natriuretic-peptide--brain and Pneumonia

A short cut review was carried out to establish the prognostic value of B-type natriuretic peptides (BNP and NT-proBNP) in community acquired pneumonia (CAP). Three cohort studies were directly relevant to the question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. The clinical bottom line was that B-type natriuretic peptides have prognostic value in CAP but further prospective studies were needed to assess their application in clinical practice.

Topics: Biomarkers; Community-Acquired Infections; Evidence-Based Emergency Medicine; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Pneumonia; Predictive Value of Tests; Prognosis

Acute dyspnea is one of the leading causes of emergency hospitalization of elderly patients. Clinical diagnostic procedures are difficult in this geriatric population. Acute heart failure is the most frequent cause of acute dyspnea in geriatric patients. The use of plasma B natriuretic peptide (BNP) assays in the general population has profoundly improved its medical management. There has also been progress recently for other frequent causes of dyspnea in the elderly, including infection and venous thromboembolic disease. Procalcitonin assays may be useful as a prognostic factor for infectious disease. Nevertheless, the real value of BNP assays in geriatric populations must be clarified by interventional studies.

Topics: Acute Disease; Aged; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Diagnosis, Differential; Dyspnea; Emergencies; Emergency Service, Hospital; Female; Fibrin Fibrinogen Degradation Products; Heart Failure; Humans; Male; Natriuretic Peptide, Brain; Patient Admission; Pneumonia; Protein Precursors; Pulmonary Disease, Chronic Obstructive; Thromboembolism; Troponin

There is a natural physiological decline in pulmonary function and the cardiovascular system with age. In emergency medicine, acute dyspnoea is a common problem among elderly patients. Some causes, such as pulmonary embolism and diastolic heart failure, are probably under-diagnosed. A good clinical history and examination are as important as arterial blood gas analysis, chest radiography and electrocardiography. Few studies have examined acute dyspnoea in elderly patients, except in the setting of pneumonia. Establishing the underlying diagnosis is often difficult because of atypical presentation and the interaction between cardiac and pulmonary underlying functions. This topic describes several respiratory and cardiac diseases presenting as acute dyspnoea, especially "cardiac asthma" and pulmonary embolism. The clinical usefulness of new investigations such as cardiac and lung echography, pulmonary function tests, serum Brain Natriuretic Peptide and thoracic CT scan are discussed. Further studies looking at acute dyspnoea in elderly patients are needed.

Topics: Acute Disease; Aged; Aging; Algorithms; Blood Gas Analysis; Decision Trees; Diagnosis, Differential; Dyspnea; Echocardiography, Doppler; Electrocardiography; Emergency Treatment; Heart Failure; Humans; Medical History Taking; Natriuretic Peptide, Brain; Physical Examination; Pneumonia; Pulmonary Embolism; Pulmonary Medicine; Radiography, Thoracic; Respiratory Function Tests; Tomography, X-Ray Computed

We hypothesized that aromatic microbial metabolites (AMM), such as phenyllactic (PhLA), p-hydroxyphenylacetic (p-HPhAA), and p-hydroxyphenyllactic (p-HPhLA) acids, contribute to the pathogenesis of septic shock.. Clinical and laboratory data of patients with community-acquired pneumonia were obtained on intensive care unit admission and the next day. Patients were divided into two groups based on septic shock presence or absence. The levels of AMM (PhLA, p-HPhAA, p-HPhLA, and their sum, ∑3AMM), catecholamine metabolites (3,4-dihydroxymandelic [DHMA], 3,4-dihydroxyphenylacetic [DOPAC], and homovanillic [HVA] acids), lactate, N-terminal pro-brain natriuretic peptide (NT-proBNP), inducible nitric oxide synthase (iNOS), and procalcitonin (PCT) were compared. Correlations between AMM and clinical and laboratory data were calculated.. There were 20 patients in the septic shock group and 21 in the nonseptic shock group. On admission, the septic shock patients demonstrated significantly higher levels of PhLA (2.3 vs. 0.8 μmol/L), p-HPhAA (4.6 vs. 1.4 μmol/L), p-HPhLA (7.4 vs. 2.6 μmol/L), HVA, lactate, and significantly lower levels of iNOS. The next day, the two groups also showed significant differences in the levels of PCT and NT-proBNP. The correlation between ∑3AMM and presence of shock, levels of lactate, HVA, and NT-proBNP on admission was 0.44, 0.67, 0.57, and 0.38, respectively, and the correlation on the next day was 0.59, 0.73, 0.76, and 0.6, respectively (P < 0.01). These findings can be explained by the ability of AMM to reduce tyrosine hydroxylase activity, thus limiting the synthesis of catecholamines.. AMM are involved in the pathogenesis of septic shock.

Topics: 3,4-Dihydroxyphenylacetic Acid; Acetates; Aged; Female; Homovanillic Acid; Humans; Lactates; Male; Mandelic Acids; Middle Aged; Natriuretic Peptide, Brain; Nitric Oxide Synthase Type II; Peptide Fragments; Pneumonia; Shock, Septic

The effectiveness of neoadjuvant chemotherapy (nCT) or chemoradiotherapy (nCRT) for esophageal cancer patients is well established. However, neoadjuvant therapy may induce severe adverse effects that could increase postoperative morbidity. The current study evaluated the impacts of nCT and nCRT on postoperative cardiopulmonary complications in patient with esophageal cancer. We conducted a prospective study in esophageal cancer patients who received nCT (n  =  126) or nCRT (n  =  141) prior to surgery. Surgery was performed in all these patients following nCT or nCRT treatment. More patients occurred pneumonia in the nCRT-treated group compared with the nCT group (P < 0.01). The E-velocity (early diastolic filling velocity) decreased significantly (P = 0.026), while the N-terminal pro-brain natriuretic peptide (NT-proBNP) significantly increased (P < 0.01) in patients of the nCRT group compared with patients from the nCT group. Furthermore, a multivariate analysis revealed that nCRT was correlated with the incidence of pneumonia and NT-proBNP level significantly. The nCRT caused more cardiopulmonary toxicity than nCT. The strategies are needed to prevent the postoperative cardiopulmonary complications especially in patients with nCRT treatment.

Topics: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Chemoradiotherapy, Adjuvant; Cisplatin; Esophageal Neoplasms; Esophagectomy; Female; Fluorouracil; Humans; Incidence; Male; Middle Aged; Multivariate Analysis; Natriuretic Peptide, Brain; Neoadjuvant Therapy; Peptide Fragments; Pneumonia; Postoperative Complications; Postoperative Period; Prospective Studies; Pulmonary Heart Disease; Treatment Outcome

Community-acquired pneumonia (CAP) is the leading infectious cause of death in developed countries. Risk stratification has previously been difficult.. Markers of cardiac stress (B-type natriuretic peptide, BNP) and inflammation (C-reactive protein, white blood cell count, procalcitonin) as well as the pneumonia severity index (PSI) were determined in 302 consecutive patients presenting to the emergency department (ED) with CAP. The accuracy of these parameters to predict death was evaluated as the primary endpoint. Prediction of treatment failure was considered as the secondary endpoint.. B-type natriuretic peptide levels increased with rising disease severity as classified by the PSI (P = 0.015). BNP levels were significantly higher in nonsurvivors compared to survivors [median 439.2 (IQR 137.1-1384.6) vs. 114.3 (51.3-359.6) pg mL(-1), P < 0.001]. In a receiver operating characteristic analysis for the prediction of survival the area under the curve (AUC) for BNP was comparable to the AUC of the PSI (0.75 vs. 0.71, P = 0.52). Importantly, the combination of BNP and the PSI significantly improved the prognostic accuracy of the PSI alone (AUC 0.78 vs. 0.71; P = 0.02). The optimal cut-off for BNP was 279 pg mL(-1). The accuracy of BNP to predict treatment failure was identical to the accuracy to predict death (AUC 0.75).. In patients with CAP, BNP levels are powerful and independent predictors of death and treatment failure. When used in conjunction with the PSI, BNP levels significantly improve the risk prediction when compared with the PSI alone.

