Division of Pulmonology, Medical Department 1, University Hospital Carl Gustav Carus, Fetscherstr. 74, 01307 Dresden, Germany.
Respir Med. 2012 Sep;106(9):1320-8. doi: 10.1016/j.rmed.2012.06.008. Epub 2012 Jun 23.
Optimal risk prediction of early clinical deterioration in community-acquired pneumonia (CAP) remains unresolved. We prospectively examined the predictive value of the new biomarkers copeptin and proadrenomedullin (MR-proADM) in comparison to clinical scores and inflammatory markers to predict early high risk prognosis in CAP.
51 consecutive hospitalised adult patients were enrolled. We measured CRB-65- and PSI-scores, the ATS/IDSA 2007 minor criteria to predict ICU-admission and the biomarkers CRP, procalcitonin, copeptin and MR-proADM on admission. Predefined outcome parameters were combined mortality or ICU-admission after 7 days and clinical instability after 72 h.
Copeptin was the only biomarker significantly elevated in patients with either adverse short term outcome (p = 0.003). According to ROC-curve analysis, copeptin predicted ICU admission or death within 7 days (AUC 0.81, cut-off 35 pmol/l: sensitivity 78%, specificity 79%) and persistent clinical instability after 72 h (AUC 0.74). In Kaplan-Meier-analysis patients with high copeptin showed lower ICU-free survival within 7 days (p = 0.001). The diagnostic accuracy of copeptin was superior to the CRB-65 score and comparable to the PSI-score and the ATS/IDSA minor criteria. If copeptin was included as additional minor criterion for combined 7-day mortality or ICU-admission, the diagnostic accuracy of the minor criteria was significantly improved (p = 0.045).
Copeptin predicts early deterioration and persistent clinical instability in hospitalised CAP and improves the predictive properties of existing clinical scores. It should be evaluated within a biomarker guided strategy for early identification of high risk CAP patients who most likely benefit from early intensified management strategies.
社区获得性肺炎（CAP）早期临床恶化的最佳风险预测仍未解决。我们前瞻性地研究了新生物标志物 copeptin 和 proadrenomedullin（MR-proADM）与临床评分和炎症标志物相比，预测 CAP 早期高危预后的预测价值。
连续纳入 51 例住院成年患者。我们测量了 CRB-65 评分和 PSI 评分、ATS/IDSA 2007 年预测 ICU 入住的次要标准以及入院时 CRP、降钙素原、copeptin 和 MR-proADM 等生物标志物。预设的结局参数是 7 天后的合并死亡率或 ICU 入住率以及 72 小时后的临床不稳定。
copeptin 是唯一在有不良短期结局的患者中显著升高的生物标志物（p = 0.003）。根据 ROC 曲线分析，copeptin 预测 7 天内 ICU 入住或死亡（AUC 0.81，cut-off 35 pmol/l：敏感性 78%，特异性 79%）和 72 小时后持续的临床不稳定（AUC 0.74）。在 Kaplan-Meier 分析中，高 copeptin 患者 7 天内 ICU 无生存率较低（p = 0.001）。copeptin 的诊断准确性优于 CRB-65 评分，与 PSI 评分和 ATS/IDSA 次要标准相当。如果将 copeptin 作为联合 7 天死亡率或 ICU 入住的附加次要标准，次要标准的诊断准确性显著提高（p = 0.045）。
copeptin 预测住院 CAP 的早期恶化和持续的临床不稳定，并改善了现有临床评分的预测性能。它应该在生物标志物指导的策略中进行评估，以早期识别最有可能受益于早期强化管理策略的高危 CAP 患者。
