Malézieux-Picard Astrid, Azurmendi Leire, Pagano Sabrina, Vuilleumier Nicolas, Sanchez Jean-Charles, Zekry Dina, Reny Jean-Luc, Stirnemann Jérôme, Garin Nicolas, Prendki Virginie
Department of Rehabilitation and Geriatrics, Division of Internal Medicine for the Aged, University Hospitals of Geneva, Hôpital des Trois-Chêne, 1226 Thonex, Switzerland.
Department of Internal Medecine, Medical Faculty, Geneva University Hospitals, 1205 Geneva, Switzerland.
J Clin Med. 2021 Dec 25;11(1):105. doi: 10.3390/jcm11010105.
A hospitalization for community-acquired pneumonia results in a decrease in long-term survival in elderly patients. We assessed biomarkers at admission to predict one-year mortality in a cohort of elderly patients with pneumonia.
A prospective observational study included patients >65 years hospitalized with pneumonia. Assessment of PSI, CURB-65, and biomarkers (C-reactive protein (CRP), procalcitonin (PCT), NT-pro-B-type natriuretic peptide (NT-proBNP), interleukin (IL)-6 and -8, tumor necrosis factor alpha (TNF-α), serum amyloid A (SAA), neopterin (NP), myeloperoxidase (MPO), anti-apolipoprotein A-1 IgG (anti-apoA-1), and anti-phosphorylcholine IgM (anti-PC IgM)) was used to calculate prognostic values for one-year mortality using ROC curve analyses. Post hoc optimal cutoffs with corresponding sensitivity (SE) and specificity (SP) were determined using the Youden index.
A total of 133 patients were included (median age 83 years [IQR: 78-89]). Age, dementia, BMI, NT-proBNP (AUROC 0.65 (95% CI: 0.55-0.77)), and IL-8 (AUROC 0.66 (95% CI: 0.56-0.75)) were significantly associated with mortality, with NT-proBNP (HR 1.01 (95% CI 1.00-1.02) and BMI (HR 0.92 (95% CI 0.85-1.000) being independent of age, gender, comorbidities, and PSI with Cox regression. At the cutoff value of 2200 ng/L, NT-proBNP had 67% sensitivity and 70% specificity. PSI and CURB-65 were not associated with mortality.
NT-proBNP levels upon admission and BMI displayed the highest prognostic accuracy for one-year mortality and may help clinicians to identify patients with poor long-term prognosis.
社区获得性肺炎住院会导致老年患者长期生存率下降。我们评估了入院时的生物标志物，以预测一组老年肺炎患者的一年死亡率。
一项前瞻性观察性研究纳入了年龄大于65岁的肺炎住院患者。评估肺炎严重指数（PSI）、CURB-65评分以及生物标志物（C反应蛋白（CRP）、降钙素原（PCT）、N末端B型利钠肽原（NT-proBNP）、白细胞介素（IL）-6和-8、肿瘤坏死因子α（TNF-α）、血清淀粉样蛋白A（SAA）、新蝶呤（NP）、髓过氧化物酶（MPO）、抗载脂蛋白A-1 IgG（抗apoA-1）和抗磷酸胆碱IgM（抗PC IgM）），并使用ROC曲线分析计算一年死亡率的预后价值。使用约登指数确定具有相应敏感性（SE）和特异性（SP）的事后最佳临界值。
共纳入133例患者（中位年龄83岁[四分位间距：78-89]）。年龄、痴呆、体重指数、NT-proBNP（曲线下面积0.65（95%可信区间：0.55-0.77））和IL-8（曲线下面积0.66（95%可信区间：0.56-0.75））与死亡率显著相关，经Cox回归分析，NT-proBNP（风险比1.01（95%可信区间1.00-1.02））和体重指数（风险比0.92（95%可信区间0.85-1.000））独立于年龄、性别、合并症和PSI。在临界值2200 ng/L时，NT-proBNP的敏感性为67%，特异性为70%。PSI和CURB-65评分与死亡率无关。
入院时的NT-proBNP水平和体重指数对一年死亡率显示出最高的预后准确性，可能有助于临床医生识别长期预后较差的患者。
