B‐type natriuretic peptide for risk stratification in community‐acquired pneumonia
Why the study?
Does B-type natriuretic peptide (BNP) predict 30-day mortality in patients with community-acquired pneumonia?
Population
58 consecutive patients with community-acquired pneumonia, age 74 ± 11 years, with extensive comorbidities…
Design
Cohort
Follow-up
30 days
Authors
Discussion
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Member takes
Implication
BNP may enhance mortality prediction over PSI in CAP; leaves open whether prospective integration improves risk stratification or outcomes.
Key Points
- To determine whether admission levels of B-type natriuretic peptide (BNP) can reliably predict mortality and assist in risk stratification for patients with community-acquired pneumonia.
- Measured baseline BNP using a rapid fluorescence immunoassay in 58 consecutive patients admitted with community-acquired pneumonia (mean age 74 ± 11 years).
- Assessed 30-day mortality and compared the prognostic accuracy of BNP against the Pneumonia Severity Index (PSI).
- BNP levels were significantly higher in patients who died within 30 days (n = 9; median 372 pg/mL [IQR, 291–1300]) compared to survivors (n = 49; median 160 pg/mL [IQR, 61–291]; P = 0.002).
- BNP predicted 30-day mortality with an area under the ROC curve of 0.821 (95% CI, 0.697–0.945), outperforming the PSI (AUC 0.553; 95% CI, 0.362–0.745).
- An optimal BNP cutoff of 282 pg/mL demonstrated 89% sensitivity, 76% specificity, a 97% negative predictive value, and was the sole independent predictor of death on multivariate analysis (P = 0.037).
Structured PICO
Does B-type natriuretic peptide (BNP) predict 30-day mortality in patients with community-acquired pneumonia?
P
Population
58 consecutive patients with community-acquired pneumonia (CAP), age 74 ± 11 years, with extensive comorbidities including coronary artery disease, arterial hypertension, and pulmonary disease in >50% of patients.
I
Intervention
Measurement of B-type natriuretic peptide (BNP) on admission using a rapid fluorescence immunoassay.
O
Outcome
Death within 30 dayshard clinical
Elevated B-type natriuretic peptide (BNP) levels on admission are an independent predictor of 30-day mortality in patients with community-acquired pneumonia, outperforming the Pneumonia Severity Index.
Limitations
- Small sample size
- Observations need to be confirmed in further studies
- Optimal cut-off value of BNP needs to be determined
Cite This Study
Mueller et al. (2005) studied this question.