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Clinical Chemistry 53: 2193-2201, 2007. First published October 19, 2007; 10.1373/clinchem.2007.085688
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(Clinical Chemistry. 2007;53:2193-2201.)
© 2007 American Association for Clinical Chemistry, Inc.

Infectious Disease

Midregional Pro-A-Type Natriuretic Peptide and Carboxy-Terminal Provasopressin May Predict Prognosis in Community-Acquired Pneumonia

Mar Masiá1,a, Jana Papassotiriou2, Nils G. Morgenthaler2, Ildefonso Hernández3, Conrado Shum4 and Félix Gutiérrez1

1 Infectious Diseases Unit, Internal Medicine Department, Hospital General Universitario de Elche, Alicante, Spain.
2 Research Department, BRAHMS AG, Hennigsdorf/Berlin, Germany.
3 Public Health Department, Universidad Miguel Hernández, Elche, Spain.
4 Pneumology Section, Hospital General Universitario de Elche, Alicante, Spain.

aAddress correspondence to this author at: Unidad de Enfermedades Infecciosas, Hospital General Universitario de Elche, Camí de la Almazara 11, 03203 ELCHE, Alicante, Spain. Fax 00-34-96-667 91 56; e-mail marmasia{at}ya.com.

Background: Markers to better assess severity of disease in patients with community-acquired pneumonia (CAP) would help improve medical care of this condition. The hemodynamic biomarkers carboxy-terminal provasopressin (CT-proAVP; copeptin) and midregional proatrial natriuretic peptide (MR-proANP) are increased under septic conditions, in which MR-proANP has been described as a prognostic predictor. We aimed to explore the diagnostic accuracy of MR-proANP and CT-proAVP to predict mortality in patients with CAP.

Methods: We conducted a prospective observational study of patients with CAP. We measured biomarkers in serum samples obtained at diagnosis and performed univariate and multivariate analyses to identify potential predictors of mortality.

Results: CT-proAVP and MR-proANP concentrations were measured in 173 patients. We found a positive correlation between pneumonia severity index (PSI) and MR-proANP (rs = 0.68, P <0.0001) and between PSI and CT-proAVP (rs = 0.44, P <0.0001). Median (interquartile range) CT-proAVP and MR-proANP values were 8.2 (5.3–16.8) and 73.6 (44.6–144.0) pmol/L, respectively. Nonsurvivors had significantly higher MR-proANP and CT-proAVP than survivors (median 259.0 vs 71.8 pmol/L, P = 0.01, and 24.9 vs 8.1 pmol/L, P = 0.03, respectively). In multivariate analysis including PSI, procalcitonin, C-reactive protein, lipopolysaccharide-binding protein, CT-proAVP, and MR-proANP concentrations, only CT-proAVP remained an independent predictor of death (odds ratio 1.05, P = 0.007). Cutoff values of >18.9 pmol/L for CT-proAVP and >227 pmol/L for MR-proANP showed the highest diagnostic accuracy to predict mortality.

Conclusions: CT-proAVP and MR-proANP may be used to predict prognosis in patients with CAP.






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Copyright © 2007 by the American Association for Clinical Chemistry.