title: The natriuretic peptide MR-proANP predicts all-cause mortality and adverse outcome in community patients: a 10-year follow-up study.
abstract: BACKGROUND
  The precursor peptide of atrial natriuretic peptide (MR-proANP) has a physiological role in fluid homeostasis and is associated with mortality and adverse clinical outcomes in heart failure patients. Little is known about the prognostic potential of this peptide for long-term mortality prediction in community-dwelling patients. We evaluated associations of MR-proANP levels with 10-year all-cause mortality in patients visiting their general practitioner for a respiratory tract infection.
  
  
  METHODS
  In this post-hoc analysis including 359 patients (78.5%) of the original trial, we calculated cox regression models and area under the receiver operating characteristic curve (AUC) to assess associations of MR-proANP blood levels with mortality and adverse outcome including death, pulmonary embolism, and major adverse cardiac or cerebrovascular events.
  
  
  RESULTS
  After a median follow-up of 10.0 years, 9.8% of included patients died. Median admission MR-proANP levels were significantly elevated in non-survivors compared to survivors (80.5 pmol/L, IQR 58.6-126.0; vs. 45.6 pmol/L, IQR 34.2-68.3; p<0.001) and associated with 10-year all-cause mortality (age-adjusted HR 2.0 [95% CI 1.3-3.1, p=0.002]; AUC 0.79). Results were similar for day 7 blood levels and also for the prediction of other adverse outcomes.
  
  
  CONCLUSIONS
  Increased MR-proANP levels were associated with 10-year all-cause mortality and adverse clinical outcome in a sample of community-dwelling patients. If diagnosis-specific cut-offs are confirmed in future studies, this marker may help to direct preventive measures in primary care.
authors.affiliation: .
authors.forename: Jonas
authors.initials: J
authors.lastname: Odermatt
authors.affiliation: .
authors.forename: Lara
authors.initials: L
authors.lastname: Hersberger
authors.affiliation: .
authors.forename: Rebekka
authors.initials: R
authors.lastname: Bolliger
authors.affiliation: .
authors.forename: Lena
authors.initials: L
authors.lastname: Graedel
authors.affiliation: .
authors.forename: Mirjam
authors.initials: M
authors.lastname: Christ-Crain
authors.affiliation: .
authors.forename: Matthias
authors.initials: M
authors.lastname: Briel
authors.affiliation: .
authors.forename: Heiner C
authors.initials: HC
authors.lastname: Bucher
authors.affiliation: .
authors.forename: Beat
authors.initials: B
authors.lastname: Mueller
authors.affiliation: .
authors.forename: Philipp
authors.initials: P
authors.lastname: Schuetz
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D045265:Natriuretic Peptides / Q000097:blood*; D016016:Proportional Hazards Models; D011446:Prospective Studies
chemical_list: D015415:Biomarkers; D045265:Natriuretic Peptides
keywords: MR-proANP; all-cause mortality; atrial natriuretic peptide; general practitioner; primary care