Source: Annual Congress 2012 - Prognostic indices in respiratory infections
Disease area: Respiratory infections

Abstract

Optimal risk prediction of early clinical deterioration in CAP remains unresolved. We prospectively examined the predictive value of the new biomarkers copeptin and proadrenomedullin (MR-proADM) in comparison to clinical scores and inflammatory markers to predict early high risk prognosis in CAP.
Methods:
51 consecutive hospitalised adult patients were enrolled. We measured CRB-65- and PSI-scores, the ATS/IDSA 2007 minor criteria to predict ICU-admission and the biomarkers CRP, procalcitonin, copeptin and MR-proADM on admission. Predefined outcome parameters were combined mortality or ICU-admission after 7 days and clinical instability after 72 hours.
Results:
Copeptin was the only biomarker significantly elevated in patients with either adverse short term outcome (p=0.003). In ROC-curve analysis copeptin predicted ICU admission or death within 7 days (AUC 0.81, cut-off 35 pmol/l: sensitivity 78%, specificity 79%) and persistent clinical instability after 72 h (AUC 0.74). In Kaplan-Meier-analysis patients with high copeptin showed lower ICU-free survival within 7 days (p=0.001). The diagnostic accuracy of copeptin was superior to the CRB-65 score and comparable to the PSI-score and the ATS/IDSA minor criteria. If copeptin was included as additional minor criterion for combined 7-day mortality / ICU-admission, the diagnostic accuracy of the criteria was significantly improved (AUC 0.85, p=0.045).
Conclusion:
Copeptin predicts early deterioration and persistent clinical instability in hospitalised CAP and improves the predictive properties of existing clinical scores. It should be evaluated within a biomarker guided strategy for early identification of high risk CAP patients.

Rating:

Share or cite this content

Citations should be made in the following way:
M. Kolditz, M. Halank, B. Schulte-Hubbert, S. Bergmann, S. Albrecht, G. Höffken (Dresden, Germany). Copeptin predicts early clinical deterioration and persistent instability in community-acquired pneumonia. Eur Respir J 2012; 40: Suppl. 56, 2518

Member's Comments

No comment yet.

Related content which might interest you: Early outcomes in CAP: clinical stability, clinical failure and nonresolving pneumonia Source: Eur Respir Monogr 2014; 63: 205-218 Year: 2014 Incidence of severe sepsis as a cause of clinical failure in patients with community-acquired pneumonia (CAP) Source: Eur Respir J 2007; 30: Suppl. 51, 42s Year: 2007 Copeptin application in severe community-acquired pneumonia (SCAP) severity assessment and outcomes Source: Annual Congress 2012 - Respiratory infections: a clinical point of view Year: 2012 Prediction of complications development and lethal outcome in patients with community-acquired pneumonia Source: Annual Congress 2011 - The new clinical spectrum of lung diseases: from bronchi to pleura Year: 2011 Management-based risk prediction in community-acquired pneumonia by scores and biomarkers Source: Eur Respir J 2013; 41: 974-984 Year: 2013 Procalcitonin and D-dimer to predict prognosis and clinical outcomes in severe community-acquired pneumonia (SCAP) patients Source: Annual Congress 2012 - Respiratory infections: a clinical point of view Year: 2012 Risk factors for early onset severe community-acquired pneumonia complications Source: International Congress 2018 – Pleural diseases and pneumonia: what's new ? Year: 2018 Procalcitonin and clinical pulmonary infection score as predictors of stroke associated pneumonia. Source: International Congress 2018 – Critically ill patients: prognostic factors and biomarkers Year: 2018 Biomarkers and clinical stability in community-acquired pneumonia Source: Annual Congress 2009 - Assessment of severity in respiratory infections: severity scales and biomarkers Year: 2009 The possibility to predict the danger of destabilization development of the ischemic heart disease course in patients with community-acquired pneumonia infected with chlamydophila pneumonia Source: Annual Congress 2010 - Recent developments of molecular pathology and functional genomics in chronic and acute airway diseases Year: 2010 Thrombocytosis is a marker of poor outcome in community-acquired pneumonia Source: Annual Congress 2012 - Respiratory infections: prognosis and outcome Year: 2012 Comparison of inflammatory response biomarkers to predict complications in hospitalized patients with community-acquired pneumonia Source: Annual Congress 2011 - Biomarkers and outcomes of community-acquired pneumonia Year: 2011 Admission hypoglycaemia is associated with adverse outcome in community-acquired pneumonia Source: Eur Respir J 2009; 34: 932-939 Year: 2009 I like clinical pulmonary infection scores to define the role of clinical evaluation to diagnose pneumonia and ventilator-associated pneumonia Source: Annual Congress 2009 - Diagnosis of ventilator-associated pneumonia: challenge the dogmas! Year: 2009 Initial and persistent inflammatory response in treatment failure in community-acquired pneumonia Source: Annual Congress 2007 - Prognostic laboratory tests in community-acquired pneumonia Year: 2007 An unbalanced inflammatory response on admission impacts clinical stability in hospitalized patients with community-acquired pneumonia (CAP) Source: Annual Congress 2011 - Biomarkers and outcomes of community-acquired pneumonia Year: 2011 is hypercapnia associated with severe forms of community-acquired pneumonia? Source: Virtual Congress 2020 – Lower respiratory tract infections in clinical practice Year: 2020 Admission lactate predicts poor prognosis independently of the CRB/CURB-65 scores in community-acquired pneumonia. Source: International Congress 2017 – Update on community acquired pneumonia Year: 2017 Biomarkers in severe community-acquired pneumonia (SCAP) prognosis, complications and outcomes Source: Annual Congress 2011 - Biomarkers and outcomes of community-acquired pneumonia Year: 2011 Biomarkers for the prognostic assessment and disease severity evaluation in community-acquired pneumonia (CAP) Source: Annual Congress 2010 - The prognosis of community-acquired pneumonia: old and new markers of severity Year: 2010