Topics: Aged; Area Under Curve; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Community-Acquired Infections; Female; Follow-Up Studies; Humans; Leukocyte Count; Male; Natriuretic Peptide, Brain; Pneumonia; Predictive Value of Tests; Prognosis; Protein Precursors; Risk Assessment; Severity of Illness Index; Survival Analysis; Switzerland

The aim of this study was to define the impact of B-type natriuretic peptide (BNP) levels on the management of elderly patients presenting with acute dyspnoea.. We performed a prospective randomized controlled study in 269 elderly patients at least 70 years of age included in the B-type natriuretic peptide for Acute Shortness of breath Evaluation (BASEL) study. Patients were randomly assigned to a diagnostic strategy with (n = 136, BNP group) or without (n = 133, control group) the use of BNP levels provided by a rapid bedside assay. The time to discharge and the total cost of treatment were the primary end-points.. Amongst elderly patients, baseline characteristics were well matched between both groups. The use of BNP levels significantly reduced the time to discharge (median 9.0 in the BNP group versus 11.0 days in the control group; P = 0.029). Total treatment cost was $5381 (95% CI, 4482-6280) in the BNP group when compared with $7411 (95% CI, 6180-8642; P = 0.009) in the control group. In addition, a significant reduction in 30-day mortality was observed (9% in the BNP group versus 17% in the control group; P = 0.039).. Used in conjunction with other clinical information, rapid measurement of BNP in the emergency department improved the management of elderly patients presenting with acute dyspnoea and thereby reduced the time to discharge and the total treatment cost. In addition, BNP testing seemed to reduce 30-day mortality.

Topics: Acute Disease; Aged; Aged, 80 and over; Cardiac Output, Low; Dyspnea; Female; Hospitalization; Humans; Male; Natriuretic Peptide, Brain; Pneumonia; Prospective Studies; Pulmonary Disease, Chronic Obstructive

The primary objective of the study was to determine the diagnostic value of serum N-terminal probrain natriuretic peptide (NT-proBNP) levels to differentiate neonatal pneumonia (NP) and transient tachypnea of the newborn (TTN). The secondary objective was to investigate the prognostic role of NT-proBNP levels in neonates with severe respiratory distress (RD).. A prospective, observational, single-blinded study involving 58 late preterm and term newborns who were diagnosed with TTN or NP was conducted between June 2020 and June 2021 at a level-3 neonatal intensive care unit in Kırıkkale University Faculty of Medicine. TTN and NP groups were compared for serum NT-proBNP levels measured at the 1st and 24th hours of life. Optimal cut-off NT-proBNP value was determined by Youden index to predict the diagnosis of NP. Lung ultrasound was used to support the diagnosis of TTN and NP. In addition, lung ultrasound score (LUS) was used to determine severe RD.. The median of NT-proBNP level was significantly higher at the 24th hour of life in the NP group than in the TTN group, respectively 7263.5 pg/mL (1643-35,000) and 3308 pg/mL (69-19,746), p = 0.004. At a cut-off value of 5515.5 pg/mL, NT-proBNP had a sensitivity of 75% and specificity of 73.8% to predict NP [AUC= 0.749 (95% CI: 0.602-0.895; p = 0.004)]. The study population was divided into two groups as high score group (n: 23, LUS ≥ 7) and low score group (n: 35, LUS < 7) according to the LUS at the 6th hour of life. NT-proBNP values at 24th hour of life were 6320 pg/mL (69-35,000) in high score group and 3500 pg/mL (570-15,948) in low score group, p = 0.044. Duration of oxygen support (p = 0.006), noninvasive ventilation (p = 0.008) and NICU stay (p = 0.004) were higher in high-score group.. NT-proBNP values at 24th hour of life can be used as a relatively early predictor in the differentiation between NP and TTN in late preterm and term neonates. In addition, elevated NT-proBNP values are related to the higher LUS which reflects the severity of RD regardless of diagnosis.

Topics: Biomarkers; Humans; Infant, Newborn; Natriuretic Peptide, Brain; Peptide Fragments; Pneumonia; Prospective Studies; Transient Tachypnea of the Newborn

Topics: Biomarkers; Body Mass Index; Community-Acquired Infections; Emergency Service, Hospital; Heart Failure; Humans; Natriuretic Peptide, Brain; Patient Discharge; Peptide Fragments; Pneumonia; Prognosis

Tropical India holds about 23% of the global pneumonia burden with case fatalities ranging between 15 to 30%, with CAP being one of the prominent causes of morbidity and mortality among adults. BNP, a hormone from ventricular myocytes during myocardial stretch or stress, causes vasodilation and natriuresis. Perhaps established as an efficient biomarker in cardiac illnesses, the possibility of it being a predictor of severity and mortality in CAP is studied. Material: 175 participants with CAP were included in the study excluding anemia and cardiac/ renal/ hepatic morbidities. Clinical history and examination, BNP, CRP, ESR, TLC, CRB-65 scores were elucidated at the time of presentation and after two weeks. Observation: At presentation, the mean values of BNP, CRP, ESR, and TLC values at presentation were 189.59, 137.29, 69.31, and 18.53* 103, whereas after two weeks of treatment, they were 94.08, 43.21, 33.01, 11.14 respectively all being significant (p <0.05). 41 participants had a CRB-65 score of one (mean BNP of 149.68), whereas rest 34 had more than one (mean BNP of 229.51). The BNP levels correlated positively with CRP, and ESR both at baseline (r=0.62, p< 0.05; r= 0.74, p< 0.05) and after treatment (r=0.39, p< 0.05; r= 0.56, p< 0.05) Conclusion: Gauging BNP levels at admission is a rapid and reliable means to triage CAP pneumonia patients into various levels of care. BNP correlates well with other biomarkers and CRB-65 scores and thus the clinical severity and outcome of CAP.

Topics: Adult; Biomarkers; Community-Acquired Infections; Follow-Up Studies; Humans; Natriuretic Peptide, Brain; Pneumonia; Prognosis; Prospective Studies; Severity of Illness Index

The objective of this study was to explore the clinical, laboratory, and imaging features of severe Chlamydia psittaci pneumonia in order to improve early diagnosis and treatment success rates.. We conducted a retrospective record review of 14 cases of severe Chlamydia psittaci pneumonia diagnosed by metagenomic next-generation sequencing technology in our hospital. We extracted and analyzed data on the clinical symptoms and signs, contact history, laboratory investigations, chest computed tomography, treatment, and clinical outcomes.. Of the 14 patients, 12 (86%) were male and two (14%) were female, with a mean age of 57 years (SD: 7 years). Eleven patients (79%) had a history of poultry contact. The main clinical manifestations were fever (n = 14, 100%), flu-like symptoms (n = 10, 71%), cough, sputum (n = 9, 64%), and dyspnea (n = 5, 36%). Blood tests revealed marked elevation of neutrophil percentage, C-reactive protein, procalcitonin, brain natriuretic peptide, and creatine kinase levels; slight elevation of aspartate aminotransferase, creatinine, urea, fibrinogen, and D-dimer levels; and decreased albumin, sodium, and calcium levels. Chest computed tomography showed bilateral lesions (n = 7, 50%), middle-lower lobe lesions (n = 10, 71%), lesions in multiple lobes (n = 9, 64%), consolidation shadows (n = 11, 79%), and pleural effusions (n = 11, 79%). The median time from disease onset to hospital admission was 4.5 days (interquartile range: 1-17 days); the mean length of hospital stay was 20.9 ± 8.5 days, and the mean time from admission to diagnosis was 5.1 ± 2.6 days. After diagnosis, patients were either treated with doxycycline alone or doxycycline combined with quinolones. All 14 patients developed respiratory failure and received invasive mechanical ventilation; two (14%) received veno-venous extracorporeal membrane oxygenation, four (29%) received continuous renal replacement therapy, and three (21%) died.. A poultry contact history and typical flu-like symptoms are early indicators of Chlamydia psittaci pneumonia. Substantial elevations in procalcitonin, creatine kinase, and brain natriuretic peptide indicate severe disease. Metagenomic next-generation sequencing is useful for diagnosis. Early empirical antibiotic therapy with quinolones can reduce the mortality in critically ill patients.

Topics: Chlamydophila psittaci; Creatine Kinase; Doxycycline; Female; High-Throughput Nucleotide Sequencing; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Pneumonia; Procalcitonin; Psittacosis; Quinolones; Retrospective Studies

The relationship between body mass index (BMI) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) has not been fully investigated in patients with community-acquired pneumonia (CAP).. This prospective observational study examined 510 consecutive patients hospitalized for CAP. NT-proBNP, BMI, and the pneumonia severity index (PSI) were determined for all participants. The moderating effects of BMI on the relationship between NT-proBNP and CAP mortality were examined using interaction terms in a multivariable regression model. The ability of NT-proBNP to predict mortality was evaluated using the area under the curve (AUC).. A significant inverse relationship was observed between BMI and NT-proBNP. After multivariable adjustment including BMI, NT-proBNP remained a significant predictor of CAP mortality. The AUC of the fully adjusted (including BMI) NT-proBNP model was significantly higher than that excluding BMI (p = 0.021) and that of PSI (p = 0.038), respectively. The predictive performance of NT-proBNP for mortality significantly differed by BMI group, with the NT-proBNP of the overweight and obesity group having a significantly higher AUC than that of the underweight and normal-weight group. The AUC of NT-proBNP was significantly higher and tended to be higher than that of PSI in the overweight group (p = 0.013) and the obesity group (p = 0.113), respectively.. BMI significantly strengthens the prognostic performance of NT-proBNP in CAP patients. The BMI-NT-proBNP interaction is significantly associated with CAP mortality, but as a prognostic determinant for CAP, NT-proBNP seems to be more useful for overweight and obese patients than for underweight and normal-weight patients.

