Cardiovascular and inflammatory biomarkers to predict short- and long-term survival in community-acquired pneumonia: Results from the German Competence Network, CAPNETZ

Am J Respir Crit Care Med. 2010 Dec 1;182(11):1426-34. doi: 10.1164/rccm.201003-0415OC. Epub 2010 Jul 16.


Rationale: Several new biomarkers are related to mortality in community-acquired pneumonia (CAP).

Objectives: Aim of this study was to compare new biomarkers for the prediction of short- and long-term all-cause mortality in CAP.

Methods: We enrolled 728 patients (59.0 ± 18.2 yr) with CAP. Midregional proadrenomedullin (MR-proADM), midregional proatrial natriuretic peptide (MR-proANP), proarginin-vasopressin (copeptin), proendothelin-1 (CT-proET-1), procalcitonin (PCT), C-reactive protein, white blood cell (WBC) count, and clinical confusion, respiratory rate, blood pressure, and age over 65 years (CRB-65) score were determined on admission. Patients were followed up for 180 days.

Measurements and main results: In patients who died of any cause within 28 and 180 days (2.5 and 5.1%, respectively), MR-proADM, MR-proANP, copeptin, CT-proET-1 and PCT as well as CRB-65 were significantly higher compared with survivors. MR-proADM had the best performance for 28 days (HR 3.67) and 180 days (HR 2.84) survival. The C index of MR-proADM for 28-day survival (0.85) was superior to MR-proANP (0.81), copeptin (0.78), CT-proET-1 (0.79), and CRB-65 (0.72) for the prediction of mortality. For prediction of mortality at 180 days, the C index of MR-proADM (0.78) was higher than that for MR-proANP (0.74), copeptin (0.73), CT-proET-1 (0.76), PCT, C-reactive protein, and white blood cells. MR-proADM was independent of CRB-65, and added prognostic information for short- and long-term mortality. MR-proADM was an independent and strong predictor of short- and long-term mortality.

Conclusions: All new biomarkers were good predictors of short- and long-term all-cause mortality, superior to inflammatory markers, and at least comparable to CRB-65 score. MR-proADM showed the best performance. A combination of CRB-65 with MR-proADM might be the best predictor for mortality.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adrenomedullin / blood
  • Adult
  • Age Distribution
  • Aged
  • Aged, 80 and over
  • Atrial Natriuretic Factor / blood
  • Biomarkers / blood
  • Blood Pressure
  • C-Reactive Protein
  • Calcitonin / blood
  • Calcitonin Gene-Related Peptide
  • Cardiovascular Diseases / blood
  • Cardiovascular Diseases / epidemiology*
  • Community-Acquired Infections / blood
  • Community-Acquired Infections / epidemiology
  • Comorbidity
  • Endothelin-1 / blood
  • Female
  • Germany / epidemiology
  • Humans
  • Inflammation / blood*
  • Leukocyte Count
  • Male
  • Middle Aged
  • Pneumonia / blood
  • Pneumonia / epidemiology*
  • Predictive Value of Tests
  • Protein Precursors / blood
  • Respiratory Rate
  • Survival Analysis
  • Vasopressins / blood
  • Young Adult


  • Biomarkers
  • CALCA protein, human
  • Endothelin-1
  • Protein Precursors
  • midregional pro-atrial natriuretic peptide, human
  • proadrenomedullin
  • proendothelin 1
  • Vasopressins
  • Adrenomedullin
  • Atrial Natriuretic Factor
  • Calcitonin
  • C-Reactive Protein
  • Calcitonin Gene-Related Peptide