title: Soluble ST2 as a prognostic marker in community-acquired pneumonia.
abstract: OBJECTIVE
  Community-acquired pneumonia (CAP) is associated with high mortality when initial treatment fails. Early identification of these patients allows physicians to modify treatments earlier, increasing survival.
  
  
  METHODS
  Ninety-one hospitalized patients with CAP were studied. Serum soluble ST2 levels were measured at diagnosis and at 3, 7, and 14 days (days 0, 3, 7, and 14) after the initiation of antimicrobial treatment. The predictive value of all-cause in-hospital mortality and the additive effect of soluble ST2 on the pneumonia severity index (PSI) were evaluated.
  
  
  RESULTS
  In univariate analysis, high serum levels of soluble ST2 at days 0, 3, 7, and 14 were predictive of death (hazard ratios: 3.1, 10.0, 12.0, and 22.6, respectively). In multivariate analysis, a combination of soluble ST2 at day 3 (above 2700 pg/ml) and PSI were predictive of death with higher accuracy than PSI alone (net reclassification improvement, 0.44; integrated discrimination improvement, 0.17; P = 0.001 for both). Specifically, simultaneous presence of high soluble ST2 (day 3) and a PSI of 5 was suggestive of higher mortality risk than a PSI of 5 alone (mortality 78% vs. 39%, respectively).
  
  
  CONCLUSIONS
  Soluble ST2 is prognostic indicator of CAP and can add to the predictive value of the PSI.
authors.affiliation: Department of Respiratory Medicine, Kyorin University School of Medicine, Tokyo 181-8166, Japan; Respiratory Medicine Division, Fukujuji Hospital, Japan-Anti Tuberculosis Association, Tokyo 204-8522, Japan. Electronic address: masato@ks.kyorin-u.ac.jp.
authors.forename: Masato
authors.initials: M
authors.lastname: Watanabe
authors.affiliation: Department of Respiratory Medicine, Kyorin University School of Medicine, Tokyo 181-8166, Japan.
authors.forename: Hajime
authors.initials: H
authors.lastname: Takizawa
authors.affiliation: Department of Respiratory Medicine, Kyorin University School of Medicine, Tokyo 181-8166, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Tamura
authors.affiliation: Department of Respiratory Medicine, Kyorin University School of Medicine, Tokyo 181-8166, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Nakajima
authors.affiliation: Department of Respiratory Medicine, Kyorin University School of Medicine, Tokyo 181-8166, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kurai
authors.affiliation: Department of Respiratory Medicine, Kyorin University School of Medicine, Tokyo 181-8166, Japan.
authors.forename: Haruyuki
authors.initials: H
authors.lastname: Ishii
authors.affiliation: Department of Respiratory Medicine, Kyorin University School of Medicine, Tokyo 181-8166, Japan.
authors.forename: Saori
authors.initials: S
authors.lastname: Takata
authors.affiliation: Department of Respiratory Medicine, Kyorin University School of Medicine, Tokyo 181-8166, Japan.
authors.forename: Keitaro
authors.initials: K
authors.lastname: Nakamoto
authors.affiliation: Department of Respiratory Medicine, Kyorin University School of Medicine, Tokyo 181-8166, Japan.
authors.forename: Erei
authors.initials: E
authors.lastname: Sohara
authors.affiliation: Department of Respiratory Medicine, Kyorin University School of Medicine, Tokyo 181-8166, Japan.
authors.forename: Koujirou
authors.initials: K
authors.lastname: Honda
authors.affiliation: Department of Respiratory Medicine, Kyorin University School of Medicine, Tokyo 181-8166, Japan.
authors.forename: Masuo
authors.initials: M
authors.lastname: Nakamura
authors.affiliation: Department of Respiratory Medicine, Kyorin University School of Medicine, Tokyo 181-8166, Japan.
authors.forename: Toshiya
authors.initials: T
authors.lastname: Inui
authors.affiliation: Department of Respiratory Medicine, Kyorin University School of Medicine, Tokyo 181-8166, Japan.
authors.forename: Hiroo
authors.initials: H
authors.lastname: Wada
authors.affiliation: Department of Respiratory Medicine, Kyorin University School of Medicine, Tokyo 181-8166, Japan.
authors.forename: Hajime
authors.initials: H
authors.lastname: Goto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood*; D017714:Community-Acquired Infections / Q000175:diagnosis* / Q000382:microbiology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D000072179:Interleukin-1 Receptor-Like 1 Protein; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000175:diagnosis* / Q000382:microbiology; D011379:Prognosis; D012372:ROC Curve; D011956:Receptors, Cell Surface / Q000097:blood*; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; C079241:IL1RL1 protein, human; D000072179:Interleukin-1 Receptor-Like 1 Protein; D011956:Receptors, Cell Surface
keywords: Biomarker; Infection; Severity; Suppression of tumorigenicity 2; Treatment