Topics: Biomarkers; Body Mass Index; Heart Failure; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Pneumonia; Prognosis

Pneumonia is a common type of infection in maintenance hemodialysis (MHD) patients, while the treatment and prevention progress still keep limited. N-terminal-pro-brain natriuretic peptide (NT-proBNP) is an important marker in reflecting cardiac failure which also is a risk factor for pneumonia. This study aimed to determine the possible predictive value of NT-proBNP for pneumonia in MHD patients.. In this prospective study, the basic information of 276 MHD patients was collected in Fudan university Zhongshan hospital, followed up for 1 year. The primary endpoint was the first pneumonia event during follow-up. The value of NT-proBNP in patients with pneumonia and without pneumonia was analyzed, to elucidate the predictive value of the NT-proBNP in hemodialysis patients with pneumonia.. Two hundred and seventy-six patients were finally enrolled in this prospective study, including 170 men. The mean age was 59.7 ± 14.0 years old. The average duration of hemodialysis is 56 (30-82.8) months. Enrolled patients were followed up for 1 year. During follow-up, 38 patients got pneumonia. After adjustment for other confounding factors, age (hazard ratio [HR] 1.031, 95% CI 1.003-1.060, p = 0.028), log NT-proBNP (HR 2.512, 95% CI 1.124-5.612, p = 0.025), history of smoking (HR 6.326, 95% CI 2.505-15.974, p < 0.001), β2-microglobin (HR 1.042, 95% CI 1.007-1.079, p = 0.019), and history of cerebrovascular disease (HR 2.303, 95% CI 1.107-4.719, p = 0.026) were independent predictors of pneumonia. Receiver operating characteristic curves of log NT-proBNP to predict 1 year pneumonia cases, log NT-proBNP had an area under the curve of 0.647 (95% CI [0.564-0.729], p < 0.01).. NT-proBNP is a predictive factor of pneumonia in hemodialysis patients.

Topics: Aged; Biomarkers; Female; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Pneumonia; Predictive Value of Tests; Prognosis; Proportional Hazards Models; Prospective Studies; Renal Dialysis; Risk Factors

Risk stratification is important for the management of community-acquired pneumonia (CAP). The present study aimed to investigate the clinical impact of N-terminal prohormone of brain natriuretic peptide (NT-proBNP) on prognosis and to identify clinical characteristics associated with NT-proBNP elevation in CAP patients.. This retrospective study included patients hospitalized for CAP at a tertiary referral center and who underwent measurement plasma NT-proBNP levels. Based on 30-day mortality, patients (n = 1,821) were divided into 2 groups, survivors (n = 150) and nonsurvivors (n = 1,671), and clinical and laboratory findings were compared.. In multivariate analysis, blood levels of NT-proBNP (>942.5 pg/mL), albumin (<3.3 g/dL), and troponin I (>0.018 ng/mL) independently predicted 30-day mortality. Of these blood biomarkers, NT-proBNP exhibited the highest C-statistic, followed by albumin. NT-proBNP level/CURB-65 score and NT-proBNP level/pneumonia severity index (PSI) class exhibited significantly higher C-statistics than CURB-65 score and PSI class alone, respectively. The 3-test combinations of CURB-65 score/NT-proBNP level/albumin level and PSI class/NT-proBNP level/albumin level exhibited significantly higher C-statistics than the 2-test combinations. NT-proBNP elevation was associated with increased age, heart disease and chronic kidney disease and NT-proBNP levels only weakly or moderately correlated with other blood biomarkers.. NT-proBNP level was a useful marker for the prediction of 30-day mortality in patients hospitalized with CAP, and provided additional prognostic value to PSI or CURB-65 alone.

Topics: Age Factors; Aged; Aged, 80 and over; Biomarkers; Community-Acquired Infections; Female; Humans; Male; Multivariate Analysis; Natriuretic Peptide, Brain; Peptide Fragments; Pneumonia; Predictive Value of Tests; Retrospective Studies; Severity of Illness Index

Pneumonia is a leading cause of mortality worldwide, especially in the elderly. The use of clinical risk scores to determine prognosis is complex and therefore leads to errors in clinical practice. Pneumonia can cause increases in the levels of cardiac biomarkers such as N-terminal pro-brain natriuretic peptide (NT-proBNP). The prognostic role of the NT-proBNP level in community acquired pneumonia (CAP) remains unclear. The aim of this study was to evaluate the prognostic role of the NT-proBNP level in patients with CAP, as well as its correlation with clinical risk scores.. Consecutive inpatients with CAP were enrolled in the study. At hospital admission, venous blood samples were collected for the evaluation of NT-proBNP levels. The Pneumonia Severity Index (PSI) and the Confusion, Urea, Respiratory rate, Blood pressure, and age ≥ 65 years (CURB-65) score were calculated. The primary outcome of interest was all-cause mortality within the first 30 days after hospital admission, and a secondary outcome was ICU admission.. The NT-proBNP level was one of the best predictors of 30-day mortality, with an area under the curve (AUC) of 0.735 (95% CI: 0.642-0.828; p < 0.001), as was the PSI, which had an AUC of 0.739 (95% CI: 0.634-0.843; p < 0.001), whereas the CURB-65 had an AUC of only 0.659 (95% CI: 0.556-0.763; p = 0.006). The NT-proBNP cut-off level found to be the best predictor of ICU admission and 30-day mortality was 1,434.5 pg/mL.. The NT-proBNP level appears to be a good predictor of ICU admission and 30-day mortality among inpatients with CAP, with a predictive value for mortality comparable to that of the PSI and better than that of the CURB-65 score.

Topics: Aged; Aged, 80 and over; Biomarkers; Community-Acquired Infections; Female; Humans; Intensive Care Units; Length of Stay; Logistic Models; Male; Middle Aged; Multivariate Analysis; Natriuretic Peptide, Brain; Peptide Fragments; Pneumonia; Predictive Value of Tests; Prognosis; Prospective Studies; Reference Values; Risk Assessment; Risk Factors; ROC Curve; Severity of Illness Index; Statistics, Nonparametric

Topics: Biomarkers; Community-Acquired Infections; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Pneumonia; Prognosis

The longer survival of patients with Duchenne muscular dystrophy due to advances in clinical care has increased the incidence of Duchenne muscular dystrophy-associated cardiomyopathy, a nearly consistent feature in the third decade of life. A 26-year-old patient with Duchenne muscular dystrophy experienced severe acute heart failure triggered by pneumonia. Levosimendan was effective in improving heart function.

Topics: Acute Disease; Adult; Cardiomyopathies; Cardiotonic Agents; Heart Failure; Humans; Lactic Acid; Male; Muscular Dystrophy, Duchenne; Natriuretic Peptide, Brain; Pneumonia; Simendan

Topics: Hospitalization; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Pneumonia; Sepsis

Topics: Community-Acquired Infections; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Pneumonia

Hyponatremia is a well-known sequela of community-acquired pneumonia (CAP). B-type natriuretic peptide (BNP) has a natriuretic effect and was found to be elevated in patients with CAP. We investigated whether BNP has a role in the pathophysiology of hyponatremia in pediatric CAP.. Serum and urine electrolytes and osmolality, as well as NT-pro-BNP (N-BNP), were obtained in 49 hospitalized pediatric patients with CAP (29 with hyponatremia, 20 with normal sodium levels.. Urine sodium levels were lower in the hyponatremic group compared with the normonatremic group (24.3 meq/L vs 66.7 meq/L, P = 0.006). No difference in N-BNP levels was found between groups (median, 103.8 vs 100.1; P = 0.06; interquartile range, 63.7-263.3 pg/mL vs 47.4-146.4 pg/mL). N-BNP was not associated with serum or urinary sodium levels.. These results indicate that BNP is unlikely to play a causative role in the mechanism of hyponatremia in CAP.

