Pneumology Department, Hospital Universitario y Politécnico La Fe/Instituto de Investigación Sanitaria La Fe, Valencia, Spain; Center for Biomedical Research Network in Respiratory Diseases (CIBERES, CB06/06/0028), Madrid, Spain; University of Valencia, Valencia, Spain.
Pneumology Department, Hospital Universitario y Politécnico La Fe/Instituto de Investigación Sanitaria La Fe, Valencia, Spain.
Chest. 2019 Dec;156(6):1080-1091. doi: 10.1016/j.chest.2019.06.040. Epub 2019 Aug 2.
Community-acquired pneumonia (CAP) increases the risk of cardiovascular complications during and following the episode. The goal of this study was to determine the usefulness of cardiovascular and inflammatory biomarkers for assessing the risk of early (within 30 days) or long-term (1-year follow-up) cardiovascular events.
A total of 730 hospitalized patients with CAP were prospectively followed up during 1 year. Cardiovascular (proadrenomedullin [proADM], pro-B-type natriuretic peptide (proBNP), proendothelin-1, and troponin T) and inflammatory (interleukin 6 [IL-6], C-reactive protein, and procalcitonin) biomarkers were measured on day 1, at day 4/5, and at day 30.
Ninety-two patients developed an early event, and 67 developed a long-term event. Significantly higher initial levels of proADM, proendothelin-1, troponin, proBNP, and IL-6 were recorded in patients who developed cardiovascular events. Despite a decrease at day 4/5, levels remained steady until day 30 in those who developed late events. Biomarkers (days 1 and 30) independently predicted cardiovascular events adjusted for age, previous cardiac disease, Pao/Fio < 250 mm Hg, and sepsis: ORs (95% CIs), proendothelin-1, 2.25 (1.34-3.79); proADM, 2.53 (1.53-4.20); proBNP, 2.67 (1.59-4.49); and troponin T, 2.70 (1.62-4.49) for early events. For late events, the ORs (95% CIs) were: proendothelin-1, 3.13 (1.41-7.80); proADM, 2.29 (1.01-5.19); and proBNP, 2.34 (1.01-5.56). Addition of IL-6 levels at day 30 to proendothelin-1 or proADM increased the ORs to 3.53 and 2.80, respectively.
Cardiac biomarkers are useful for identifying patients with CAP at high risk for early and long-term cardiovascular events. They may aid personalized treatment optimization and for designing future interventional studies to reduce cardiovascular risk.
社区获得性肺炎 (CAP) 会增加发作期间和之后心血管并发症的风险。本研究的目的是确定心血管和炎症生物标志物用于评估早期（30 天内）或长期（1 年随访）心血管事件风险的有用性。
730 例住院 CAP 患者前瞻性随访 1 年。在第 1 天、第 4/5 天和第 30 天测量心血管（前肾上腺髓质素 [proADM]、前 B 型利钠肽（proBNP）、内皮素-1 和肌钙蛋白 T）和炎症（白细胞介素 6 [IL-6]、C 反应蛋白和降钙素原）生物标志物。
92 例患者发生早期事件，67 例患者发生长期事件。发生心血管事件的患者初始 proADM、内皮素-1、肌钙蛋白、proBNP 和 IL-6 水平显著升高。尽管在第 4/5 天下降，但在发生晚期事件的患者中，这些水平一直稳定到第 30 天。生物标志物（第 1 天和第 30 天）独立预测心血管事件，调整了年龄、既往心脏病、Pao/Fio < 250mmHg 和脓毒症：比值比（95%CI），内皮素-1，2.25（1.34-3.79）；proADM，2.53（1.53-4.20）；proBNP，2.67（1.59-4.49）；肌钙蛋白 T，2.70（1.62-4.49）用于早期事件。对于晚期事件，比值比（95%CI）为：内皮素-1，3.13（1.41-7.80）；proADM，2.29（1.01-5.19）；和 proBNP，2.34（1.01-5.56）。在第 30 天添加 IL-6 水平到内皮素-1或 proADM 分别将比值比增加到 3.53 和 2.80。
心脏生物标志物可用于识别 CAP 患者发生早期和长期心血管事件的风险较高。它们可以帮助优化个性化治疗，并设计未来的干预研究以降低心血管风险。
