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Christian Müller, MD; Albina Nowak, MD
Author and Funding Information

From the Department of Internal Medicine (Dr Müller), University Hospital Basel; and the University Hospital Zurich (Dr Nowak).

Correspondence to: Christian Müller, MD, University Hospital Basel, Department of Internal Medicine, Petersgraben 4, Basel, 4031, Switzerland; e-mail: chmueller@uhbs.ch

Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Müller has received research support and speakers’ honoraria from Abbott Laboratories, Alere, BRAHMS, Nanosphere Inc, Hoffman-La Roche Inc, and Siemens AG. Dr Nowak has reported that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.


Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Müller has received research support and speakers’ honoraria from Abbott Laboratories, Alere, BRAHMS, Nanosphere Inc, Hoffman-La Roche Inc, and Siemens AG. Dr Nowak has reported that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2012;142(1):265. doi:10.1378/chest.12-0516
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To the Editor:

We thank Drs Chang and Hancox for their interest in our work on natriuretic peptides in community-acquired pneumonia.14 The current report1 extends our previous observations and tries to highlight findings that (1) apply to the whole family of natriuretic peptides in general and (2) provide a direct comparison of the clinical potential of all three commercially available natriuretic peptides (B-type natriuretic peptide [BNP], N-terminal pro-B-type natriuretic peptide, and midregional pro-atrial natriuretic peptide). In this analysis, we used the data from all patients who presented to our institution with community-acquired pneumonia in whom we had the measurements of all three natriuretic peptides available. As correctly mentioned by Drs Chang and Hancox, some of these patients were in earlier cohorts that dealt exclusively with BNP. About one-third of the patients were included in the recruitment period from April 2006 to March 2007.

Drs Chang and Hancox are also correct in highlighting that in some patients, physicians used procalcitonin levels as additional information for the tailoring of the duration of antibiotic treatment. Regarding blinding, physicians were blinded to N-terminal pro-B-type natriuretic peptide and midregional pro-atrial natriuretic peptide levels in all patients. These levels were measured from frozen samples long after the discharge of patients. The blinding regarding BNP levels was not uniform. In about one-half of the patients, BNP levels were measured in a blinded fashion; in the other half, BNP levels would have been available to physicians via the electronic patient records.

Novak A, Breidthardt T, Christ-Crain M, et al. Direct comparison of three natriuretic peptides for prediction of short- and long-term mortality in patients with community acquired pneumonia. Chest. 2012;141(4):974-982. [PubMed] [CrossRef]
 
Christ-Crain M, Breidthardt T, Stolz D, et al. Use of B-type natriuretic peptide in the risk stratification of community-acquired pneumonia. J Intern Med. 2008;264(2):166-176.
 
Müeller C, Laule-Kilian K, Scholer A, Perruchoud AP. B-type natriuretic peptide for risk stratification in community-acquired pneumonia. J Intern Med. 2005;258(4):391-393.
 
Christ-Crain M, Stolz D, Bingisser R, et al. Procalcitonin guidance of antibiotic therapy in community-acquired pneumonia: a randomized trial. Am J Respir Crit Care Med. 2006;174(1):84-93.
 

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References

Novak A, Breidthardt T, Christ-Crain M, et al. Direct comparison of three natriuretic peptides for prediction of short- and long-term mortality in patients with community acquired pneumonia. Chest. 2012;141(4):974-982. [PubMed] [CrossRef]
 
Christ-Crain M, Breidthardt T, Stolz D, et al. Use of B-type natriuretic peptide in the risk stratification of community-acquired pneumonia. J Intern Med. 2008;264(2):166-176.
 
Müeller C, Laule-Kilian K, Scholer A, Perruchoud AP. B-type natriuretic peptide for risk stratification in community-acquired pneumonia. J Intern Med. 2005;258(4):391-393.
 
Christ-Crain M, Stolz D, Bingisser R, et al. Procalcitonin guidance of antibiotic therapy in community-acquired pneumonia: a randomized trial. Am J Respir Crit Care Med. 2006;174(1):84-93.
 
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