title: Direct comparison of three natriuretic peptides for prediction of short- and long-term mortality in patients with community-acquired pneumonia.
abstract: BACKGROUND
  Early and accurate risk stratification for patients with community-acquired pneumonia (CAP) is an unmet clinical need.
  
  
  METHODS
  We enrolled 341 unselected patients presenting to the ED with CAP in whom blinded measurements of N-terminal pro-B-type natriuretic peptide (NT-proBNP), midregional pro-atrial natriuretic peptide (MR-proANP), and B-type natriuretic peptide (BNP) were performed. The potential of these natriuretic peptides to predict short- (30-day) and long-term mortality was compared with the pneumonia severity index (PSI) and CURB-65 (confusion, urea plasma level, respiratory rate, BP, age over 65 years). The median follow-up was 942 days.
  
  
  RESULTS
  NT-proBNP, MR-proANP, and BNP levels at presentation were higher in short-term (median 4,882 pg/mL vs 1,133 pg/mL; 426 pmol/L vs 178 pmol/L; 436 pg/mL vs 155 pg/mL, all P < .001) and long-term nonsurvivors (3,515 pg/mL vs 548 pg/mL; 283 pmol/L vs 136 pmol/L; 318 pg/mL vs 103 pg/mL, all P < .001) as compared with survivors. Receiver operating characteristics analysis to quantify the prognostic accuracy showed comparable areas under the curve for the three natriuretic peptides to PSI for short-term (PSI 0.76, 95% CI, 0.71-0.81; NT-proBNP 0.73, 95% CI, 0.67-0.77; MR-proANP 0.72, 95% CI, 0.67-0.77; BNP 0.68, 95% CI, 0.63-0.73) and long-term (PSI 0.72, 95% CI, 0.66-0.77; NT-proBNP 0.75, 95% CI, 0.70-0.80; MR-proANP 0.73, 95% CI, 0.67-0.77, BNP 0.70, 95% CI, 0.65-0.75) mortality. In multivariable Cox-regression analysis, NT-proBNP remained an independent mortality predictor (hazard ratio 1.004, 95% CI, 1.00-1.01, P = .02 for short-term; hazard ratio 1.004, 95% CI, 1.00-1.01, P = .001 for long-term, increase of 300 pg/mL). A categorical approach combining PSI point values and NT-pro-BNP levels adequately identified patients at low, medium, and high short- and long-term mortality risk.
  
  
  CONCLUSIONS
  Natriuretic peptides are simple and powerful predictors of short- and long-term mortality for patients with CAP. Their prognostic accuracy is comparable to PSI.
authors.affiliation: Department of Internal Medicine, University Hospital Basel, Basel, Switzerland; Division of Internal Medicine, University Hospital Zürich, Zürich, Switzerland.
authors.forename: Albina
authors.initials: A
authors.lastname: Nowak
authors.affiliation: Department of Internal Medicine, University Hospital Basel, Basel, Switzerland; Division of Nephrology, University Hospital Basel, Basel, Switzerland.
authors.forename: Tobias
authors.initials: T
authors.lastname: Breidthardt
authors.affiliation: Division of Endocrinology, University Hospital Basel, Basel, Switzerland.
authors.forename: Mirjam
authors.initials: M
authors.lastname: Christ-Crain
authors.affiliation: Emergency Department, University Hospital Basel, Basel, Switzerland.
authors.forename: Roland
authors.initials: R
authors.lastname: Bingisser
authors.affiliation: Department of Internal Medicine, University Hospital Basel, Basel, Switzerland.
authors.forename: Christophe
authors.initials: C
authors.lastname: Meune
authors.affiliation: Department of Internal Medicine, University Hospital Basel, Basel, Switzerland.
authors.forename: Yunus
authors.initials: Y
authors.lastname: Tanglay
authors.affiliation: Department of Internal Medicine, University Hospital Basel, Basel, Switzerland.
authors.forename: Corinna
authors.initials: C
authors.lastname: Heinisch
authors.affiliation: Department of Internal Medicine, University Hospital Basel, Basel, Switzerland.
authors.forename: Miriam
authors.initials: M
authors.lastname: Reiter
authors.affiliation: Department of Internal Medicine, University Hospital Basel, Basel, Switzerland.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Drexler
authors.affiliation: Department of Internal Medicine, University Hospital Basel, Basel, Switzerland.
authors.forename: Nisha
authors.initials: N
authors.lastname: Arenja
authors.affiliation: Department of Internal Medicine, University Hospital Basel, Basel, Switzerland.
authors.forename: Raphael
authors.initials: R
authors.lastname: Twerenbold
authors.affiliation: Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel, Basel, Switzerland.
authors.forename: Daiana
authors.initials: D
authors.lastname: Stolz
authors.affiliation: Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel, Basel, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Tamm
authors.affiliation: Medical University Clinic, Kantonsspital, Aarau, Switzerland.
authors.forename: Beat
authors.initials: B
authors.lastname: Müller
authors.affiliation: Department of Internal Medicine, University Hospital Basel, Basel, Switzerland; Medical University Clinic, Kantonsspital, Aarau, Switzerland. Electronic address: chmueller@uhbs.ch.
authors.forename: Christian
authors.initials: C
authors.lastname: Müller
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D009320:Atrial Natriuretic Factor / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D017714:Community-Acquired Infections / Q000097:blood / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011014:Pneumonia / Q000097:blood / Q000401:mortality*; D011379:Prognosis; D012044:Regression Analysis; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C552580:midregional pro-atrial natriuretic peptide, human; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor