Validation of a B-type natriuretic peptide as a prognostic marker in pneumonia patients: a prospective cohort study

Establishment and validation of clinical prediction model and prognosis of perioperative pneumonia in elderly patients with hip fracture complicated with preoperative acute heart failure

BACKGROUND

Elderly hip fracture was a common orthopedic emergency with high perioperative complication risks. Combined with preoperative acute heart failure, the risk increases further, with pneumonia being a common complication. The aim of this study was to construct and evaluate risk factor prediction models for perioperative pneumonia in these patients and to explore prognostic factors.

METHODS

A retrospective study design was used to collect data on elderly patients with hip fracture combined with preoperative acute heart failure at the Third Hospital of Hebei Medical University from January 2020 to December 2022. The feature variables were screened by logistic regression and nomogram was constructed. The receiver operating characteristics curve (ROC), decision curve analysis (DCA), and calibration curve were employed to assess the predictive power of the model. Correlation heatmaps and shapley additive explanation (SHAP) were employed to assess key variables and their impact. Employing the Kaplan-Meier curve and Cox regression, the patients' prognosis was ultimately evaluated.

RESULTS

535 elderly patients with hip fracture combined with preoperative acute heart failure were included in this study. Logistic regression analysis was used to identify combined respiratory disease, hemoglobin, albumin, neutrophils, and blood glucose as independent danger factors for perioperative pneumonia (p < 0.05). The nomogram was designed to display the outcomes instinctively, with an AUC of 0.819. The model was internally validated by initiating self-sampling 1000 times. The calibration curve indicated that the model had excellent treaty. The DCA curve showed that the model had good validity and clinical practicability. Correlation heatmaps and SHAP were visualized and analyzed. The K-M curves indicated that the prognosis of the non-pneumonia group was better than that of the pneumonia group (p = 0.014). COX regression analysis found that the major risk factors for all-cause mortality in patients with acute heart failure(AHF) were age, brain natriuretic peptide, platelet count, and combined respiratory failure (p < 0.05).

CONCLUSION

The prediction model, established in this study, was highly accurate and proved a potent instrument for clinical evaluation of the perioperative pneumonia risk of elderly hip fracture patients with preoperative acute heart failure. We hope that this study can reduce the occurrence of perioperative pneumonia in patients and improve the prognosis of patients.

An investigation of the umbilical artery N-terminal proBrain natriuretic peptide levels of fetuses due to fetal distress in term pregnancies

OBJECTIVE

This study aimed to investigate umbilical artery N-terminal proBrain natriuretic peptide (NT-proBNP) in fetuses delivered by cesarean section due to fetal distress in term pregnancies.

METHODS

This prospective case-control study was conducted at the Antalya Training and Research Hospital Obstetric Department, Turkiye. A total of 140 pregnant women, 70 underwent elective cesarean sections between weeks 37 and 40 of gestation (Group 1, the control group) and 70 underwent cesarean sections due to fetal distress (Group 2, the study group), were included. The participants' sociodemographic and obstetric data and fetal umbilical blood NT-proBNP levels were recorded in a database.

RESULTS

Age, body mass index, gestational age, prenatal diagnostic tests, fetal anatomical scanning, and baby gender ratios were comparable between the groups (p>0.05), while statistically significant differences were observed in terms of gravidity (3.0 vs. 1.0, p≤0.001) and parity numbers (2 vs. 0, p≤0.001), baby height (50.36±0.88 vs. 49.80±0.86, p≤0.001) and weight (3422.43±409.16 vs. 3239.86±293.74, p=0.003), 1-min Apgar (9.0±0.1 vs. 8.5±1.3, p≤0.001) and 5-min Apgar (10.0±0.1 vs. 9.8±0.4, p=0.026) scores, umbilical artery pH (7.32±0.05 vs. 7.25±0.07, p≤0.001), umbilical artery base deficit (-2.48±1.23 vs. -4.36±1.09. p≤0.001), and NT-proBNP levels [8.77 (7.72-9.39) vs. 12.35 (9.69-12.92), p<0.001].

CONCLUSION

This study showed that NT-proBNP can be used as an important marker in the diagnosis of fetal distress. Prospective studies with more participants are now needed to confirm the accuracy of our results.

Procalcitonin, brain natriuretic peptide and albumin as markers to predict prognosis in hospitalized older Japanese patients with a risk of infection

AIM

Whether serum concentration of procalcitonin (PCT), brain natriuretic peptide (BNP) and albumin (Alb) have an association with the outcome of hospitalized older patients is unclear. We investigated clinical outcomes and any predictive factors in hospitalized Japanese older patients with a risk of infection.

METHODS

In the retrospective study, 820 Japanese patients were followed up for 30 days or until death. During the observation period, 656 patients survived and 164 patients died. The predictive factors of death were analyzed according to demographic and clinical variables.

