atrial-natriuretic-factor and Respiratory-Tract-Infections

This review aims to provide physicians with an overview of the potential of biomarkers to complement existing clinical severity scores and in conjunction with clinical parameters to improve the diagnosis, risk-stratification and management of lower respiratory tract infections (LRTIs). The usefulness of biomarkers for diagnosing LRTIs is still unclear. However, the specificity of pneumonia diagnosis is high when high sensitivity C-reactive protein (CRP) and procalcitonin (PCT) are used. PCT, CRP and particularly pro-atrial natriuretic peptide (MR-proANP), pro-vasopressin (CT-proAVP) and proadrenomedullin (proADM) levels can reliably predict LRTIs mortality. These markers do not significantly improve the severity scores predictive values, confirming that biomarkers are meant to complement, rather than supersede, clinician's judgment and validated severity scores. Biomarkers, and particularly PCT, are useful tools as antibiotic treatment duration indicators both in pneumonia and exacerbations of chronic obstructive pulmonary disease (COPD). Even if more data are required to fully appreciate the role of biomarkers in LRTIs management, there is emerging evidence that biomarkers have the potential to improve the daily clinical management of LRTIs.

Topics: Adrenomedullin; Atrial Natriuretic Factor; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Humans; Pneumonia; Prognosis; Protein Precursors; Pulmonary Disease, Chronic Obstructive; Respiratory Tract Infections; Vasopressins

Previous research found precursor levels of the atrial natriuretic peptide (MR-proANP) to be promising prognostic markers. This study aims to validate these findings and describe patterns of MR-proANP in a large cohort of patients with lower respiratory tract infections.. We conducted a multicenter prospective cohort study, and measured MR-proANP in patients with lower respiratory tract infections on admission, and days 3, 5 and 7. The prognostic value of MR-proANP for predicting 30-day and 180-day mortalities was evaluated. We stratified MR-proANP levels a priori into quartiles, and compared it with severity of illness using the pneumonia severity index.. A total of 1359 patients, including 925 with community-acquired pneumonia, were enrolled. The mortality risk at days 30 and 180 significantly increased with increasing MR-proANP quartiles (<84 pmol/L, 84-158 pmol/L, >158-311 pmol/L, and >311 pmol/L). This was true for low-risk, as well as high-risk subjects (pneumonia severity index classes I-III and IV-V). In Kaplan-Meier survival curves, MR-proANP quartiles significantly separated survivors from non-survivors in the overall cohort (p log-rank<0.001), and in low-risk (p log-rank<0.03) and high-risk (p log-rank=0.007) pneumonia severity index patients at day 30. In multivariate logistic regression analysis, MR-proANP was an independent risk factor for 30-day and 180-day mortalities (odds ratio per unit increase of log transformation MR-proANP level: 5.58, 95%CI 1.97-15.82 and 5.08, 95%CI 2.44-10.60).. This study confirms the high prognostic performance of MR-proANP for short- and long-term mortality, particularly its high negative predictive value, in lower respiratory tract infections and community-acquired pneumonia, thereby complementing clinical risk assessment with the pneumonia severity index.

Topics: Aged; Aged, 80 and over; Atrial Natriuretic Factor; Community-Acquired Infections; Female; Follow-Up Studies; Humans; Male; Pneumonia; Predictive Value of Tests; Prospective Studies; Randomized Controlled Trials as Topic; Respiratory Tract Infections; Time Factors; Treatment Outcome

To analyse the mid region of plasma N-terminal pro-atrial natriuretic peptide (MR-proANP) levels in patients with lower respiratory tract infections to evaluate its prognostic use for the severity of disease and outcome.. Prospective observational study. Setting. Emergency department of a university hospital.. A total of 545 consecutive patients with lower respiratory tract infections and 50 healthy controls. Interventions. MR-proANP was measured in serum from all patients using a new sandwich immunoassay.. MR-proANP levels (median [IQR], in pmol L(-1)) were significantly higher in patients with lower respiratory tract infections when compared with controls (138.0 [74.1-279.0] vs. 72.7 [62.5-89.5], P < 0.001), with highest levels in patients with community-acquired pneumonia (CAP). MR-proANP, but not C-reactive protein (CRP) levels, gradually increased with increasing severity of CAP, classified according to the pneumonia severity index (PSI) score (P < 0.001). On admission, MR-proANP levels were significantly higher in nonsurvivors when compared with survivors (293.0 [154.0-633.0] vs. 129.0 [71.4-255.0], P < 0.001). In a receiver operating characteristic (ROC) analysis for the prediction of survival of patients with CAP the area under the ROC curve (AUC) for MR-proANP was 0.69, similar when compared with the PSI (AUC 0.74, P = 0.31), and better when compared with other biomarkers, i.e. procalcitonin (AUC 0.57, P = 0.08), CRP (AUC 0.52, P = 0.02), and leucocyte count (AUC 0.56, P = 0.07).. MR-proANP levels are increased in lower respiratory tract infections, especially in CAP. Together with other clinical, radiographic and laboratory findings, MR-proANP levels might be helpful for the risk stratification in CAP.

Topics: Acute Disease; Aged; Atrial Natriuretic Factor; Biomarkers; Bronchitis; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Chronic Disease; Community-Acquired Infections; Female; Humans; Leukocyte Count; Male; Pneumonia; Prognosis; Prospective Studies; Protein Precursors; Pulmonary Disease, Chronic Obstructive; Respiratory Tract Infections; ROC Curve; Severity of Illness Index