Natriuretic peptides for early prediction of acute kidney injury in community-acquired pneumonia

• Published in: Clinica chimica acta Vol. 419; pp. 67 - 72
• Main Authors: Nowak, Albina, Breidthardt, Tobias, Dejung, Sarah, Christ-Crain, Mirjam, Bingisser, Roland, Drexler, Beatrice, Meune, Christophe, Marono, David, Mosimann, Tamina, Müller, Beat, Müller, Christian
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 18.04.2013
• Subjects: Acute Kidney Injury - blood; Acute Kidney Injury - diagnosis; Acute renal failure; Aged; Aged, 80 and over; Community-Acquired Infections - blood; Community-Acquired Infections - diagnosis; Community-acquired pneumonia; Creatinine - blood; Early Diagnosis; Female; Humans; Male; Middle Aged; Natriuretic peptides; Natriuretic Peptides - blood; Pneumonia - blood; Pneumonia - diagnosis; Prognosis; CRP; NP; BNP; HR; mRNA; TNF; Acute renal failure; AUC; AKIN; NT-proBNP; MR-proANP; CKD; AKI; ED; OR; IL; CURB-65; CI; PSI; ROC; Community-acquired pneumonia; EDTA; proANP; CAP; HIV; Natriuretic peptides
• ISSN: 0009-8981; 1873-3492
• DOI: 10.1016/j.cca.2013.01.014

Community-acquired pneumonia (CAP) is common and associated with a considerable risk of acute kidney injury (AKI). We prospectively enrolled 341 patients presenting to the emergency department with CAP (mean age 72, male 61%). Blinded measurements of three natriuretic peptides (NT-proBNP, MR-proANP and BNP) were performed upon presentation. The primary endpoint was the accuracy of the natriuretic peptides to predict AKI within 48h. AKI occurred in 24 patients (7.6%) within the first 48h. NPs and creatinine were significantly higher in AKI compared with patients without AKI (NT-proBNP 9517 [2042–26,792] vs 1177 [280–4167]pg/ml; MR-proANP 641 [196–1075] vs 182 [99–352]pmol/l; BNP 592 [230–1630] vs 160 [64–463]pg/ml; creatinine 166 [131–289] versus 100 [78–134]μmol/l, P<0.001 for each). Predictive accuracy as quantified by the area under the receiver operating characteristics curve was moderate to high: NT-proBNP 0.79 (95%CI 0.70–0.88), MR-proANP 0.78 (95%CI 0.67–0.88), BNP 0.74 (95%CI 0.63–0.85), creatinine 0.77 (95%CI 0.66–0.88). In multivariate logistic regression analysis, NPs remained the only independent AKI predictors: NT-proBNP (increase of 200pg/ml) OR=1.01, 95%CI 1.00–1.01, P=0.009; MR-proANP (increase of 100pg/ml) OR=1.23, 95%CI 1.09–1.39, P=0.001; BNP (increase of 100pg/ml) OR=1.08, 95%CI 1.03–1.14, P=0.002. NP levels are significantly elevated in CAP-patients experiencing early AKI. Their potential to predict early AKI is comparable to serum creatinine and might be useful in cases of diagnostic uncertainty. ► Community-acquired pneumonia (CAP) is associated with acute kidney injury (AKI). ► Natriuretic peptides were accurate predictors of early in-hospital AKI. ► The predictive accuracy of the NPs is similar to the accuracy of serum creatinine.