title: Clinical risk scores and blood biomarkers as predictors of long-term outcome in patients with community-acquired pneumonia: a 6-year prospective follow-up study.
abstract: OBJECTIVE
  Prediction of long-term outcomes in patients with community-acquired pneumonia (CAP) is incompletely understood. We investigated the value of clinical risk scores [pneumonia severity index (PSI) and CURB-65] (Confusion, Urea, Respiratory rate, Blood Pressure, Age >65 years) and blood biomarkers of different physiopathological pathways in predicting long-term survival in a well-characterized cohort of patients with CAP enrolled in an antibiotic stewardship trial.
  
  
  METHODS
  Patients admitted with CAP to six medical centres in Switzerland were prospectively followed for 6 years. Cox regression models and area under the receiver operating characteristics curve (AUC) were used to investigate associations between initial risk assessment and all-cause mortality.
  
  
  METHODS
  All-cause mortality during a 6-year follow-up period.
  
  
  RESULTS
  Six-year mortality in the present cohort (median age 73 years) was 45.1% [95% confidence interval (CI) 41.8-48.3%]. Initial PSI and CURB-65 scores both had excellent long-term prognostic accuracy, with a stepwise increase in mortality per risk class. The hazard ratios (95% CI) of the highest PSI and CURB-65 classes (reference: lowest class) were 38.0 (14.0-103.0) and 7.8 (2.2-14.5), respectively, after 6 years. The addition of inflammatory (pro-adrenomedullin) and cardiac (pro-atrial natriuretic peptide) blood biomarkers measured upon hospital admission further improved the prognostic capabilities of the PSI (AUC increase from 0.79 to 0.83; P < 0.0001) and the CURB-65 score (AUC increase from 0.73 to 0.80; P < 0.001).
  
  
  CONCLUSIONS
  Risk assessment using clinical scores allowed accurate long-term prognostication, which was further improved by the addition of two inflammatory (pro-adrenomedullin) and cardiac (pro-atrial natriuretic peptide) blood biomarkers. These data provide a rationale for a more risk-adapted, 'personalized' strategy for long-term management of patients with CAP.
authors.affiliation: University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Alan
authors.affiliation: University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland.
authors.forename: E
authors.initials: E
authors.lastname: Grolimund
authors.affiliation: University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland.
authors.forename: A
authors.initials: A
authors.lastname: Kutz
authors.affiliation: Department of Internal Medicine, Division of Endocrinology, Diabetes and Clinical Nutrition, University Hospital Basel, Basel, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Christ-Crain
authors.affiliation: Department of Internal Medicine, Bürgerspital Solothurn, Solothurn, Switzerland.
authors.forename: R
authors.initials: R
authors.lastname: Thomann
authors.affiliation: Basel University Medical Clinic Liestal, Liestal, Switzerland.
authors.forename: C
authors.initials: C
authors.lastname: Falconnier
authors.affiliation: Department of Internal Medicine, Kantonsspital Münsterlingen, Münsterlingen, Switzerland.
authors.forename: C
authors.initials: C
authors.lastname: Hoess
authors.affiliation: Department of Internal Medicine, Kantonsspital Lucerne, Lucerne, Switzerland.
authors.forename: C
authors.initials: C
authors.lastname: Henzen
authors.affiliation: Basel University Medical Clinic Liestal, Liestal, Switzerland.
authors.forename: W
authors.initials: W
authors.lastname: Zimmerli
authors.affiliation: University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland.
authors.forename: B
authors.initials: B
authors.lastname: Mueller
authors.affiliation: University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland.
authors.forename: P
authors.initials: P
authors.lastname: Schuetz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood*; D002423:Cause of Death / Q000639:trends; D017714:Community-Acquired Infections / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D013557:Switzerland / Q000453:epidemiology; D013997:Time Factors
chemical_list: D015415:Biomarkers
keywords: community-acquired pneumonia; long-term; mortality; outcomes; prognosis