Biomarkers of cardiac dysfunction and mortality from community-acquired pneumonia in adults.
BACKGROUND: Cardiac dysfunction is common in acute respiratory diseases and may influence prognosis. We hypothesised that blood levels of N-terminal B-type natriuretic peptide (NT-proBNP) and high-sensitivity Troponin T would predict mortality in adults with community-acquired pneumonia. METHODS AND...
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2013-01-01
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| Series: | PLoS ONE |
| Online Access: | http://europepmc.org/articles/PMC3646835?pdf=render |
| _version_ | 1818623760765288448 |
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| author | Catherina L Chang Graham D Mills Noel C Karalus Lance C Jennings Richard Laing David R Murdoch Stephen T Chambers Dominic Vettise Christine M Tuffery Robert J Hancox |
| author_facet | Catherina L Chang Graham D Mills Noel C Karalus Lance C Jennings Richard Laing David R Murdoch Stephen T Chambers Dominic Vettise Christine M Tuffery Robert J Hancox |
| author_sort | Catherina L Chang |
| collection | DOAJ |
| description | BACKGROUND: Cardiac dysfunction is common in acute respiratory diseases and may influence prognosis. We hypothesised that blood levels of N-terminal B-type natriuretic peptide (NT-proBNP) and high-sensitivity Troponin T would predict mortality in adults with community-acquired pneumonia. METHODS AND FINDINGS: A prospective cohort of 474 consecutive patients admitted with community-acquired pneumonia to two New Zealand hospitals over one year. Blood taken on admission was available for 453 patients and was analysed for NT-proBNP and Troponin T. Elevated levels of NT-proBNP (>220 pmol/L) were present in 148 (33%) and 86 (19%) of these patients respectively. Among the 26 patients who died within 30 days of admission, 23 (89%) had a raised NT-proBNP and 14 (53%) had a raised Troponin T level on admission compared to 125 (29%) and 72 (17%) of the 427 who survived (p values<0.001). Both NT-proBNP and Troponin T predicted 30-day mortality in age-adjusted analysis but after mutual adjustment for the other cardiac biomarker and the Pneumonia Severity Index, a raised N-terminal pro-brain natriuretic peptide remained a predictor of 30-day mortality (OR = 5.3, 95% CI 1.4-19.8, p = 0.013) but Troponin T did not (OR = 1.3, 95% CI 0.5-3.2, p = 0.630). The areas under the receiver-operating curves to predict 30-day mortality were similar for NT-proBNP (0.88) and the Pneumonia Severity Index (0.87). CONCLUSIONS: Elevated N-terminal B-type natriuretic peptide is a strong predictor of mortality from community-acquired pneumonia independent of clinical prognostic indicators. The pathophysiological basis for this is unknown but suggests that cardiac involvement may be an under-recognised determinant of outcome in pneumonia and may require a different approach to treatment. In the meantime, measurement of B-type natriuretic peptides may help to assess prognosis. |
| first_indexed | 2024-12-16T18:46:11Z |
| format | Article |
| id | doaj.art-4a3d8db980114bd6911dc81917326888 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-16T18:46:11Z |
| publishDate | 2013-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-4a3d8db980114bd6911dc819173268882022-12-21T22:20:51ZengPublic Library of Science (PLoS)PLoS ONE1932-62032013-01-0185e6261210.1371/journal.pone.0062612Biomarkers of cardiac dysfunction and mortality from community-acquired pneumonia in adults.Catherina L ChangGraham D MillsNoel C KaralusLance C JenningsRichard LaingDavid R MurdochStephen T ChambersDominic VettiseChristine M TufferyRobert J HancoxBACKGROUND: Cardiac dysfunction is common in acute respiratory diseases and may influence prognosis. We hypothesised that blood levels of N-terminal B-type natriuretic peptide (NT-proBNP) and high-sensitivity Troponin T would predict mortality in adults with community-acquired pneumonia. METHODS AND FINDINGS: A prospective cohort of 474 consecutive patients admitted with community-acquired pneumonia to two New Zealand hospitals over one year. Blood taken on admission was available for 453 patients and was analysed for NT-proBNP and Troponin T. Elevated levels of NT-proBNP (>220 pmol/L) were present in 148 (33%) and 86 (19%) of these patients respectively. Among the 26 patients who died within 30 days of admission, 23 (89%) had a raised NT-proBNP and 14 (53%) had a raised Troponin T level on admission compared to 125 (29%) and 72 (17%) of the 427 who survived (p values<0.001). Both NT-proBNP and Troponin T predicted 30-day mortality in age-adjusted analysis but after mutual adjustment for the other cardiac biomarker and the Pneumonia Severity Index, a raised N-terminal pro-brain natriuretic peptide remained a predictor of 30-day mortality (OR = 5.3, 95% CI 1.4-19.8, p = 0.013) but Troponin T did not (OR = 1.3, 95% CI 0.5-3.2, p = 0.630). The areas under the receiver-operating curves to predict 30-day mortality were similar for NT-proBNP (0.88) and the Pneumonia Severity Index (0.87). CONCLUSIONS: Elevated N-terminal B-type natriuretic peptide is a strong predictor of mortality from community-acquired pneumonia independent of clinical prognostic indicators. The pathophysiological basis for this is unknown but suggests that cardiac involvement may be an under-recognised determinant of outcome in pneumonia and may require a different approach to treatment. In the meantime, measurement of B-type natriuretic peptides may help to assess prognosis.http://europepmc.org/articles/PMC3646835?pdf=render |
| spellingShingle | Catherina L Chang Graham D Mills Noel C Karalus Lance C Jennings Richard Laing David R Murdoch Stephen T Chambers Dominic Vettise Christine M Tuffery Robert J Hancox Biomarkers of cardiac dysfunction and mortality from community-acquired pneumonia in adults. PLoS ONE |
| title | Biomarkers of cardiac dysfunction and mortality from community-acquired pneumonia in adults. |
| title_full | Biomarkers of cardiac dysfunction and mortality from community-acquired pneumonia in adults. |
| title_fullStr | Biomarkers of cardiac dysfunction and mortality from community-acquired pneumonia in adults. |
| title_full_unstemmed | Biomarkers of cardiac dysfunction and mortality from community-acquired pneumonia in adults. |
| title_short | Biomarkers of cardiac dysfunction and mortality from community-acquired pneumonia in adults. |
| title_sort | biomarkers of cardiac dysfunction and mortality from community acquired pneumonia in adults |
| url | http://europepmc.org/articles/PMC3646835?pdf=render |
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