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Original Research |

Direct Comparison of Three Natriuretic Peptides for Prediction of Short- and Long-term Mortality in Patients With Community-Acquired PneumoniaNatriuretic Peptides for Risk Stratification

Albina Nowak, MD; Tobias Breidthardt, MD; Mirjam Christ-Crain, MD; Roland Bingisser, MD, FCCP; Christophe Meune, MD; Yunus Tanglay, BS; Corinna Heinisch, MD; Miriam Reiter, MD; Beatrice Drexler, MD; Nisha Arenja, MD; Raphael Twerenbold, MD; Daiana Stolz, MD; Michael Tamm, MD, FCCP; Beat Müller, MD; Christian Müller, MD; German Competence Network for the Study of Community Acquired Pneumonia (CAPNETZ) Study Group
Author and Funding Information

From the Department of Internal Medicine (Drs Nowak, Breidthardt, Meune, Heinisch, Reiter, Drexler, Arenja, Twerenbold, and C. Müller and Mr Tanglay), University Hospital Basel, Basel; Division of Internal Medicine (Dr Nowak), University Hospital Zürich, Zürich; Division of Nephrology (Dr Breidthardt), Division of Endocrinology (Dr Christ-Crain), Emergency Department (Dr Bingisser), and Clinic of Respiratory Medicine and Pulmonary Cell Research (Drs Stolz and Tamm), University Hospital Basel, Basel; and Medical University Clinic (Dr B. Müller), Kantonsspital, Aarau, Switzerland.

Correspondence to: Christian Müller, MD, Klinik Innere Medizin, Petersgraben 4, CH-4031, Basel, Switzerland; e-mail: chmueller@uhbs.ch


Drs Nowak and Breidthardt are coauthors of this article.

Funding/Support: Dr Meune was supported by a grant from the FAQ (Freie Akademische Gesellschaft), Basel, Switzerland.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2012 American College of Chest Physicians


Chest. 2012;141(4):974-982. doi:10.1378/chest.11-0824
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Background:  Early and accurate risk stratification for patients with community-acquired pneumonia (CAP) is an unmet clinical need.

Methods:  We enrolled 341 unselected patients presenting to the ED with CAP in whom blinded measurements of N-terminal pro-B-type natriuretic peptide (NT-proBNP), midregional pro-atrial natriuretic peptide (MR-proANP), and B-type natriuretic peptide (BNP) were performed. The potential of these natriuretic peptides to predict short- (30-day) and long-term mortality was compared with the pneumonia severity index (PSI) and CURB-65 (confusion, urea plasma level, respiratory rate, BP, age over 65 years). The median follow-up was 942 days.

Results:  NT-proBNP, MR-proANP, and BNP levels at presentation were higher in short-term (median 4,882 pg/mL vs 1,133 pg/mL; 426 pmol/L vs 178 pmol/L; 436 pg/mL vs 155 pg/mL, all P < .001) and long-term nonsurvivors (3,515 pg/mL vs 548 pg/mL; 283 pmol/L vs 136 pmol/L; 318 pg/mL vs 103 pg/mL, all P < .001) as compared with survivors. Receiver operating characteristics analysis to quantify the prognostic accuracy showed comparable areas under the curve for the three natriuretic peptides to PSI for short-term (PSI 0.76, 95% CI, 0.71-0.81; NT-proBNP 0.73, 95% CI, 0.67-0.77; MR-proANP 0.72, 95% CI, 0.67-0.77; BNP 0.68, 95% CI, 0.63-0.73) and long-term (PSI 0.72, 95% CI, 0.66-0.77; NT-proBNP 0.75, 95% CI, 0.70-0.80; MR-proANP 0.73, 95% CI, 0.67-0.77, BNP 0.70, 95% CI, 0.65-0.75) mortality. In multivariable Cox-regression analysis, NT-proBNP remained an independent mortality predictor (hazard ratio 1.004, 95% CI, 1.00-1.01, P = .02 for short-term; hazard ratio 1.004, 95% CI, 1.00-1.01, P = .001 for long-term, increase of 300 pg/mL). A categorical approach combining PSI point values and NT-pro-BNP levels adequately identified patients at low, medium, and high short- and long-term mortality risk.

Conclusions:  Natriuretic peptides are simple and powerful predictors of short- and long-term mortality for patients with CAP. Their prognostic accuracy is comparable to PSI.

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