Topics: Child; Child, Preschool; Community-Acquired Infections; Electrolytes; Female; Humans; Hyponatremia; Infant; Male; Natriuretic Peptide, Brain; Peptide Fragments; Pneumonia

To validate a B-type natriuretic peptide (BNP) as a prognostic marker in pneumonia patients.. A prospective cohort study.. Kanazawa Medical University Himi Municipal (a 250-bed community hospital in Himi-shi, Toyama-ken, Japan).. All patients diagnosed with pneumonia by the physician and admitted to our hospital between 1 January 2012 and 31 March 2015 whose BNP levels had been determined in the first 24 h of admission. A total of 673 patients were enrolled. Of these, BNP levels were measured for a total of 369 patients on admission.. After enrolment, baseline, demographic, clinical and laboratory characteristics including levels of suspected prognostic markers for pneumonia proposed in previous papers, were collected. All patients were followed up until discharge. During analysis, they were divided into categories as follows: community-acquired pneumonia (CAP), aspiration pneumonia (AP), healthcare-associated pneumonia (HCAP) and pneumonia with acute heart failure (PAHF). A univariate and multivariable Cox-regression analysis were applied to each parameter to identify predictors of death. Three cut-off points, namely 40, 100 and 200 pg/mL, as well as the mean, were applied when comparing BNP levels.. 30-day mortality.. Of the 369 patients finally included, 137 were diagnosed with CAP, 122 with AP, 74 with HCAP, and 36 with PAHF. In the univariate analysis, BNP levels (mean, cut-off points 100 pg/mL and 200 pg/mL, p<0.01, respectively) were associated with death in CAP, and similar situation was found for BNP (cut-off points 200 pg/mL, p<0.05) in AP, but not for HCAP, or PAHF. In multivariable Cox-regression analysis, BNP remained an independent mortality predictor (HR 10.01, 95% CI 1.32 to 75.7, p=0.03) in CAP.. BNP levels may be a useful single prognostic marker for CAP. Further research for validation is warranted.

Topics: Aged, 80 and over; Biomarkers; Cohort Studies; Female; Humans; Japan; Male; Natriuretic Peptide, Brain; Pneumonia; Prognosis; Proportional Hazards Models; Prospective Studies; Reproducibility of Results; Severity of Illness Index

Secretoneurin is produced in neuroendocrine cells, and the myocardium and circulating secretoneurin levels provide incremental prognostic information to established risk indices in cardiovascular disease. As myocardial dysfunction contributes to poor outcome in critically ill patients, we wanted to assess the prognostic value of secretoneurin in two cohorts of critically ill patients with infections.. Two prospective, observational studies.. Twenty-four and twenty-five ICUs in Finland.. A total of 232 patients with severe sepsis (cohort #1) and 94 patients with infections and respiratory failure (cohort #2).. None.. We measured secretoneurin levels by radioimmunoassay in samples obtained early after ICU admission and compared secretoneurin with other risk indices. In patients with severe sepsis, admission secretoneurin levels (logarithmically transformed) were associated with hospital mortality (odds ratio, 3.17 [95% CI, 1.12-9.00]; p = 0.030) and shock during the hospitalization (odds ratio, 2.17 [1.06-4.46]; p = 0.034) in analyses that adjusted for other risk factors available on ICU admission. Adding secretoneurin levels to age, which was also associated with hospital mortality in the multivariate model, improved the risk prediction as assessed by the category-free net reclassification index: 0.35 (95% CI, 0.06-0.64) (p = 0.02). In contrast, N-terminal pro-B-type natriuretic peptide levels were not associated with mortality in the multivariate model that included secretoneurin measurements, and N-terminal pro-B-type natriuretic peptide did not improve patient classification on top of age. Secretoneurin levels were also associated with hospital mortality after adjusting for other risk factors and improved patient classification in cohort #2. In both cohorts, the optimal cutoff for secretoneurin levels at ICU admission to predict hospital mortality was ≈ 175 pmol/L, and higher levels were associated with mortality also when adjusting for Simplified Acute Physiology Score II and Sequential Organ Failure Assessment scores.. Secretoneurin levels provide incremental information to established risk indices for the prediction of mortality and shock in critically ill patients with severe infections.

Topics: Age Factors; Aged; Body Mass Index; Comorbidity; Critical Illness; Female; Finland; Hospital Mortality; Humans; Intensive Care Units; Male; Middle Aged; Natriuretic Peptide, Brain; Neuropeptides; Organ Dysfunction Scores; Pneumonia; Prognosis; Prospective Studies; Risk Factors; Secretogranin II; Sepsis; Sex Factors

In patients with severe burns, resuscitation with large volumes of fluid is needed, partly because of an increase in capillary leakage. Corticosteroids might be beneficial by diminishing capillary leakage. This study aimed to assess in severely burned nonseptic patients whether hydrocortisone (HC) improved outcome and diminished capillary leakage.. Retrospective analyses of a prospectively collected database were performed, including 39 patients (age 52 [35-62] years, 72% male). Patients were divided based on HC therapy. First, in patients in whom HC was started late, that is when deteriorating (late; 5-12 days postburn) data before and after start of HC were compared. Second, patients in whom HC was started day 0 or 1 postburn (upfront; within 48 hours) were compared with patients who did not receive HC (control). Outcome was assessed as organ dysfunction by Denver Multiple Organ Failure (MOF) score and Sequential Organ Failure Assessment (SOFA) score. As markers for capillary leakage and hydration state, proteinuria, B-type natriuretic peptide (BNP), and fluid administration were assessed. Follow-up was 20 days postburn. Possible adverse effects including mortality were recorded. Repeated measurement regression analyses were performed using MLwiN.. In the late group, Denver MOF and SOFA scores significantly decreased after HC (P<.001). Proteinuria tended to decrease (P=.13), BNP increased on the days HC was used (P<.001), and amounts of fluids diminished (P<.001). In the upfront vs control group, Denver MOF and SOFA scores (P<.001) decreased more quickly. Proteinuria (P=.006) and administered fluids decreased more rapidly (P<.001). Mortality rate, numbers of positive blood cultures, incidence of pneumonia, and graft loss were similar in all groups.. Hydrocortisone treatment in severe burned patients without sepsis might improve organ dysfunction possibly because of a reduction in capillary leakage, as reflected by a decrease of proteinuria, an increase of BNP, and diminished fluid resuscitation volumes.

Topics: Adult; Anti-Inflammatory Agents; Bacteremia; Biomarkers; Blood Culture; Burns; Capillary Permeability; Case-Control Studies; Databases, Factual; Female; Fluid Therapy; Follow-Up Studies; Humans; Hydrocortisone; Male; Middle Aged; Multiple Organ Failure; Natriuretic Peptide, Brain; Organ Dysfunction Scores; Pneumonia; Proteinuria; Resuscitation; Retrospective Studies

The aim of this study was to determine the prognostic role of echocardiography and compare with admission N-terminal proB-type natriuretic peptide (NT-proBNP) levels in adult patients with community-acquired pneumonia (CAP). Consecutive adult patients hospitalized with CAP were prospectively enrolled and followed-up until hospital discharge or death. Echocardiography was performed within the first 48 hours. Complicated hospitalization (CH) was defined as intensive care unit admission, need for mechanical ventilation or in-hospital mortality. This study was registered with ClinicalTrials.gov, number NCT02441855. A total of 15 CH (13.5%) occurred among 111 patients with CAP. CAP patients with a CH compared with those without CH had significantly higher NT-proBNP values (1267.4±1146.1 vs. 305.6±545.7 pg/mL, p <0.001) and troponin I (23.8±24.3 vs. 10.3±6.3 ng/mL, p 0.02) but had lower left ventricle ejection fraction (52.7±8.7 vs. 60.5±6.7%, p <0.001) and tricuspid annular plane systolic excursion (TAPSE), which is a measure of right ventricular systolic function (17.1±4.4 vs. 21.8±4 mm; p 0.001). Patients with elevation of NT-proBNP and decreased TAPSE at presentation had a significantly higher probability of CH (60%) than patients with either elevated NT-proBNP or decreased TAPSE (40%). Patients with neither elevated NT-proBNP nor decreased TAPSE had a 0% probability of CH. This is the first study to demonstrate that decreased right ventricular systolic function is associated with increased rates of adverse events in patients with CAP.

Topics: Aged; Anti-Bacterial Agents; Biomarkers; Community-Acquired Infections; Echocardiography; Endpoint Determination; Female; Follow-Up Studies; Heart Diseases; Hospital Mortality; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Pneumonia; Prognosis; Prospective Studies

There is limited data about ICU, short and long-term mortality prediction of severe CAP with neutrophil-to-lymphocyte ratio (NLR): N-terminal proB- type natriuretic peptide (NT-proBNP): C-reactive protein (CRP).. Besides the known severity indexes of ICU, can NLR, NT-proBNP, CRP predict ICU, short and long term mortality?. A retrospective cohort study was carried out in a level III ICU of a tertiary training hospital for chest diseases and thoracic surgery.. Over the study period, a total of 143 patients were enrolled in the study. The APACHE II scoring showed a significantly higher predicting performance for ICU mortality (p = 0.002). The performance for predicting short term mortality NLR (p = 0.039) and long term mortality NTproBNP (p = 0.002) had a significantly higher performance. The survival analysis revealed that mortality was significantly higher in patients with CURB65 score ≥ 4 (p = 0.047).. NLR, NTproBNP > 2000pg/mL can be used to predict pneumonia severity in ICU alike CURB65 and PSI. Higher NLR, APACHE II and atrial fibrillation can cause an important mortality factor in long term. Consequently, clinicians should take an attention for good cardiac evaluation and cardiac follow-up of patients with CAP (Tab. 4, Fig. 3, Ref. 36).

