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Prognostic value of plasma N ‐terminal pro B ‐type natriuretic peptide levels in pneumonia patients requiring intensive care unit admission
Author(s) -
Lin ShihChang,
Tsai YiJu,
Huang ChunTa,
Kuo YaoWen,
Ruan ShengYuan,
Chuang YuChung,
Yu ChongJen
Publication year - 2013
Publication title -
respirology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.857
H-Index - 85
eISSN - 1440-1843
pISSN - 1323-7799
DOI - 10.1111/resp.12096
Subject(s) - medicine , natriuretic peptide , receiver operating characteristic , intensive care unit , area under the curve , pneumonia , apache ii , multivariate analysis , prospective cohort study , risk stratification , n terminal pro brain natriuretic peptide , gastroenterology , cardiology , heart failure
Background and objective: 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 ‐pro BNP ) can serve as a prognostic marker in this setting. Methods This prospective study enrolled 216 pneumonia patients admitted to intensive care unit. Plasma NT ‐pro BNP samples were obtained upon admission and primary outcome was all‐cause mortality at 30 days. Meanwhile, A cute P hysiology and C hronic H ealth E valuation ( APACHE ) II and I nfectious D iseases S ociety of A merica/ A merican T horacic S ociety ( IDSA / ATS ) 2007 minor criteria were assessed. Results Overall 30‐day mortality was 30%. NT ‐pro BNP 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 ‐pro BNP , 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 ‐pro BNP 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 ‐pro BNP and APACHE II cut‐offs of 2177.5 pg/ mL and 25.5, respectively. In multivariate analysis, both NT ‐pro BNP and APACHE II values above cut‐offs had a significantly higher probability of death than those below cut‐offs. A categorical approach combining NT ‐pro BNP and APACHE II cut‐offs provides additional risk stratification over a single marker approach. Conclusions For pneumonia patients admitted to intensive care unit, NT ‐pro BNP strongly and independently predicts mortality, and its prognostic accuracy is comparable with APACHE II and IDSA / ATS 2007 minor criteria.