Biomarkers for assessing severity and complications in community-acquired pneumonia


Early prognostic assessment by the clinical scale with the biomarker panel is crucial for the optimized management of community-acquired pneumonia (CAP).
The aim was to evaluate the usefulness of several biomarkers (representing different pathophysiological pathways) and thyroid hormones in combination with the CURB‑65 scale to understand how these biomarkers might be used in clinical practice for assessing CAP severity as well as the relationship between these biomarkers and adverse clinical outcomes. Methods. A total of 62 in-patients with proven CAP of CURB‑65 class 2-5 were enrolled into the study. We measured the values of C-reactive protein (CRP), procalcitonin (PCT), d-Dimer (d-D), copeptin (CP), adrenomedullin (ADM) and thyroid hormones such as free triiodothyronine (FT3), tetraiodothyronine (FT4) and thyroid stimulating hormone (TSH). Results. Intensification of CAP severity and in-hospital mortality (IHM) cases were associated with increased values of infection and inflammation biomarkers (CRP, PCT), disorders of coagulation (d-D) and vascular tone (CP, ADM). Non-survivors had significantly higher values of CRP, PCT, d-D and CP vs. survivors. PCT, d-D showed significantly higher concentrations in patients requiring vasopressor support (VS) vs. those with stable haemodynamics (by 10 and 2.1 times respectively). On admission in intensive care unit (ICU) CRP, PCT and D-d values were significantly correlated with need for VS (r=0.39; 0.74 and 0.54) and IHM (r=0.38; 0.72 and 0.48). Both CP and ADM values were significantly associated with duration of ICU stay (r=0.43; 0.91) as well as CP with the need for VS (r=0.54). The levels of FT3 and FT4 were significantly lower in nonsevere
and severe CAP groups (by 12% and 23%) vs. the control group as well as in patients requiring invasive mechanical ventilation (IMV). There were a relevant correlations between FT4 and CAP severity (r= –0.55), FT3 and IHM (r= –0.44) as well as between FT3, TSH and the need for IMV (r= –0.47; r=0.37 respectively). The development of non-thyroidal illness syndrome (NTIS) was detected in 42% of these CAP patients. Conclusion. This biomarker panel and thyroid dysfunction can be used for adequately assessing the severity of CAP. We detected a close relationship between this biomarker panel and some adverse clinical outcomes.



1. Rodriguez A., Lisboa T., Blot S. et al. Community-Acquired Pneumonia Intensive Care Units (CAPUCI) Study Investigators. Mortality in ICU patients
with bacterial community-acquired pneumonia: when antibiotics are not enough // Intensive Care Med. — 2009. — Vol. 35. — Р. 430-8.
2. Baudouin S.V. The pulmonary physician in critical care: Critical care management of community-acquired pneumonia // Thorax. — 2002. — 57. — Р. 267-271.
3. Aujesky D., Auble T.L., Yealy D.M. et al. Prospective comparison of three validated prediction rules // Am. J. Med. — 2005. — Vol. 118. — Р. 384-392.
4. Aliberti S., Faverio P., Blasi F. Hospital admission decision for patients with community-acquired pneumonia // Curr. Infect. Dis. Rep. — 2013. — Vol. 15. — Р. 167-176.
5. Chalmers J.D., Mandal P., Singanayagam A. et al. Severity assessment tools to guide ICU admission in community-acquired pneumonia: systematic review and meta-analysis // Intensive Care Med. — 2011. — Vol. 37. — Р. 1409-1420.
6. Ehsam M., Metersky M.L. Management of community acquired pneumonia // Curr. Respir. Care Rep. — 2013. — Vol. 2. — Р. 218-225.
7. Sankar V., Webster N.R. Clinical application of sepsis biomarkers // J. Anesth. — 2013. — Vol. 27. — Р. 269-283.
8. Kutz A., Grolimund E., Christ-Crain M. et al. (for the ProHOSP Study group) Pre-analytic factors and initial biomarker levels in community-acquired pneumonia patients // Anesthesiology. — 2014. — Vol. 14. — Р. 102-111.
9. Schuetz P., Briel M., Mueller B. Clinical outcomes associated with procalcitonin algorithms to guide antibiotic therapy in respiratory tract infections // JAMA. — 2013. — Vol. 309 (7). — Р. 717-718.
10. Christ-Crain M., Muller B. Biomarkers in respiratory tract infections: diagnostic guides to antibiotic prescription, prognostic markers and mediators // Eur. Respir. J. — 2007. — Vol. 30 (3). — P. 556-573.
11. Menendez R., Martinez R., Reyes S. et al. Biomarkers improve mortality prediction by prognostic scales in community-acquired pneumonia // Thorax. — 2009. — Vol. 64. — P. 587-591.
12. Schuetz P., Wolbers M., Christ-Crain M. et al. Prohormones for prediction of adverse medical outcome in community-acquired pneumonia and lower respiratory tract infections // Critical. Care. — 2010. — Vol. 14. — R106.
13. Schuetz P., Litke A., Albrich W.C. et al. Blood biomarkers for personalized treatment and patient management decisions in community-acquired pneumonia // Curr. Opin. Infect. Dis. — 2013. — Vol. 26 (2). — P. 159-167.
14. Kolditz M., Ewig S., Hoffken G. Management-based risk prediction in community-acquired pneumonia by scores and biomarkers // Eur. Respir. J. — 2013. — Vol. 41 (4). — P. 974-984.
15. Que Y., Virgini V., Dupuis Lozeron E. et al. Low C-reactive protein values at admission predict mortality in patients with severe community-acquired pneumonia caused by Streptococcus pneumonia that require intensive care management // Infection. — 2015. — Vol. 43. — P. 193-199.


Дані завантаження ще не доступні.