Topics: Aged; Aged, 80 and over; Biomarkers; C-Reactive Protein; Cause of Death; Female; Hospital Mortality; Humans; Intensive Care Units; Leukocyte Count; Lymphocytes; Male; Middle Aged; Natriuretic Peptide, Brain; Neutrophils; Pneumonia; Predictive Value of Tests; Respiratory Insufficiency; Risk Factors; Survival Analysis; Turkey

The etiologic diagnosis of acute dyspnea in the emergency department (ED) remains difficult, especially for elderly patients or those with previous cardiorespiratory medical history. This may lead to inappropriate treatment and potentially a higher mortality rate. Our objective was to evaluate the performance of cardiopulmonary ultrasound compared with usual care for the etiologic diagnosis of acute dyspnea in the ED.. Patients admitted to the ED for acute dyspnea underwent upon arrival a cardiopulmonary ultrasound performed by an emergency physician, in addition to standard care. The performances of the clinical examination, chest x-ray, N-terminal brain natriuretic peptide (NT-proBNP), and cardiopulmonary ultrasound were compared with the final diagnosis made by 2 independent physicians.. One hundred thirty patients were analyzed. For the diagnosis of acute left-sided heart failure, cardiopulmonary ultrasound had an accuracy of 90% (95% confidence interval [CI], 84-95) vs 67% (95% CI, 57-75), P = .0001 for clinical examination, and 81% (95% CI, 72-88), P = .04 for the combination "clinical examination-NT-proBNP-x-ray". Cardiopulmonary ultrasound led to the diagnosis of pneumonia or pleural effusion with an accuracy of 86% (95% CI, 80-92) and decompensated chronic obstructive pulmonary disease or asthma with an accuracy of 95% (95% CI, 92-99). Cardiopulmonary ultrasound lasted an average of 12 ± 3 minutes.. Cardiopulmonary ultrasounds performed in the ED setting allow one to rapidly establish the etiology of acute dyspnea with an accuracy of 90%.

Topics: Aged; Aged, 80 and over; Asthma; Cohort Studies; Disease Progression; Dyspnea; Echocardiography; Emergency Service, Hospital; Female; Heart Failure; Humans; Lung; Male; Natriuretic Peptide, Brain; Peptide Fragments; Physical Examination; Pleural Effusion; Pneumonia; Prospective Studies; Pulmonary Disease, Chronic Obstructive; Radiography, Thoracic; Sensitivity and Specificity

Since lung cancer surgery is still associated with a high complication rate, it is important to efficiently identify patients at high risk for postoperative complications following lung cancer surgery. We previously reported that elderly patients with elevated preoperative B-type natriuretic peptide (BNP) levels (>30 pg/mL) have an increased risk for postoperative atrial fibrillation and cardiopulmonary complications following lung cancer surgery. The objective of this study was to evaluate the clinical utility of BNP-guided risk classification for postoperative complications after lung cancer surgery.. A total of 675 consecutive patients who underwent curative surgery for lung cancer in two specialized thoracic centers between 2007 and 2011 were included in this retrospective study. We evaluated the association between the incidence of postoperative complications and preoperative BNP levels.. Univariable and multivariable stepwise logistic regression analyses revealed that an elevated preoperative BNP level was the most significant predictor of postoperative complications. All patients were classified by their preoperative BNP levels into a normal group (<30 pg/mL), a mildly elevated group (30-100 pg/mL), and a severely elevated group (>100 pg/mL). The incidence of postoperative complications was significantly higher in the severely and mildly elevated groups than in the control group (85 % and 47 % vs. 11 %, P < 0.0001). Furthermore, there were more severe complications and a higher mortality rate in the severely elevated group.. Risk assessment using preoperative BNP levels was clinically useful for the identification of patients at high risk for postoperative complications.

Topics: Adult; Aged; Aged, 80 and over; Area Under Curve; Atrial Fibrillation; Biomarkers; Carcinoma, Non-Small-Cell Lung; Female; Humans; Lung Neoplasms; Male; Middle Aged; Myocardial Infarction; Natriuretic Peptide, Brain; Pneumonectomy; Pneumonia; Predictive Value of Tests; Preoperative Period; Respiratory Distress Syndrome; Retrospective Studies; Risk Assessment; ROC Curve; Thoracic Surgery, Video-Assisted; Thoracotomy; Young Adult

We aimed to determine the role of inferior vena cava (IVC) diameter in making a differentiation between dyspnea of cardiac (acute heart failure [AHF]) and pulmonary origin. We also attempted to determine the best sonographic method for the measurement of IVC diameter.. This prospective observational study was conducted at the intensive care unit of the emergency department of a training and research hospital. This study enrolled patients with the main symptom of dyspnea who were categorized into 2 groups, cardiac dyspnea and pulmonary dyspnea groups, based on the final diagnosis. All patients underwent sonographic measurement of minimum and maximum diameters of IVC, and the caval index (CI) was calculated in both M-mode and B-mode. The sensitivity, specificity, and likelihood ratios (LR) of the IVC values for the differentiation of the 2 groups were calculated.. This study included a total of 74 patients with a mean age of 72.8 years. Thirty-two patients had dyspnea of cardiac origin, and 42 patients had dyspnea of pulmonary origin. The IVC diameter measured with B-mode during inspiration (B-mode i) was the most successful method for differentiation of the 2 groups. B-mode i values greater than 9 mm predicted dyspnea of cardiac origin with a sensitivity of 84.4% and a specificity of 92.9% (+LR: 11.8, LR: 0.16).. Sonographic assessment of the IVC diameter may be used as a rapid, readily, nonexpensive, complication-free, and reproducible technique for the differentiation of cardiac and pulmonary causes of dyspnea. B-mode i measurement may be more successful in the differentiation of dyspnea compared with other IVC diameters and calculations.

Topics: Aged; Aged, 80 and over; Area Under Curve; Diagnosis, Differential; Disease Progression; Dyspnea; Echocardiography; Emergency Service, Hospital; Female; Heart Failure; Humans; Intensive Care Units; Male; Middle Aged; Natriuretic Peptide, Brain; Organ Size; Pneumonia; Prospective Studies; Pulmonary Disease, Chronic Obstructive; Pulmonary Embolism; Sensitivity and Specificity; Vena Cava, Inferior

The role of echocardiography in adult patients with community-acquired pneumonia (CAP) has not been tested in a clinical trial. The aim of the study was to assess the cardiac changes secondary to CAP by echocardiography and to find out the correlation between echocardiographic findings and the severity of CAP.. A total of 111 unselected consecutive adult patients hospitalized with CAP were enrolled. The control group consisted of 100 consecutive sex- and age-matched patients. The severity of CAP was evaluated with the pneumonia severity index and the CURB-65 (confusion, urea, respiratory rate, arterial blood pressure and age) score. Blood samples were taken and echocardiography was performed within the first 48 hours.. White blood count, N-terminal pro-brain natriuretic peptide, and red blood cell distribution width were significantly higher in the CAP group compared with the control group. The 2 groups did not differ in terms of left and right ventricle ejection fraction, left atrial diameter, pulmonary artery systolic pressure, and left ventricular end-diastolic and end-systolic diameter. However, tricuspid annular plane systolic excursion (21.1 ± 4.3 vs 22.3 ± 4.1 mm; P = .04), aortic distensibility (2.5 ± 0.9 vs 3.5 ± 0.9 cm(2):dyne:10, P < .001), and aortic strain (5.8% ± 2% vs 6.5% ± 1.9%, P = .009) were significantly reduced in CAP group than in controls. The plasma concentration of N-terminal pro-brain natriuretic peptide correlated with aortic strain, aortic distensibility, tricuspid annular plane systolic excursion, pneumonia severity index score, and CURB-65 score.. Tricuspid annular plane systolic excursion and elastic properties of aorta may play a role in the diagnosis and clinical assessment of CAP severity, which could potentially guide the development of new prognostic models.