RESULTS

The survival rate was decreased as the serum PCT increased from <0.5 to ≥10 ng/mL, as was also the case with BNP from <300 to ≥300 pg./mL, whereas low Alb (<2.5 g/dL) showed a lower survival rate than high Alb (≥2.5 g/dL; P < 0.01). Using the Cox regression model, the multivariable-adjusted hazard ratios (95% confidence interval) were as follows: PCT 0.5-2 versus <0.5 ng/mL: 1.61(1.04-2.49), PCT 2-10 versus <0.5 ng/mL: 1.91(1.15-3.16), PCT ≥10 versus <0.5 ng/mL: 2.90(1.84-4.59), high BNP 1.26 (0.89-1.76) and low Alb 0.68 (0.52-0.87). The mortality rate increased as the number of scores (PCT + BNP + Alb) increased.

CONCLUSIONS

Concentration-dependent high PCT, high BNP and low Alb were positive risk factors associated with poor prognosis in hospitalized older patients with a risk of infection. Geriatr Gerontol Int 2024; 24: 571-576.

C-reaktives Protein (CRP) – ein diagnostischer Entzündungsmarker am Beispiel ausgewählter Indikationen

Im Rahmen der Serie „Biomarker“, die im Zentralblatt für Arbeitsmedizin, Arbeitsschutz und Ergonomie publiziert wird, ist das CRP (C-reaktives Protein) zugehörig als häufiger Marker in der Diagnostik von akuten und chronischen Entzündungserkrankungen. Die Bestimmung von CRP stellt einen wesentlichen Bestandteil der Diagnostik von Infektionserkrankungen dar. Virale und bakterielle Infektionen können anhand der Konzentrationshöhe von CRP erkannt werden. CRP erwies sich als Marker mit einer hohen Sensitivität und Spezifität bei Infektionserkrankungen. Werden die unterschiedlichsten Aspekte der arbeitsmedizinischen Vorsorge betrachtet, so hat die CRP-Bestimmung im Bereich der Diagnostik der Infektionen ihre Berechtigung.

How to use N-terminal pro-brain natriuretic peptide (NT-proBNP) in assessing disease severity in bronchiolitis

Bronchiolitis is a common viral illness which can lead to severe respiratory compromise and can coexist with or mask cardiac failure. Brain natriuretic peptide (BNP) and the inactive portion of its pro-hormone: N-terminal pro-BNP (NT-proBNP) are excreted in response to cardiomyocyte stretching and are established biomarkers in cardiac failure. Here, we discuss the technicalities of NT-proBNP testing and review available evidence regarding NT-proBNP testing in bronchiolitis. We identified and appraised seven studies assessing the role of BNP or NT-proBNP as biomarkers of bronchiolitis severity, in children with and without underlying congenital cardiac disease. One study of 76 children with dyspnoea showed that the median NT-proBNP level in children with cardiac failure was 7321 pg/mL vs 241 pg/mL in children with a respiratory cause of dyspnoea vs 87.21 pg/mL in healthy controls (p<0.05). A cut-off of 726 pg/mL could aid differentiation between cardiac and respiratory causes of respiratory distress. Other evidence showed a positive correlation between BNP levels and bronchiolitis severity, and that raised BNP can predict acute heart failure in children with congenital cardiac disease presenting with bronchiolitis. However, most studies consisted of small cohorts with conflicting evidence between them. Furthermore, several studies assessed BNP rather than NT-proBNP directly. BNP has a shorter half-life, which may affect analysis. In conclusion, NT-proBNP is a rapid and inexpensive test with the potential to be a useful biomarker in severe bronchiolitis and cases complicated by acute cardiac failure. However, studies with larger cohorts are required to better establish this role.

Do N-terminal pro-brain natriuretic peptide levels determine the prognosis of community acquired pneumonia?

OBJECTIVE

Pneumonia is a leading cause of mortality worldwide, especially in the elderly. The use of clinical risk scores to determine prognosis is complex and therefore leads to errors in clinical practice. Pneumonia can cause increases in the levels of cardiac biomarkers such as N-terminal pro-brain natriuretic peptide (NT-proBNP). The prognostic role of the NT-proBNP level in community acquired pneumonia (CAP) remains unclear. The aim of this study was to evaluate the prognostic role of the NT-proBNP level in patients with CAP, as well as its correlation with clinical risk scores.

METHODS

Consecutive inpatients with CAP were enrolled in the study. At hospital admission, venous blood samples were collected for the evaluation of NT-proBNP levels. The Pneumonia Severity Index (PSI) and the Confusion, Urea, Respiratory rate, Blood pressure, and age ≥ 65 years (CURB-65) score were calculated. The primary outcome of interest was all-cause mortality within the first 30 days after hospital admission, and a secondary outcome was ICU admission.

RESULTS

The NT-proBNP level was one of the best predictors of 30-day mortality, with an area under the curve (AUC) of 0.735 (95% CI: 0.642-0.828; p < 0.001), as was the PSI, which had an AUC of 0.739 (95% CI: 0.634-0.843; p < 0.001), whereas the CURB-65 had an AUC of only 0.659 (95% CI: 0.556-0.763; p = 0.006). The NT-proBNP cut-off level found to be the best predictor of ICU admission and 30-day mortality was 1,434.5 pg/mL.

