Muğla Sıtkı Koçman University, Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Turkey.
Muğla Sıtkı Koçman University, Faculty of Medicine, Department of Cardiology, Turkey.
Clin Microbiol Infect. 2016 Dec;22(12):1006.e1-1006.e6. doi: 10.1016/j.cmi.2016.08.016. Epub 2016 Sep 3.
The aim of this study was to determine the prognostic role of echocardiography and compare with admission N-terminal proB-type natriuretic peptide (NT-proBNP) levels in adult patients with community-acquired pneumonia (CAP). Consecutive adult patients hospitalized with CAP were prospectively enrolled and followed-up until hospital discharge or death. Echocardiography was performed within the first 48 hours. Complicated hospitalization (CH) was defined as intensive care unit admission, need for mechanical ventilation or in-hospital mortality. This study was registered with ClinicalTrials.gov, number NCT02441855. A total of 15 CH (13.5%) occurred among 111 patients with CAP. CAP patients with a CH compared with those without CH had significantly higher NT-proBNP values (1267.4±1146.1 vs. 305.6±545.7 pg/mL, p <0.001) and troponin I (23.8±24.3 vs. 10.3±6.3 ng/mL, p 0.02) but had lower left ventricle ejection fraction (52.7±8.7 vs. 60.5±6.7%, p <0.001) and tricuspid annular plane systolic excursion (TAPSE), which is a measure of right ventricular systolic function (17.1±4.4 vs. 21.8±4 mm; p 0.001). Patients with elevation of NT-proBNP and decreased TAPSE at presentation had a significantly higher probability of CH (60%) than patients with either elevated NT-proBNP or decreased TAPSE (40%). Patients with neither elevated NT-proBNP nor decreased TAPSE had a 0% probability of CH. This is the first study to demonstrate that decreased right ventricular systolic function is associated with increased rates of adverse events in patients with CAP.
这项研究的目的是确定超声心动图在成人社区获得性肺炎（CAP）中的预后作用，并与入院时 N 末端 B 型利钠肽前体（NT-proBNP）水平进行比较。连续入组并前瞻性随访因 CAP 住院的成年患者，直至出院或死亡。在入院后 48 小时内进行超声心动图检查。复杂住院（CH）定义为入住重症监护病房、需要机械通气或院内死亡。本研究在 ClinicalTrials.gov 上注册，编号为 NCT02441855。111 例 CAP 患者中共有 15 例发生 CH（13.5%）。与无 CH 的 CAP 患者相比，发生 CH 的 CAP 患者的 NT-proBNP 值（1267.4±1146.1 比 305.6±545.7 pg/ml，p<0.001）和肌钙蛋白 I（23.8±24.3 比 10.3±6.3 ng/ml，p<0.02）显著升高，但左心室射血分数（52.7±8.7 比 60.5±6.7%，p<0.001）和三尖瓣环平面收缩期位移（TAPSE），即右心室收缩功能的指标（17.1±4.4 比 21.8±4mm；p<0.001）降低。入院时 NT-proBNP 升高和 TAPSE 降低的患者发生 CH 的概率（60%）明显高于 NT-proBNP 升高或 TAPSE 降低的患者（40%）。既无 NT-proBNP 升高也无 TAPSE 降低的患者发生 CH 的概率为 0%。这是第一项表明右心室收缩功能降低与 CAP 患者不良事件发生率增加相关的研究。
