YKL-40, CCL18 and SP-D predict mortality in patients hospitalized with community-acquired pneumonia.

Autor: Spoorenberg SM; Department of Internal Medicine, St Antonius Hospital, Nieuwegein, The Netherlands., Vestjens SM; Department of Internal Medicine, St Antonius Hospital, Nieuwegein, The Netherlands., Rijkers GT; Department of Medical Microbiology and Immunology, St Antonius Hospital, Nieuwegein, The Netherlands.; Department of Sciences, University College Roosevelt, Middelburg, The Netherlands., Meek B; Department of Medical Microbiology and Immunology, St Antonius Hospital, Nieuwegein, The Netherlands., van Moorsel CH; Department of Pulmonology, St Antonius Hospital, Nieuwegein, The Netherlands.; Division of Heart and Lungs, University Medical Centre Utrecht, Utrecht, The Netherlands., Grutters JC; Department of Pulmonology, St Antonius Hospital, Nieuwegein, The Netherlands.; Division of Heart and Lungs, University Medical Centre Utrecht, Utrecht, The Netherlands., Bos WJ; Department of Internal Medicine, St Antonius Hospital, Nieuwegein, The Netherlands.
Jazyk: angličtina
Zdroj: Respirology (Carlton, Vic.) [Respirology] 2017 Apr; Vol. 22 (3), pp. 542-550. Date of Electronic Publication: 2016 Oct 26.
DOI: 10.1111/resp.12924
Abstrakt: Background and Objective: The aim of this study was to investigate the prognostic value of four biomarkers, YKL-40, chemokine (C-C motif) ligand 18 (CCL18), surfactant protein-D (SP-D) and CA 15-3, in patients admitted with community-acquired pneumonia (CAP). These markers have been studied extensively in chronic pulmonary disease, but in acute pulmonary disease their prognostic value is unknown.
Methods: A total of 289 adult patients who were hospitalized with CAP and participated in a randomized controlled trial were enrolled. Biomarker levels were measured on the day of admission. Intensive care unit admission, 30-day, 1-year and long-term mortality (median follow-up of 5.4 years, interquartile range (IQR): 4.7-6.1) were recorded as outcomes.
Results: Median YKL-40 and CCL18 levels were significantly higher and levels of SP-D were significantly lower in CAP patients compared to healthy controls. Significantly higher YKL-40, CCL18 and SP-D levels were found in patients classified in pneumonia severity index classes 4-5 and with a CURB-65 score ≥2 compared to patients with less severe pneumonia. Furthermore, these three markers were significant predictors for long-term mortality in multivariate analysis and compared with C-reactive protein and procalcitonin level on admission, area under the curves were higher for 30-day, 1-year and long-term mortality. CA 15-3 levels were less predictive.
Conclusion: YKL-40, CCL18 and SP-D levels were higher in patients with more severe pneumonia, possibly reflecting the extent of pulmonary inflammation. Of these, YKL-40 most significantly predicts mortality for CAP.
(© 2016 Asian Pacific Society of Respirology.)
Databáze: MEDLINE
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