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Circulating levels of pro‐atrial natriuretic peptide in lower respiratory tract infections
Author(s) -
MÜLLER B.,
SÜESS E.,
SCHUETZ P.,
MÜLLER C.,
BINGISSER R.,
BERGMANN A.,
STOLZ D.,
TAMM M.,
MORGENTHALER N. G.,
CHRISTCRAIN M.
Publication year - 2006
Publication title -
journal of internal medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.625
H-Index - 160
eISSN - 1365-2796
pISSN - 0954-6820
DOI - 10.1111/j.1365-2796.2006.01722.x
Subject(s) - medicine , procalcitonin , gastroenterology , pneumonia , area under the curve , natriuretic peptide , receiver operating characteristic , lower respiratory tract infection , community acquired pneumonia , brain natriuretic peptide , prospective cohort study , respiratory tract infections , respiratory disease , c reactive protein , respiratory system , heart failure , sepsis , lung , inflammation
. Objective. 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. Design. Prospective observational study. Setting. Emergency department of a university hospital. Subjects. 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. Results. 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). Conclusions. 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.