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Pro-atrial natriuretic peptide and pro-vasopressin to predict severity and prognosis in community-acquired pneumonia

Results from the German competence network CAPNETZ

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Abstract

Objective

Community acquired pneumonia (CAP) is the most important clinical infection. Therefore, the CAP competence network CAPNETZ was instituted in Germany. The aim of this substudy was to evaluate the value of pro-atrial natriuretic peptide (MR-proANP) and pro-vasopressin (CT-proAVP) for severity assessment and outcome prediction in CAP.

Design

Prospective observational study.

Setting

German CAP competence network CAPNETZ.

Methods

We enrolled 589 patients (age 61 ± 18 years, 46% female) with proven CAP. MR-proANP, CT-proAVP, C-reactive protein (CRP), procalcitonin (PCT) and CRB-65 score were determined on admission.

Results

MR-proANP, CT-proAVP and PCT levels, but not CRP, increased with increasing severity of CAP, classified according to the CRB-65 score. In patients who died during 28-day follow-up, median MR-proANP and CT-proAVP levels (respectively 237.0 vs. 93.5 pmol/l and 44.2 vs. 12.4 pmol/l, each p < 0.0001) were significantly higher than in survivors. In receiver operating characteristic (ROC) analysis for survival, the area under the curve (AUC) values for CT-proAVP (0.86, 95% CI 0.83–0.89) and MR-proANP (0.76, 95% CI 0.72–0.80) were similar to the AUC of CRB-65 (0.73, 95% CI 0.70–0.77). In multivariable Cox proportional-hazards regression analyses including MR-proANP/CT-proAVP, coexisting illnesses and CRB-65, increased MR-proANP and CT-proAVP concentrations were the strongest predictors of mortality.

Conclusions

MR-proANP and CT-proAVP are useful new biomarkers for the risk stratification of CAP patients. They are significantly lower in CAP survivors and correlate with the severity of the disease measured by CRB-65 score.

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Acknowledgements

This study was supported by the German Federal Ministry of Education and Research (Bundesministerium für Bildung und Forschung, BMBF), grants 01KI0103-105, Competence Network CAPNETZ. The authors are grateful to their fellow members of the CAPNETZ Study Group and to all study nurses. Furthermore, the authors wish to thank Angelina Herzberg, Johanna Hetzel, Barbara Schäffus, and Anne Schmiedel for excellent technical assistance.

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Correspondence to Stefan Krüger.

Additional information

Contributors: Stefan Krüger and Jana Papassotiriou helped to plan the study, performed data processing and interpretation and wrote the manuscript. Nils Morgenthaler helped to plan the study and interpret the results. Norbert Suttorp, Reinhard Marre and Tobias Welte organised CAPNETZ and data processing, planned the study and helped with the manuscript. Klaus Richter was involved in planning the study and statistical analysis. Christian Schumann helped in data processing and patient recruitment. Heike von Baum organised microbiological work in the central study unit.

Conflict of interest: Jana Papassotiriou and Nils Morgenthaler are employees of Brahms AG, the manufacturer of the assays Brahms MR-proANP LIA and Brahms CT-proAVP LIA (Hennigsdorf, Germany).

This article is discussed in the editorial available at: http://dx.doi.org/10.1007/s00134-007-0896-4.

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Members of CAPNETZ Study Group

Members of CAPNETZ Study Group

Markus Becker, Antje Kuhnke, Hartmut Lode, Malina Schmidt-Ioanas, Norbert Suttorp, (Berlin); Torsten Bauer, Santiago Ewig, Barbara Schlosser (Bochum); Matthias Pletz, Tobias Welte (Hannover); Klaus Dalhoff, Sven Pischke, Niels Schübel (Lübeck); Ingrid Huntemann, Joachim Lorenz (Lüdenscheid); Thomas Klante (Magdeburg); Tom Schaberg, Konstanze Voigt (Rotenburg); Stefan Krüger, Christian Schumann (Ulm); Berthold Jany, Uwe Ziegler (Würzburg); Torsten Illmann, Michael Wallner, Michael Weber (IT); Heike von Baum, Susanne Gonschior, Klaus Richter (main office).

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Krüger, S., Papassotiriou, J., Marre, R. et al. Pro-atrial natriuretic peptide and pro-vasopressin to predict severity and prognosis in community-acquired pneumonia. Intensive Care Med 33, 2069–2078 (2007). https://doi.org/10.1007/s00134-007-0895-5

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  • DOI: https://doi.org/10.1007/s00134-007-0895-5

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