Elevated levels of cardiac biomarkers such as proendothelin-1, proadrenomedullin (proADM), pro B-type natriuretic peptide (proBNP), and troponin T can help identify patients with community-acquired pneumonia (CAP) who are at high risk for early- and long-term cardiovascular events, according to study results published in CHEST.
Patients with CAP who were hospitalized at 3 different centers in the Spanish National Health Service were enrolled (n=730). During a 1-year period, researchers assessed the correlation between various cardiac biomarkers and cardiac events. Levels of cardiovascular proADM, proBNP, proendothelin-1, and troponin T and inflammatory-interleukin 6 (IL-6), C-reactive protein, and procalcitonin were measured on day 1 (T1) and at days 4 and 5 (T2), as well as at 30 days (T3).
Cardiovascular events that occurred within a 30-day period (early events) or between day 31 and 1-year follow-up (long-term events) included acute coronary syndrome (acute myocardial infarction or unstable angina), new or worsening heart failure, de novo or recurrent arrhythmia requiring hospitalization or emergency department care, and cerebrovascular accident (ie, stroke or transient ischemic attack).
A total of 95 patients and 67 patients experienced early- and long-term cardiovascular events, respectively. At 1 year, mortality was higher in patients who experienced early vs late cardiovascular events (22.8% vs 8%, respectively; P <.0001).
Initial higher proendothelin-1 (median, 144.2; interquartile range [IQR], 92-214.7; P <.001), troponin T (median, 27; IQR, 17-55.2; P <.001), proADM (median, 1.6; IQR, 1.1-2.3; P <.001), and proBNP (median, 2811.5; IQR, 1156-8019; P <.001) levels at T1 were associated with early cardiovascular events. Similar associations were observed at T2.
Biomarkers at days 1 and 30 were predictive of cardiovascular events in the analysis adjusted for age, prior cardiac disease, partial pressure of oxygen in the alveoli/fraction of inspired oxygen <250, and sepsis. The biomarkers predictive of early events included proendothelin-1 >104 pmol/L (odds ratio [OR], 2.25; 95% CI, 1.34-3.79; P =.002), proADM >1.2 nmol/L (OR, 2.53; 95% CI, 1.53-4.20; P <.001), proBNP >1619 pg/mL (OR, 2.67; 95% CI, 1.59-4.49; P <.001), and troponin T >21.9 ng/mL (OR, 2.70; 95% CI, 1.62-4.49; P <.001).
For late events, predictive biomarkers included proendothelin-1 >70.7 pmol/L (OR, 3.13; 95% CI, 1.41-7.80; P =.006), proADM >0.83 nmol/L (OR, 2.29; 95% CI, 1.01-5.19; P =.048), and proBNP >315 pg/mL (OR, 2.34; 95% CI, 1.01-5.56; P =.047). Increased ORs occurred when 30-day IL-6 levels were added to either proendothelin-1 (OR, 3.53; 95% CI, 1.51-8.26; P =.004) or proADM (OR, 2.80; 95% CI, 1.20-6.57; P =.018).
Limitations of the study included the lack of a control group, as well as missing data on mortality causes.
The researchers suggested that the identified cardiac biomarkers may assist in individual risk assessment and “may guide the design of personalized cardiovascular rehabilitation programs and treatment optimization in patients both with and without known prior cardiac disorders.”
Menéndez R, Méndez R, Aldás I, et al. Community-acquired pneumonia patients at-risk for early and long-term cardiovascular events are identified by cardiac biomarkers [published online August 2, 2019]. CHEST. doi:10.1016/j.chest.2019.06.040