Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China.
Shanghai Medical Center of Kidney, Shanghai, China.
Blood Purif. 2020;49(3):348-355. doi: 10.1159/000504524. Epub 2020 Jan 24.
BACKGROUND/AIMS: Pneumonia is a common type of infection in maintenance hemodialysis (MHD) patients, while the treatment and prevention progress still keep limited. N-terminal-pro-brain natriuretic peptide (NT-proBNP) is an important marker in reflecting cardiac failure which also is a risk factor for pneumonia. This study aimed to determine the possible predictive value of NT-proBNP for pneumonia in MHD patients.
In this prospective study, the basic information of 276 MHD patients was collected in Fudan university Zhongshan hospital, followed up for 1 year. The primary endpoint was the first pneumonia event during follow-up. The value of NT-proBNP in patients with pneumonia and without pneumonia was analyzed, to elucidate the predictive value of the NT-proBNP in hemodialysis patients with pneumonia.
Two hundred and seventy-six patients were finally enrolled in this prospective study, including 170 men. The mean age was 59.7 ± 14.0 years old. The average duration of hemodialysis is 56 (30-82.8) months. Enrolled patients were followed up for 1 year. During follow-up, 38 patients got pneumonia. After adjustment for other confounding factors, age (hazard ratio [HR] 1.031, 95% CI 1.003-1.060, p = 0.028), log NT-proBNP (HR 2.512, 95% CI 1.124-5.612, p = 0.025), history of smoking (HR 6.326, 95% CI 2.505-15.974, p < 0.001), β2-microglobin (HR 1.042, 95% CI 1.007-1.079, p = 0.019), and history of cerebrovascular disease (HR 2.303, 95% CI 1.107-4.719, p = 0.026) were independent predictors of pneumonia. Receiver operating characteristic curves of log NT-proBNP to predict 1 year pneumonia cases, log NT-proBNP had an area under the curve of 0.647 (95% CI [0.564-0.729], p < 0.01).
NT-proBNP is a predictive factor of pneumonia in hemodialysis patients.
背景/目的：肺炎是维持性血液透析（MHD）患者常见的感染类型，而治疗和预防进展仍受到限制。N 端脑利钠肽前体（NT-proBNP）是反映心力衰竭的重要标志物，也是肺炎的危险因素。本研究旨在确定 NT-proBNP 对 MHD 患者肺炎的可能预测价值。
在这项前瞻性研究中，收集了复旦大学中山医院 276 例 MHD 患者的基本信息，随访 1 年。主要终点是随访期间首次发生肺炎。分析肺炎患者和无肺炎患者的 NT-proBNP 值，以阐明 NT-proBNP 在血液透析肺炎患者中的预测价值。
最终有 276 例患者纳入本前瞻性研究，其中 170 例为男性。平均年龄为 59.7±14.0 岁。血液透析平均时间为 56（30-82.8）个月。纳入患者随访 1 年。随访期间，38 例患者发生肺炎。在调整其他混杂因素后，年龄（风险比[HR]1.031，95%置信区间 1.003-1.060，p=0.028）、log NT-proBNP（HR 2.512，95%置信区间 1.124-5.612，p=0.025）、吸烟史（HR 6.326，95%置信区间 2.505-15.974，p<0.001）、β2-微球蛋白（HR 1.042，95%置信区间 1.007-1.079，p=0.019）和脑血管疾病史（HR 2.303，95%置信区间 1.107-4.719，p=0.026）是肺炎的独立预测因素。log NT-proBNP 预测 1 年肺炎病例的受试者工作特征曲线，log NT-proBNP 的曲线下面积为 0.647（95%置信区间[0.564-0.729]，p<0.01）。
NT-proBNP 是血液透析患者肺炎的预测因素。