Topics: Adult; Aged; Aorta; Biomarkers; Case-Control Studies; Community-Acquired Infections; Echocardiography, Doppler, Color; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Pneumonia; Prospective Studies; Severity of Illness Index; Troponin I; Ventricular Function, Right

To analyze the expression of heart-fatty acid-binding protein (H-FABP), N-terminal pro-brain natriuretic peptide (NT-proBNP), and cTnI in children with congenital heart disease (CHD) and pneumonia, and evaluate its diagnostic value in heart failure (HF).. The levels of serum H-FABP, NT-proBNP, and cardiac troponin 1 (cTnI) were measured by immunoassays in 22 children with CHD, pneumonia, and HF (group I), 25 children with CHD and pneumonia (group II), and 25 healthy children without CHD or pneumonia (control group).. The concentration and positive rate of serum H-FABP, NT-proBNP, and cTnI were significantly higher in group I than those in group II. Compared to control group, these indexes were increased in both group I and group II. There were statistical significant differences in the positive rate of NT-proBNP and cTnI but not H-FABP between groups of patients with different classes of heart function.. The levels of H-FABP, NT-proBNP, and cTnI were correlated with heart function, and can be used for the diagnosis of early-stage HF in children with CHD.

Topics: Biomarkers; Child, Preschool; Fatty Acid Binding Protein 3; Fatty Acid-Binding Proteins; Female; Heart; Heart Defects, Congenital; Heart Failure; Humans; Male; Natriuretic Peptide, Brain; Peptide Fragments; Pneumonia; Troponin I

Community-acquired pneumonia is associated with a significant long-term mortality after initial recovery. It has been acknowledged that additional research is urgently needed to examine the contributors to this long-term mortality. The objective of the present study was to assess whether diabetes or newly discovered hyperglycaemia during pneumonia affects long-term mortality.. A prospective, observational cohort study.. A single secondary centre in eastern Finland.. 153 consecutive hospitalised patients who survived at least 30 days after mild-to-moderate community-acquired pneumonia.. Plasma glucose levels were recorded seven times during the first day on the ward. Several possible confounders were also recorded. The surveillance status and causes of death were recorded after median of 5 years and 11 months.. In multivariate Cox regression analysis, a previous diagnosis of diabetes among the whole population (adjusted HR 2.84 (1.35-5.99)) and new postprandial hyperglycaemia among the non-diabetic population (adjusted HR 2.56 (1.04-6.32)) showed independent associations with late mortality. New fasting hyperglycaemia was not an independent predictor. The mortality rates at the end of follow-up were 54%, 37% and 10% among patients with diabetes, patients without diabetes with new postprandial hyperglycaemia and patients without diabetes without postprandial hyperglycaemia, respectively (p<0.001). The underlying causes of death roughly mirrored those in the Finnish general population with a slight excess in mortality due to chronic respiratory diseases. Pneumonia was the immediate cause of death in just 8% of all late deaths.. A previous diagnosis of diabetes and newly discovered postprandial hyperglycaemia increase the risk of death for several years after community-acquired pneumonia. As the knowledge about patient subgroups with an increased late mortality risk is gradually gathering, more studies are needed to evaluate the possible postpneumonia interventions to reduce late mortality.

Topics: Aged; Blood Glucose; C-Reactive Protein; Cohort Studies; Community-Acquired Infections; Diabetes Mellitus; Female; Finland; Humans; Hyperglycemia; Length of Stay; Male; Middle Aged; Mortality; Multivariate Analysis; Natriuretic Peptide, Brain; Peptide Fragments; Pneumonia; Proportional Hazards Models; Prospective Studies; Urea

Correct and early risk stratification for critically ill pneumonia patients remains an unmet medical need. This study aimed to test whether N-terminal pro B-type natriuretic peptide (NT-proBNP) can serve as a prognostic marker in this setting.. This prospective study enrolled 216 pneumonia patients admitted to intensive care unit. Plasma NT-proBNP samples were obtained upon admission and primary outcome was all-cause mortality at 30 days. Meanwhile, Acute Physiology and Chronic Health Evaluation (APACHE) II and Infectious Diseases Society of America/American Thoracic Society (IDSA/ATS) 2007 minor criteria were assessed.. Overall 30-day mortality was 30%. NT-proBNP levels were significantly higher in nonsurvivors than survivors (11 938 ± 13 121 vs 5658 ± 9240 pg/mL, P = 0.001). Area under receiver operating characteristic curves of NT-proBNP, APACHE II and IDSA/ATS 2007 minor criteria were not significantly different regarding prediction of mortality (0.715, 0.754 vs 0.654, P = 0.085). Adding NT-proBNP to APACHE II significantly increased the area under receiver operating characteristic curve from 0.754 to 0.794 (P = 0.048). Receiver operating characteristic analysis revealed optimal NT-proBNP and APACHE II cut-offs of 2177.5 pg/mL and 25.5, respectively. In multivariate analysis, both NT-proBNP and APACHE II values above cut-offs had a significantly higher probability of death than those below cut-offs. A categorical approach combining NT-proBNP and APACHE II cut-offs provides additional risk stratification over a single marker approach.. For pneumonia patients admitted to intensive care unit, NT-proBNP strongly and independently predicts mortality, and its prognostic accuracy is comparable with APACHE II and IDSA/ATS 2007 minor criteria.

Topics: Aged; Aged, 80 and over; APACHE; Biomarkers; Female; Humans; Intensive Care Units; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Pneumonia; Predictive Value of Tests; Prognosis; Prospective Studies; Survival Rate

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.. 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).. 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.

Topics: Aged; Aged, 80 and over; Biomarkers; Cohort Studies; Community-Acquired Infections; Female; Heart; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Pneumonia; ROC Curve; Troponin T

Topics: Female; Humans; Intensive Care Units; Male; Natriuretic Peptide, Brain; Peptide Fragments; Pneumonia

Early and accurate risk stratification for patients with community-acquired pneumonia (CAP) is an unmet clinical need.. We enrolled 341 unselected patients presenting to the ED with CAP in whom blinded measurements of N-terminal pro-B-type natriuretic peptide (NT-proBNP), midregional pro-atrial natriuretic peptide (MR-proANP), and B-type natriuretic peptide (BNP) were performed. The potential of these natriuretic peptides to predict short- (30-day) and long-term mortality was compared with the pneumonia severity index (PSI) and CURB-65 (confusion, urea plasma level, respiratory rate, BP, age over 65 years). The median follow-up was 942 days.. NT-proBNP, MR-proANP, and BNP levels at presentation were higher in short-term (median 4,882 pg/mL vs 1,133 pg/mL; 426 pmol/L vs 178 pmol/L; 436 pg/mL vs 155 pg/mL, all P < .001) and long-term nonsurvivors (3,515 pg/mL vs 548 pg/mL; 283 pmol/L vs 136 pmol/L; 318 pg/mL vs 103 pg/mL, all P < .001) as compared with survivors. Receiver operating characteristics analysis to quantify the prognostic accuracy showed comparable areas under the curve for the three natriuretic peptides to PSI for short-term (PSI 0.76, 95% CI, 0.71-0.81; NT-proBNP 0.73, 95% CI, 0.67-0.77; MR-proANP 0.72, 95% CI, 0.67-0.77; BNP 0.68, 95% CI, 0.63-0.73) and long-term (PSI 0.72, 95% CI, 0.66-0.77; NT-proBNP 0.75, 95% CI, 0.70-0.80; MR-proANP 0.73, 95% CI, 0.67-0.77, BNP 0.70, 95% CI, 0.65-0.75) mortality. In multivariable Cox-regression analysis, NT-proBNP remained an independent mortality predictor (hazard ratio 1.004, 95% CI, 1.00-1.01, P = .02 for short-term; hazard ratio 1.004, 95% CI, 1.00-1.01, P = .001 for long-term, increase of 300 pg/mL). A categorical approach combining PSI point values and NT-pro-BNP levels adequately identified patients at low, medium, and high short- and long-term mortality risk.. Natriuretic peptides are simple and powerful predictors of short- and long-term mortality for patients with CAP. Their prognostic accuracy is comparable to PSI.

Topics: Aged; Aged, 80 and over; Atrial Natriuretic Factor; Biomarkers; Community-Acquired Infections; Female; Follow-Up Studies; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Pneumonia; Prognosis; Regression Analysis; Severity of Illness Index

Topics: Atrial Natriuretic Factor; Community-Acquired Infections; Female; Humans; Male; Natriuretic Peptide, Brain; Peptide Fragments; Pneumonia

The prognostic role of N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with community-acquired pneumonia (CAP) has not been evaluated. The aim of the present study was to investigate whether NT-proBNP level could predict mortality in hospitalised CAP patients.. We performed a structured medical record review of all hospitalised CAP patients from May 2003 to October 2006, and classified patients into the 30-day survival and non-survival group. Data included demographic and clinical characteristics, and laboratory findings including NT-proBNP levels. The APACHE II scores, PSI (pneumonia severity index) and CURB65 (confusion, urea, respiratory rate, blood pressure and aged 65 or more) scores were calculated. Comparisons between survivors and non-survivors were made with χ(2), non-parametric tests and logistic regression and ROC analysis were used to compare the ability of NT-proBNP (adjusted for age, heart failure and creatinine), APACHE II, PSI and CURB65 to predict mortality.. Of 502 patients, 61 (12.2%) died within 30 days. NT-proBNP levels were measured in 167 patients and were significantly higher in non-survivors compared to survivors (median 841.7 (IQR 267.1-3137.3) pg/ml vs 3658.0 (1863.0-7025.0) pg/ml, p=0.019). NT-proBNP was an independent predictor of mortality (adjusted OR 1.53; 95% CI 1.16 to 2.02, p=0.002). The AUC for NT-proBNP was 0.712 (95% CI, 0.613 to 0.812), which was comparable to those of PSI (0.749, p=0.531) and CURB65 (0.698, p=0.693), but inferior to that of APACHE II (0.831, p=0.037). Adding NT-proBNP to APACHE II, PSI and CURB65 did not significantly increase the AUCs, respectively.. NT-proBNP level is an independent predictor of mortality in hospitalised CAP patients. The performance of NT-proBNP level is comparable to those of PSI and CURB65 in predicting mortality.

