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Medientyp:
E-Artikel
Titel:
YKL‐40, CCL18 and SP‐D predict mortality in patients hospitalized with community‐acquired pneumonia
Beteiligte:
Spoorenberg, Simone M.C.;
Vestjens, Stefan M.T.;
Rijkers, Ger T.;
Meek, Bob;
van Moorsel, Coline H.M.;
Grutters, Jan C.;
Bos, Willem Jan W.
Beschreibung:
<jats:title>
<jats:styled-content style="fixed-case">ABSTRACT</jats:styled-content>
</jats:title><jats:sec><jats:title>Background and objective</jats:title><jats:p>The aim of this study was to investigate the prognostic value of four biomarkers, <jats:styled-content style="fixed-case">YKL</jats:styled-content>‐40, chemokine (C‐C motif) ligand 18 (<jats:styled-content style="fixed-case">CCL18</jats:styled-content>), surfactant protein‐<jats:styled-content style="fixed-case">D</jats:styled-content> (<jats:styled-content style="fixed-case">SP‐D</jats:styled-content>) and <jats:styled-content style="fixed-case">CA</jats:styled-content> 15‐3, in patients admitted with community‐acquired pneumonia (<jats:styled-content style="fixed-case">CAP</jats:styled-content>). These markers have been studied extensively in chronic pulmonary disease, but in acute pulmonary disease their prognostic value is unknown.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>A total of 289 adult patients who were hospitalized with <jats:styled-content style="fixed-case">CAP</jats:styled-content> 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 (<jats:styled-content style="fixed-case">IQR</jats:styled-content>): 4.7–6.1) were recorded as outcomes.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Median <jats:styled-content style="fixed-case">YKL</jats:styled-content>‐40 and <jats:styled-content style="fixed-case">CCL18</jats:styled-content> levels were significantly higher and levels of <jats:styled-content style="fixed-case">SP‐D</jats:styled-content> were significantly lower in <jats:styled-content style="fixed-case">CAP</jats:styled-content> patients compared to healthy controls. Significantly higher <jats:styled-content style="fixed-case">YKL</jats:styled-content>‐40, <jats:styled-content style="fixed-case">CCL18</jats:styled-content> and <jats:styled-content style="fixed-case">SP‐D</jats:styled-content> levels were found in patients classified in pneumonia severity index classes 4–5 and with a <jats:styled-content style="fixed-case">CURB</jats:styled-content>‐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. <jats:styled-content style="fixed-case">CA</jats:styled-content> 15‐3 levels were less predictive.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>
<jats:styled-content style="fixed-case">YKL</jats:styled-content>‐40, <jats:styled-content style="fixed-case">CCL18</jats:styled-content> and <jats:styled-content style="fixed-case">SP‐D</jats:styled-content> levels were higher in patients with more severe pneumonia, possibly reflecting the extent of pulmonary inflammation. Of these, <jats:styled-content style="fixed-case">YKL</jats:styled-content>‐40 most significantly predicts mortality for <jats:styled-content style="fixed-case">CAP</jats:styled-content>.</jats:p></jats:sec>