• Am. J. Respir. Crit. Care Med. · Dec 2010

    Cardiovascular and inflammatory biomarkers to predict short- and long-term survival in community-acquired pneumonia: Results from the German Competence Network, CAPNETZ.

    • Stefan Krüger, Santiago Ewig, Sven Giersdorf, Oliver Hartmann, Norbert Suttorp, Tobias Welte, and German Competence Network for the Study of Community Acquired Pneumonia (CAPNETZ) Study Group.
    • Medical Clinic I, Rheinisch Westfälische Technische Hochschule University Aachen, Germany.
    • Am. J. Respir. Crit. Care Med. 2010 Dec 1;182(11):1426-34.

    RationaleSeveral new biomarkers are related to mortality in community-acquired pneumonia (CAP).ObjectivesAim of this study was to compare new biomarkers for the prediction of short- and long-term all-cause mortality in CAP.MethodsWe 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.Measurements And Main ResultsIn 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.ConclusionsAll 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.

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