The Use of Cardiac Biomarkers to Determine Cardiac Risk in Community-acquired Pneumonia Patients

Patients with community-acquired pneumonia (CAP) have a greater risk of cardiovascular complications while they are ill and afterward. In this study, researchers measured the value of cardiovascular and inflammatory biomarkers as predictors of 30-day and one-year cardiovascular events. Over a one-year period, 730 hospitalized CAP patients were prospectively followed-up. At days one, four/five, and 30, the following cardiovascular biomarkers were measured: proadrenomedullin (proADM), pro B-type natriuretic peptide (proBNP), proendothelin-1, and troponin T; inflammatory biomarkers interleukin 6 (IL-6), C-reactive protein (CRP), and procalcitonin (PCT) were measured at the same time points. During follow-up, 92 patients developed an early event and 67 developed a long-term event. Patients who developed cardiovascular events presented significantly higher initial levels of proADM, proendothelin-1, troponin, proBNP, and IL-6. A decrease was observed at day four/five, but among patients who developed late events, levels remained relatively steady until day 30. When adjusting for age, cardiac disease history, PaO2/FiO2<250, and sepsis, biomarkers at days one and 30 were independently associated with cardiovascular events: for early events, proendothelin-1 odds ratio (OR) 2.25 (95% confidence interval [CI] 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 late events, proendothelin-1 3.13 (1.41-7.80), proADM 2.29 (1.01-5.19), and proBNP 2.34 (1.01-5.56). Adding IL-6 levels at day 30 to proendothelin-1 increased the OR to 3.53, and when adding to proADM, the OR increased to 2.80.

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