Topics: Aged; Aged, 80 and over; Biomarkers; Cohort Studies; Community-Acquired Infections; Emergency Service, Hospital; Female; Hospital Mortality; Hospitalization; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Pneumonia; Predictive Value of Tests; Retrospective Studies; Survival Rate

The prognostic value of NT-proBNP levels in patients admitted to hospital due to acute exacerbations of chronic pulmonary diseases (CPDs) is unknown.. Internal Medicine units at two general hospitals.. NT-proBNP levels were obtained within 72 h after admission in 192 consecutive patients with acute exacerbations of CPDs and no history of heart failure or diuretic treatment. Clinical characteristics and main outcomes were assessed over a 12-month follow-up. NT-proBNP cut-points for outcomes were obtained by ROC (receiver operating characteristics) curve analysis.. Chronic obstructive lung disease (69.3%) and chronic asthma (22.4%) were the most prevalent CPDs, and non-pneumonic acute respiratory infection (72.4%) and pneumonia (22.9%) were the most frequent causes of exacerbation. Atrial flutter or fibrillation rate was 11%. During the one-year follow-up period, 22 patients died, 42 were re-admitted, 46 received new long-term oxygen therapy, and 39 received new diuretic treatment. NT-proBNP values correlated with hospitalisation days. NT-proBNP values over 587.9 pg/ml were associated with significantly raised one-year mortality (OR=3.90; 95% IC 1.46-10.47; p=0.006) and over 782.2 pg/ml with cardio-pulmonary deaths (OR=6.38; 95% IC 1.91-21.3; p=0.002). That association persisted after adjustment for age, gender, creatinine levels and cardiac rhythm. NT-proBNP values over 628.7 pg/ml were associated with significantly higher probability of new diuretic treatment (OR=4.38; IC 95% 2.07-9.25; p<0.001). The negative predictive values for these cut-points ranged from 89% to 97%.. NT-proBNP levels below 587.9 pg/ml in patients with acute exacerbations of CPD were associated with favourable one-year outcomes.

Topics: Adult; Aged; Aged, 80 and over; Asthma; Chronic Disease; Female; Follow-Up Studies; Humans; Lung Diseases; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Pneumonia; Prevalence; Prognosis; Protein Precursors; Pulmonary Disease, Chronic Obstructive; Respiratory Tract Infections; ROC Curve; Severity of Illness Index

The objective of the present study was to evaluate the utility of B-type natriuretic peptide for prediction of postoperative cardiopulmonary complications in elderly patients undergoing pulmonary resection for lung cancer.. A prospective observational study was performed involving 80 consecutive patients aged 75 years or older who underwent a scheduled pulmonary resection for lung cancer in two specialized thoracic centers between January 2008 and June 2010. Baseline clinical details were obtained, and spirometry and examination of serum B-type natriuretic peptide levels were performed before surgery. The primary endpoint was the incidence of postoperative cardiopulmonary complications.. Postoperative cardiopulmonary complications were identified in 34 (43%) patients; these patients had significantly higher preoperative B-type natriuretic peptide levels than those without cardiopulmonary complications (84.0±93.7 pg/mL vs 22.0±18.2 pg/mL; p<0.0001). The area under the receiver operating characteristic curve for B-type natriuretic peptide to predict postoperative cardiopulmonary complications after pulmonary resection for lung cancer was 0.85 (95% confidence interval 0.76 to 0.94; p<0.0001). A B-type natriuretic peptide value of 30 pg/mL had a sensitivity of 79% and a specificity of 83% for predicting postoperative cardiopulmonary complications after pulmonary resection for lung cancer. The incidences of both cardiovascular and respiratory complications were significantly higher in patients with preoperative B-type natriuretic peptide levels of 30 pg/mL or more.. Preoperative B-type natriuretic peptide level could be a useful predictor of postoperative cardiopulmonary complications in elderly patients after pulmonary resection for lung cancer.

Topics: Age Factors; Aged; Female; Follow-Up Studies; Heart Diseases; Humans; Immunoenzyme Techniques; Incidence; Japan; Lung Neoplasms; Male; Natriuretic Peptide, Brain; Pneumonectomy; Pneumonia; Prognosis; Prospective Studies; Respiratory Distress Syndrome; Risk Factors; ROC Curve; Survival Rate; Thoracic Surgery, Video-Assisted

Brain natriuretic peptide (BNP) is a strong prognostic predictor in congestive heart failure patients. Community-acquired pneumonia (CAP) is frequently associated with systemic inflammatory response syndrome (SIRS), evolving into septic shock, with high mortality. The aim of this study was to compare BNP mean values in CAP, chronic obstructive pulmonary disease (COPD) exacerbation, and acute bronchitis patients, and to evaluate the correlation of BNP values with length of hospital stay. In all, we analysed 56 patients (28 males and 28 females) admitted to our Emergency Department from May 2010 to April 2011 because of dyspnea. The CAP patients had significantly higher mean BNP values in comparison to acute bronchitis patients (127.2 Vs 45.9 pg/mL; p=0.003), and a significantly positive correlation was found between their BNP values and length of hospital stay (r=0.404; p=0.05). A stepwise multivariate linear regression analysis model showed white blood cell count as the only independent predictor of length of hospital stay (p=0.05). The results suggest that CAP patients with SIRS have increased mean BNP levels compared to acute bronchitis patients, but this parameter failed to predict the length of hospital stay.

Topics: Acute Disease; Aged; Aged, 80 and over; Biomarkers; Bronchitis; Community-Acquired Infections; Emergency Service, Hospital; Female; Humans; Length of Stay; Male; Middle Aged; Natriuretic Peptide, Brain; Pneumonia; Predictive Value of Tests; Prognosis; Pulmonary Disease, Chronic Obstructive; Retrospective Studies; Sensitivity and Specificity; Severity of Illness Index

Current evidence indicates that measurement of pleural fluid N-terminal pro-brain natriuretic peptide (NT-proBNP) levels can aid in distinguishing pleural effusions of cardiac origin from those of noncardiac origin. To date, only one study, to our knowledge, has described simultaneous measurement of pleural fluid brain natriuretic-32 peptide (BNP) and NT-proBNP. The purpose of the present study was to determine pleural fluid BNP and NT-proBNP levels and analyze the relationship between these two measurements. We hypothesized that there would be a positive correlation between pleural fluid NT-proBNP and BNP, whereas NT-proBNP levels would be higher than BNP levels.. Levels of pleural fluid NT-proBNP and BNP were measured by enzyme immunoassay in a total of 80 patients: 20 with congestive heart failure, 20 status post-coronary artery bypass graft, 20 with carcinoma, and 20 with pneumonia.. Comparison of NT-proBNP and BNP concentrations using the Spearman method of statistical analysis revealed a correlation coefficient of 0.572, P < .001. Evaluation of the diagnostic accuracy of BNP and NT-proBNP in patients with pleural effusions of cardiac origin demonstrated an area under the receiver operating characteristic curve of 0.700 (95% CI, 0.569-0.831) and 0.835 (95% CI, 0.721-0.949), respectively.. Although levels of pleural fluid BNP have a statistically significant correlation with those of NT-proBNP, this relationship only explains 32% of the variance in NT-proBNP levels. Furthermore, when compared with BNP, NT-proBNP is a more accurate diagnostic aid in the evaluation of pleural effusions of cardiac origin.

