B型利钠肽作为肺炎患者预后标志物的验证：一项前瞻性队列研究。
Validation of a B-type natriuretic peptide as a prognostic marker in pneumonia patients: a prospective cohort study.
作者信息
Usuda Daisuke, Sangen Ryusho, Hashimoto Yu, Muranaka Emiri, Iinuma Yoshitsugu, Kanda Tsugiyasu
机构信息
Department of Infectious Diseases, Kanazawa Medical University, Uchinada-machi, Ishikawa-ken, Japan Department of Community Medicine, Kanazawa Medical University Himi Municipal Hospital, Himi-shi, Toyama-ken, Japan.
Department of Community Medicine, Kanazawa Medical University Himi Municipal Hospital, Himi-shi, Toyama-ken, Japan.
出版信息
BMJ Open. 2016 Feb 23;6(2):e010440. doi: 10.1136/bmjopen-2015-010440.
OBJECTIVES
To validate a B-type natriuretic peptide (BNP) as a prognostic marker in pneumonia patients.
DESIGN
A prospective cohort study.
SETTING
Kanazawa Medical University Himi Municipal (a 250-bed community hospital in Himi-shi, Toyama-ken, Japan).
PARTICIPANTS
All patients diagnosed with pneumonia by the physician and admitted to our hospital between 1 January 2012 and 31 March 2015 whose BNP levels had been determined in the first 24 h of admission. A total of 673 patients were enrolled. Of these, BNP levels were measured for a total of 369 patients on admission.
INTERVENTION
After enrolment, baseline, demographic, clinical and laboratory characteristics including levels of suspected prognostic markers for pneumonia proposed in previous papers, were collected. All patients were followed up until discharge. During analysis, they were divided into categories as follows: community-acquired pneumonia (CAP), aspiration pneumonia (AP), healthcare-associated pneumonia (HCAP) and pneumonia with acute heart failure (PAHF). A univariate and multivariable Cox-regression analysis were applied to each parameter to identify predictors of death. Three cut-off points, namely 40, 100 and 200 pg/mL, as well as the mean, were applied when comparing BNP levels.
MAIN OUTCOME MEASURES
30-day mortality.
RESULTS
Of the 369 patients finally included, 137 were diagnosed with CAP, 122 with AP, 74 with HCAP, and 36 with PAHF. In the univariate analysis, BNP levels (mean, cut-off points 100 pg/mL and 200 pg/mL, p<0.01, respectively) were associated with death in CAP, and similar situation was found for BNP (cut-off points 200 pg/mL, p<0.05) in AP, but not for HCAP, or PAHF. In multivariable Cox-regression analysis, BNP remained an independent mortality predictor (HR 10.01, 95% CI 1.32 to 75.7, p=0.03) in CAP.
CONCLUSIONS
BNP levels may be a useful single prognostic marker for CAP. Further research for validation is warranted.
目的
验证B型利钠肽（BNP）作为肺炎患者的预后标志物。
设计
前瞻性队列研究。
地点
金泽医科大学冰见市立医院（日本富山县冰见市一家拥有250张床位的社区医院）。
参与者
2012年1月1日至2015年3月31日期间，所有经医生诊断为肺炎并入住我院且在入院后24小时内测定了BNP水平的患者。共纳入673例患者。其中，369例患者入院时测定了BNP水平。
干预措施
入组后，收集基线、人口统计学、临床和实验室特征，包括先前文献中提出的肺炎疑似预后标志物水平。所有患者随访至出院。分析时，将患者分为以下几类：社区获得性肺炎（CAP）、吸入性肺炎（AP）、医疗保健相关肺炎（HCAP）和伴有急性心力衰竭的肺炎（PAHF）。对每个参数进行单变量和多变量Cox回归分析，以确定死亡的预测因素。比较BNP水平时应用了三个临界值，即40、100和200 pg/mL，以及平均值。
主要观察指标
30天死亡率。
结果
最终纳入的369例患者中，137例诊断为CAP，122例为AP，74例为HCAP，36例为PAHF。在单变量分析中，BNP水平（平均值、临界值100 pg/mL和200 pg/mL，p分别<0.01）与CAP患者的死亡相关，AP患者中BNP（临界值200 pg/mL，p<0.05）也有类似情况，但HCAP或PAHF患者中未发现。在多变量Cox回归分析中，BNP在CAP中仍然是独立的死亡预测因子（HR 10.01，95%CI 1.32至75.7，p=0.03）。
结论
BNP水平可能是CAP有用的单一预后标志物。有必要进行进一步的验证研究。
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