B-type natriuretic peptide in predicting the severity of community-acquired pneumonia

doi:10.5847/wjem.j.1920-8642.2015.02.008

Abstract

Abstract:

BACKGROUND: Although pneumonia severity index (PSI) is widely used to evaluate the severity of community-acquired pneumonia (CAP), the calculation of PSI is very complicated. The present study aimed to evaluate the role of B-type natriuretic peptide (BNP) in predicting the severity of CAP.
METHODS: For 202 patients with CAP admitted to the emergency department, BNP levels, cardiac load indexes, inflammatory indexes including C-reactive protein (CRP), white blood cell count (WBC), and PSI were detected. The correlation between the indexes and PSI was investigated. BNP levels for survivor and non-survivor groups were compared, and a receiver operating characteristic (ROC) curve analysis was performed on the BNP levels versus PSI.
RESULTS: The BNP levels increased with CAP severity (r=0.782, P<0.001). The BNP levels of the high-risk group (PSI classes IV and V) were significantly higher than those of the low-risk group (PSI classes I-III) (P<0.001). The BNP levels were significantly higher in the non-survivor group than in the survivor group (P<0.001). In addition, there were positive correlations between BNP levels and PSI scores (r=0.782, P<0.001). The BNP level was highly accurate in predicting the severity of CAP (AUC=0.952). The optimal cut-off point of BNP level for distinguishing high-risk patients from low-risk ones was 125.0 pg/mL, with a sensitivity of 0.891 and a specificity of 0.946. Moreover, BNP level was accurate in predicting mortality (AUC=0.823). Its optimal cut-off point for predicting death was 299.0 pg/mL, with a sensitivity of 0.675 and a specificity of 0.816. Its negative predictive cut-off value was 0.926, and the positive predictive cut-off value was 0.426.
CONCLUSION: BNP level is positively correlated with the severity of CAP, and may be used as a biomarker for evaluating the severity of CAP.

Key words: Community-acquired pneumonia, B-type natriuretic peptide, Pneumonia severity index, Biomarker, Emergency, Disease severity assessment

Jing Li, Huan Ye, Li Zhao. B-type natriuretic peptide in predicting the severity of community-acquired pneumonia[J]. World Journal of Emergency Medicine, 2015, 6(2): 131-136.

Figures/Tables 8

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PSI class	Case number	BNP	Statistics	P
I-III	56	71.5±54.3	11.537	0.000
IV-V	146	263.2±119.6

BNP	PSI score	CRP	WBC
Correlation coefficient (r)	0.782	0.560	0.513
P	0.000	0.000	0.000

Variables	Survivor group	Non-survivor group	Student's ttest	Pvalue
BNP	183.0±121.7	343.9±125.5	-6.992	0.000
PSI score	106.6±27.1	143.6±25.7	-7.307	0.000

Variables	AUC area	Best cut-off points	Sensitivity	Specificity	PPV	NPV	PLR	NLR
BNP	0.823	299.000	0.675	0.816	0.426	0.926	3.666	0.397
CRP	0.778	113.550	0.735	0.744	0.368	0.933	2.873	0.356
PSI	0.847	125.500	0.853	0.720	0.382	0.960	3.049	0.204
WBC	0.787	14.050	0.735	0.738	0.362	0.932	2.807	0.359

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