCT, C-reactive protein, and white blood cells. MR-proADM was independent of CRB-65, and added prognostic information for short- and long-term mortality. MR-proADM was an independent and strong predictor of short- and long-term mortality.


CONCLUSIONS
All new biomarkers were good predictors of short- and long-term all-cause mortality, superior to inflammatory markers, and at least comparable to CRB-65 score. MR-proADM showed the best performance. A combination of CRB-65 with MR-proADM might be the best predictor for mortality.
Krüger
Stefan
S
Medical Clinic I, Rheinisch Westfälische Technische Hochschule University Aachen, Germany.
Ewig
Santiago
S
Giersdorf
Sven
S
Hartmann
Oliver
O
Suttorp
Norbert
N
Welte
Tobias
T
D000293:Adolescent; D053607:Adrenomedullin / Q000097:blood; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D009320:Atrial Natriuretic Factor / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D002097:C-Reactive Protein; D002116:Calcitonin / Q000097:blood; D015740:Calcitonin Gene-Related Peptide; D002318:Cardiovascular Diseases / Q000097:blood / Q000453:epidemiology*; D017714:Community-Acquired Infections / Q000097:blood / Q000453:epidemiology; D015897:Comorbidity; D019332:Endothelin-1 / Q000097:blood; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007249:Inflammation / Q000097:blood*; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000097:blood / Q000453:epidemiology*; D011237:Predictive Value of Tests; D011498:Protein Precursors / Q000097:blood; D056152:Respiratory Rate; D016019:Survival Analysis; D014667:Vasopressins / Q000097:blood; D055815:Young Adult
D015415:Biomarkers; C000606589:CALCA protein, human; D019332:Endothelin-1; D011498:Protein Precursors; C552580:midregional pro-atrial natriuretic peptide, human; C088633:proadrenomedullin; C093240:proendothelin 1; D014667:Vasopressins; D053607:Adrenomedullin; D009320:Atrial Natriuretic Factor; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide