Chest Infections: Chest Infections: Bacterial |

N-Terminal Pro-B-Type Natriuretic Peptide as a Predictor of 28-Day Mortality in Elderly Patients With Severe Pneumonia FREE TO VIEW

Xubin Huang, MD; Jun Zhang, MD; Xinyan Huang, MD; Yanzhu Chen, MD; Mian Zeng, MD
Author and Funding Information

MICU, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A90. doi:10.1016/j.chest.2016.02.095
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SESSION TITLE: Chest Infections: Bacterial

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Saturday, April 16, 2016 at 11:45 AM - 12:45 PM

PURPOSE: The role of N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) acting as a prognostic factor in critically ill patients with severe pneumonia is not fully established. The present study aimed to prospectively investigate whether NT-pro-BNP is predictive of 28-day mortality in a cohort of elderly patients with severe pneumonia admitted to the intensive care unit (ICU).

METHODS: A total of 99 consecutive patients with severe pneumonia admitted to the medical ICU, in a tertiary university hospital, during a 27-month period between May 2013 and July 2015, were assessed. Patients with recent major surgery or acute coronary syndromes in a month were excluded.

RESULTS: The median age was 76 yr (range, 65-93 yr; IQR, 71-83), and 70.9% of the patients were male. There were 25 cases of severe community acquired pneumonia, 43 severe hospital acquired pneumonia and 18 severe healthcare-associated pneumonia. 6 patients required exclusively non-invasive ventilation, 57 required exclusively invasive ventilation, 15 required both non-invasive and invasive ventilation, and 8 required only oxygen therapy. The median level of NT-pro-BNP on ICU admission was 3,839.5 pg/mL (range, 63.9-236,823.0 pg/mL; IQR, 1,243.3-9,623.3pg/mL), and the median APACHE II score was 23 (range, 13-43). The 28-day mortality rate was 61.6%. The 28-day survivors did show significantly decreased levels of NT-pro-BNP from non-survivors (3,058.0 pg/mL [range, 63.9-47,305.0 pg/mL] vs. 5,252.0 pg/mL [range, 428.0-236,823.0 pg/mL], Z=−2.216, P=0.027). In prediction of 28-day mortality, the area under the curve (AUC) for APACHE II score was 0.67 (95% CI, 0.56-0.79) and AUC for NT-pro-BNP was 0.64 (95% confidence interval [CI], 0.52-0.76). AUC was 0.68 (95%CI, 0.57-0.80) when NT-pro-BNP was combined with APACHE II score.

CONCLUSIONS: The level of NT-pro-BNP on ICU admission was decreased in survivors compared with non-survivors in a cohort of elderly patients with severe pneumonia admitted to the medical ICU. Moreover, combining NT-pro-BNP with APACHE II score on ICU admission added little additional power in predicting 28-day mortality in this cohort of elderly patients with severe pneumonia.

CLINICAL IMPLICATIONS: The NT-pro-BNP level on ICU admission might be used as a predictor of 28-day mortality in elderly patients with severe pneumonia in the medical ICU.

DISCLOSURE: The following authors have nothing to disclose: Xubin Huang, Jun Zhang, Xinyan Huang, Yanzhu Chen, Mian Zeng

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