Topics: Biomarkers; Coronary Artery Bypass; Exudates and Transudates; Heart Failure; Humans; Natriuretic Peptide, Brain; Neoplasms; Peptide Fragments; Pleural Effusion; Pleural Effusion, Malignant; Pneumonia; ROC Curve; Sensitivity and Specificity; Statistics, Nonparametric

To assess the values of serum fatty acid-binding protein (FABP) and brain natriuretic peptide (BNP) in pneumonia complicated by acute congestive heart failure (CHF) in children.. Serum levels of FABP and BNP were determined using ELISA in 36 children with pneumonia complicated by CHF (pneumonia group) and 28 healthy children (control group).. Serum levels of FABP and BNP in the pneumonia group at the acute stage were significantly higher than those in the control group and those at the recovery stage (P<0.01). Compared with the control group, serum levels of FABP and BNP in the pneumonia group at the recovery stage increased significantly (P<0.01). At the acute stage, 35 patients (97.2%) showed increased serum FABP level but 28 (77.8%) showed increased serum BNP level (P<0.05) in the pneumonia group. At the recovery stage, the incidence of abnormal serum FABP (72.2%) was significantly higher than that of BNP (44.4%) in the pneumonia group (P<0.05).. Serum levels of FABP and BNP can be regarded as biochemical markers of myocardial damage in children with pneumonia complicated by CHF and serum FABP appears to be a more sensitive one. Serum FABP and BNP remained at higher levels through the recovery stage, suggesting that myocardial damage existed though the clinical symptoms were improved at the stage.

Topics: Acute Disease; Child, Preschool; Fatty Acid-Binding Proteins; Female; Heart Failure; Humans; Infant; Male; Natriuretic Peptide, Brain; Pneumonia

Pleural effusion is not a pathognomonic sign and distinguishing between transudates and exudates often presents a diagnostic dilemma.. To examine whether the NT pro-brain natriuretic peptide (NT-proBNP) in pleural fluid is a diagnostic tool for determining the cardiac etiology of pleural effusions.. We measured pleural fluid and serum NT-proBNP levels in a consecutive series of 98 patients with heart failure and in 142 patients with other causes.. The median pleural fluid NT-proBNP levels among the heart failure patients were significantly higher (3,310 pg/mL) than hepatic hydrothorax (16 patients, 531 pg/mL), malignant pleural effusion (38 patients, 733 pg/mL), parapneumonic pleural effusion (40 patients, 294 pg/mL), and tuberculous pleural effusion (64 patients, 214 pg/mL) (p<0.001). At a cut-off point of > or = 1,714 pg/mL, the test had a sensitivity of 99%, a specificity of 99 % for the diagnosis of heart failure. There were 28 patients with pleural effusion due to heart failure misclassified as exudates by Light's criteria. Ten cases of misclassified heart failure (36% of 28 patients) showed serum-effusion protein gradient less than 3.1 g/dL; 26 of them exhibited pleural fluid NT-proBNP levels of > or = 1,714 pg/mL. The 26 patients of misclassified heart failure received diuretics before thoracentesis. Pleural fluid NT-proBNP levels were correlated with serum NT-proBNP levels (R(2)=0.928, p<0.001).. Pleural fluid NT-proBNP may be useful in the diagnosis of pleural effusion resulting from heart failure. The test may be especially useful in heart failure patients with exudates who have been treated with diuretics.

Topics: Aged; Exudates and Transudates; Female; Heart Failure; Humans; Hydrothorax; Liver Diseases; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Pleural Effusion; Pleural Effusion, Malignant; Pneumonia; Tuberculosis, Pleural

The mammalian heart synthesises and secretes B-type natriuretic peptide (BNP), which has potent diuretic, natriuretic and vascular smooth muscle-relaxing effects as well as complex interactions with the hormonal and nervous systems. Recent studies described that BNP was acute phase reactant. In this study, we aimed to evaluate BNP levels in patients with pneumonia. Twenty-one patients with pneumonia and 21 healthy control subjects were enrolled in this study. Their serum levels of BNP were measured in addition to the standard evaluations. Leucocyte count [19.3 (13.2-25.7) 10(6)/ml vs. 9.55 (3.7-13.9) 10(6)/ml, p < 0.001], erythrocyte sedimentation rate [73 (57-81) mm/h vs. 35 (4-55) mm/h, p < 0.001], C-reactive protein (CRP) [127.72 (27-290) mg/l vs. 13.19 (3-41) mg/l, p < 0.001] and BNP [53.1 (17-91) pg/ml vs. 16.24 (1-38) pg/ml, p < 0.001] levels significantly decreased after treatment period. Initial BNP levels were significantly higher than control groups (53.10 +/- 15.07 pg/ml vs. 18.62 +/- 14.05 pg/ml, p < 0.001) and decreased after treatment to the levels comparable with control subjects. BNP levels correlated with CRP levels at admission (r = 0.716, p < 0.001). We have shown that BNP levels show a transient increase in patients with pneumonia and correlate well with CRP.

Topics: Adult; C-Reactive Protein; Case-Control Studies; Community-Acquired Infections; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Pneumonia

Some research has shown that B-type brain natriuretic peptide (BNF) is helpful in differentiating cardiac from pulmonary etiologies of dyspnea in adults. This study was designed to investigate whether BNP concentration could be similarly applied in children presenting with dyspnea.. Blood samples were collected from 65 children presenting with dyspnea, due to congestive heart failure (CHF, n=24), pneumonia (n=23) or pneumonia together with CHF (n=18). The samples from 15 healthy children were used as the controls. There were no significant differences in age among the four groups. Serum BNP levels were measured using ELISA.. Serum BNP levels in the CHF group (141.55 +/- 75.99 pg/mL) were significantly higher than those in the Pneumonia group (26.00 +/- 14.57 pg/mL; P < 0.01), and the Pneumonia together with CHF group (113.73 +/- 87.05 pg/mL; P < 0.05), as well as the Control group (19.31 +/- 10.30 pg/mL; P < 0.01). The patients with pneumonia together with CHF had significantly higher serum BNP levels than those of the Pneumonia and the Control groups (P < 0.01). There were no significant differences in BNP levels between the Pneumonia and the Control groups. The area under the receive operator characteristic (ROC) curve, which demonstrated the diagnostic utility of BNP in differentiating CHF from pneumonia, was 0.978 (P < 0.01). At a cut-off of 49 pg/mL, BNP had a sensitivity of 87.5% and a specificity of 95.8% for differentiating CHF from pneumonia. In the 18 patients who were diagnosed with pneumonia together with CHF, 11 had BNP levels above 49 pg/mL. The mean levels of BNP of the 11 patients were significantly higher than those of the patients with pneumonia (172.08 +/- 56.47 pg/mL vs 25.00 +/- 14.57 pg/mL; P < 0.01) but were significantly decreased after treatment (26.12 +/- 15.71 pg/mL; P < 0.01).. BNP level is of value in differentiating cardiac from pulmonary causes of dyspnea in children. BNP level is also helpful in assessing whether or not severe pneumonia couples with heart failure in children.

Topics: Child, Preschool; Dyspnea; Female; Heart Failure; Humans; Infant; Male; Natriuretic Peptide, Brain; Pneumonia; ROC Curve

Topics: Aged; Area Under Curve; Biomarkers; Cardiovascular Diseases; Community-Acquired Infections; Female; Humans; Lung Diseases; Male; Natriuretic Peptide, Brain; Pneumonia; Risk Assessment

Circulating levels of B-type natriuretic peptide (BNP), a cardiac hormone, reflect the severity of cardiac dysfunction. Because the plasma BNP level changes dramatically during the period after the onset of acute myocardial infarction (AMI), identification of a suitable sampling time is problematic. There have been several reports indicating that the plasma BNP level obtained in the acute phase of AMI can be used as a prognostic marker. We examined whether the plasma BNP level measured 3 to 4 weeks after the onset of AMI represents a reliable prognostic marker for patients with AMI.. We analyzed 145 consecutive patients with AMI. Plasma BNP levels were measured during the 3 to 4 weeks after onset of AMI. Of those patients, 23 experienced fatal cardiac events during this study. The mean follow-up period was 58.6 months. Log BNP, left ventricular end-diastolic pressure, and pulmonary vascular resistance were all significantly higher in the cardiac death group, and there were more men and more patients with a history of heart failure in the cardiac death group. A Cox proportional hazards model analysis showed that log BNP was an independent predictor of cardiac death. The survival rate was significantly higher in patients with log BNP <2.26 (180 pg/mL) than in those with log BNP > or =2.26.. The plasma BNP level obtained 3 to 4 weeks after the onset of AMI can be used as an independent predictor of cardiac death in patients with AMI.

Topics: Adult; Aged; Aged, 80 and over; Biomarkers; Cardiac Catheterization; Cause of Death; Convalescence; Death, Sudden; Female; Follow-Up Studies; Heart Failure; Hemodynamics; Humans; Life Tables; Male; Middle Aged; Myocardial Infarction; Natriuretic Peptide, Brain; Neoplasms; Pneumonia; Proportional Hazards Models; Survival Analysis; Survival Rate