CONCLUSIONS

The NT-proBNP level appears to be a good predictor of ICU admission and 30-day mortality among inpatients with CAP, with a predictive value for mortality comparable to that of the PSI and better than that of the CURB-65 score.

Detection of myocardial enzymes, cardiac troponin T and hepatic and renal function in the diagnosis and treatment of severe pneumonia in children

OBJECTIVE

To analyze the significance of myocardial enzymes, cardiac troponin T (cTnT) and hepatic and renal function in the treatment of severe pneumonia in children.

METHODS

One hundred and twenty children with severe pneumonia who were admitted to the hospital between April 2015 and February 2017 were selected and included as a severe pneumonia group; 120 children with common pneumonia were included as a common pneumonia group; 100 healthy children were included as controls. The myocardial enzymes, cTnT and hepatic and renal function of patients in the three groups were detected and compared. The children with severe pneumonia were divided into a mild hypoxia group, a moderate hypoxia group and a severe hypoxia group according to arterial partial pressure of oxygen; the myocardial enzymes, hepatic and renal function and cTnT of the children in the three groups were compared. The correlations of partial pressure of blood oxygen with myocardial enzymes, hepatic and renal function and cTnT were analyzed.

RESULTS

The levels of myocardial enzymes, hepatic and renal function and cTnT of the severe pneumonia group, common pneumonia group and control group declined, and the differences had statistical significance (P<0.05). The levels of myocardial enzymes, hepatic and renal function and cTnT were higher in the children with severe hypoxia. The partial pressure of blood oxygen was in a negative correlation with myocardial enzymes, hepatic and renal function and cTnT in the severe pneumonia group.

CONCLUSION

Timely monitoring of myocardial enzymes, hepatic and renal function and cTnT has an extremely important role in the evaluation of children with severe pneumonia.

A small pericardial effusion is a marker of complicated hospitalization in patients with community-acquired pneumonia

OBJECTIVE

Although often asymptomatic, presence of small pericardial effusion (SPE) is shown to be associated with adverse events and increased mortality in various conditions. This study aimed to evaluate the frequency and prognostic importance of SPE in a cohort of patients hospitalized for community-acquired pneumonia (CAP).

METHODS

We prospectively followed 154 consecutive adult patients hospitalized with CAP. The severity of CAP was evaluated with the pneumonia severity index (PSI) and the CURB-65 (confusion, urea, respiratory rate, arterial blood pressure and age) score. All patients underwent transthoracic echocardiography within the first 48h of admission. Patients were followed-up until hospital discharge or death. The outcomes of interest were length of stay in hospital and complicated hospitalization (CH) which is defined as intensive care unit admission, need for mechanical ventilation or in-hospital mortality. This study was registered with ClinicalTrials.gov, number NCT02441855.

RESULTS

A total 34 episodes of CHs occurred in 21 (13.6%) patients. Older patients and those with more co-morbid conditions such as diabetes, coronary artery diseases, cerebrovascular diseases, and chronic obstructive pulmonary diseases tended to have a higher rate of CH. Patients with CH had higher N-terminal pro-brain natriuretic peptide, troponin and creatinine levels on admission compared to patients without CH. Patients with CH had also higher CURB-65 and PSI scores and had longer durations of stay compared to patients with uncomplicated course. SPE was noted in 24 (15.6%) of the patients in our study cohort. Incidence of CH was greater for patients with a SPE (26 CHs occurred in 14 of the 24 patients) compared to those without an effusion (8 CHs occurred in 7 of the 130 patients, p<0.001). Logistic multivariate analysis revealed that the presence of SPE was an independent predictor of CH (OR: 3.26; 95% CI: 2.19-8.71; p=0.008).

CONCLUSION

This study is the first to demonstrate that the presence of SPE is associated with increased adverse events in patients with CAP.

Usefulness and prognostic value of biomarkers in patients with community-acquired pneumonia in the emergency department

Between all patients treated in the Emergency Department (ED), 1.35% are diagnosed with community-acquired pneumonia (CAP). CAP is the main cause of death due to infectious disease (10-14%) and the most frequent reason of sepsis-septic shock in the ED. In the last decade, the search for objective tools to help establishing an early diagnosis, bacterial aetiology, severity, suspicion of bacteremia and the prognosis of mortality has increased. Biomarkers have shown their usefulness in this matter. Procalcitonin (obtains the highest accuracy for CAP diagnosis, bacterial aetiology and the presence of bacteremia), lactate (biomarker of hypoxia and tissue hypoperfusion) and proadrenomedullin (which has the greatest accuracy to predict mortality which in combination with the prognostic severity scales obtains even better results). The aim of this review is to highlight recently published scientific evidence and to compare the utility and prognostic accuracy of the biomarkers in CAP patients treated in the ED.