atrial-natriuretic-factor and Pneumonia--Bacterial

This study compares biomarker (including procalcitonin, pro-ANP, and copeptin) levels to pneumonia severity scores to predict 30-day mortality in NHAP (nursing home acquired pneumonia) patients.. Seventy three patients aged ≥ 65 y, admitted to general hospitals and who fulfilled the definition of NHAP were included in the study. Data collected at admission included age, gender, nursing home admission, coexisting illness, symptoms and clinical parameters (blood pressure, pulse rate, respiratory rate and status). Additional data collected included laboratory results, radiographic findings and outcome variables. Severity of pneumonia was evaluated using a prediction rule calculated by CURB-65 criteria (confusion, urea nitrogen, respiratory rate, blood pressure, age>65 y).. After adjustment for age, sex and CURB-65, copeptin (OR=5.60, 95% confidence interval (CI)=1.20-26.24) was associated with 30-day mortality in NHAP patients, while procalcitonin and pro-ANP were not. The areas under the receiver operating characteristic curves (AUCs) for CURB-65, in predicting mortality were 0.685 [95% CI 0.559-0.811], whereas copeptin showed slightly superior accuracy with an AUC of 0.698 (95% CI 0.568-0.827).. Among 3 biomakers, copeptin was the strongest predictor of 30-day mortality from NHAP. The pathophysiologic and clinical implications of this finding require further investigation.

Topics: Aged; Aged, 80 and over; Area Under Curve; Atrial Natriuretic Factor; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Cross Infection; Female; Glycopeptides; Homes for the Aged; Humans; Male; Nursing Homes; Pneumonia, Bacterial; Prognosis; Protein Precursors; ROC Curve; Severity of Illness Index; Survival Analysis

Mid-regional pro-atrial natriuretic peptide (MR-proANP) increases with severity in community-acquired pneumonia (CAP). We investigated whether changes of MR-proANP correlated to bacteremia.. 392 adult patients with CAP visiting emergency department from a prospective observational multicenter study.. MR-proANP levels increased in patients with positive bacteremia (92.8 pmol/L vs. 84.3 pmol/L, p = 0.04). Performance of MR-proANP to detect bacteremia (0.60) was equivalent to CRP (0.59) but less accurate than PCT (0.69).. MR-ANP poorly predicts bacteremia in CAP patients.

Topics: Adult; Atrial Natriuretic Factor; Bacteremia; Community-Acquired Infections; France; Humans; Middle Aged; Pneumonia, Bacterial; Prospective Studies

Markers to better assess severity of disease in patients with community-acquired pneumonia (CAP) would help improve medical care of this condition. The hemodynamic biomarkers carboxy-terminal provasopressin (CT-proAVP; copeptin) and midregional proatrial natriuretic peptide (MR-proANP) are increased under septic conditions, in which MR-proANP has been described as a prognostic predictor. We aimed to explore the diagnostic accuracy of MR-proANP and CT-proAVP to predict mortality in patients with CAP.. We conducted a prospective observational study of patients with CAP. We measured biomarkers in serum samples obtained at diagnosis and performed univariate and multivariate analyses to identify potential predictors of mortality.. CT-proAVP and MR-proANP concentrations were measured in 173 patients. We found a positive correlation between pneumonia severity index (PSI) and MR-proANP (r(s) = 0.68, P <0.0001) and between PSI and CT-proAVP (r(s) = 0.44, P <0.0001). Median (interquartile range) CT-proAVP and MR-proANP values were 8.2 (5.3-16.8) and 73.6 (44.6-144.0) pmol/L, respectively. Nonsurvivors had significantly higher MR-proANP and CT-proAVP than survivors (median 259.0 vs 71.8 pmol/L, P = 0.01, and 24.9 vs 8.1 pmol/L, P = 0.03, respectively). In multivariate analysis including PSI, procalcitonin, C-reactive protein, lipopolysaccharide-binding protein, CT-proAVP, and MR-proANP concentrations, only CT-proAVP remained an independent predictor of death (odds ratio 1.05, P = 0.007). Cutoff values of >18.9 pmol/L for CT-proAVP and >227 pmol/L for MR-proANP showed the highest diagnostic accuracy to predict mortality.. CT-proAVP and MR-proANP may be used to predict prognosis in patients with CAP.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Atrial Natriuretic Factor; Biomarkers; Community-Acquired Infections; Female; Glycopeptides; Humans; Male; Middle Aged; Pneumonia, Bacterial; Pneumonia, Viral; Predictive Value of Tests; Prognosis; Prospective Studies; Protein Precursors; Vasopressins