Do N-terminal pro-brain natriuretic peptide levels determine the prognosis of community acquired pneumonia?

Abstract

Objective: Pneumonia is a leading cause of mortality worldwide, especially in the elderly. The use of clinical risk scores to determine prognosis is complex and therefore leads to errors in clinical practice. Pneumonia can cause increases in the levels of cardiac biomarkers such as N-terminal pro-brain natriuretic peptide (NT-proBNP). The prognostic role of the NT-proBNP level in community acquired pneumonia (CAP) remains unclear. The aim of this study was to evaluate the prognostic role of the NT-proBNP level in patients with CAP, as well as its correlation with clinical risk scores. Methods: Consecutive inpatients with CAP were enrolled in the study. At hospital admission, venous blood samples were collected for the evaluation of NT-proBNP levels. The Pneumonia Severity Index (PSI) and the Confusion, Urea, Respiratory rate, Blood pressure, and age ≥ 65 years (CURB-65) score were calculated. The primary outcome of interest was all-cause mortality within the first 30 days after hospital admission, and a secondary outcome was ICU admission. Results: The NT-proBNP level was one of the best predictors of 30-day mortality, with an area under the curve (AUC) of 0.735 (95% CI: 0.642-0.828; p < 0.001), as was the PSI, which had an AUC of 0.739 (95% CI: 0.634-0.843; p < 0.001), whereas the CURB-65 had an AUC of only 0.659 (95% CI: 0.556-0.763; p = 0.006). The NT-proBNP cut-off level found to be the best predictor of ICU admission and 30-day mortality was 1,434.5 pg/mL. Conclusions: The NT-proBNP level appears to be a good predictor of ICU admission and 30-day mortality among inpatients with CAP, with a predictive value for mortality comparable to that of the PSI and better than that of the CURB-65 score.

Prognostic value of NT-proBNP in patients with severe COVID-19

“…Previous studies have found that NT-proBNP is a powerful and independent predictor of mortality in community-acquired pneumonia (CAP) [8][9][10]. In these studies, the best cut-off values of NT-proBNP for prediction 30-day mortality were 1434.5 pg/mL and 1795.5 pg/ mL, respectively [8,10].…”

“…Previous studies have found that NT-proBNP is a powerful and independent predictor of mortality in community-acquired pneumonia (CAP) [8][9][10]. In these studies, the best cut-off values of NT-proBNP for prediction 30-day mortality were 1434.5 pg/mL and 1795.5 pg/ mL, respectively [8,10]. The elevated NT-proBNP in these cases was believed owing to the cardiac complications resulted from complex interactions among preexisting conditions, relative ischemia, up-regulation of the sympathetic system, systemic inflammation and direct pathogenmediated damage to the cardiovascular system [11].…”

Prognostic value of NT-proBNP in patients with severe COVID-19

“…perpetuity. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in Previous studies have found that NT-proBNP is a powerful and independent predictor of mortality in community-acquired pneumonia (CAP) [7][8][9] . In these studies the best cutoffs of NT-proBNP for prediction 30-day mortality were 1,434.5 pg/mL and 1,795.5 pg/mL respectively 7,9 .…”

“…preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in Previous studies have found that NT-proBNP is a powerful and independent predictor of mortality in community-acquired pneumonia (CAP) [7][8][9] . In these studies the best cutoffs of NT-proBNP for prediction 30-day mortality were 1,434.5 pg/mL and 1,795.5 pg/mL respectively 7,9 . The elevated NT-proBNP in these cases was believed owing to the cardiac complications resulted from complex interactions among preexisting conditions, relative ischemia, up-regulation of the sympathetic system, systemic inflammation and direct pathogen-mediated damage to the cardiovascular system 10 .…”

Biomarkers in Community-Acquired Pneumonia (Cardiac and Non-Cardiac)

“…Akpinar EE et al [23] Prospective, observational and single-centre in CAP 179 ICU admission and short-term mortality Nowak A et al [24] Prospective, observational and single-centre in CAP 341 Short and long-term mortality Kruger S et al [25] Prospective, observational and multicentre in CAP 589 Short-term mortality Viasus D et al [26] Systematic review and meta-analysis 10319 Short-term mortality Alan M et al [27] Prospective, observational and multicentre in CAP 925 Long-term mortality Kruger S et al [28] Prospective, observational and multicentre in CAP 728 Short and long-term mortality…”