Abstract
Background:
Most clinical research investigated prognostic biomarkers for their ability to predict cardiovascular events or mortality. It is unknown whether biomarkers allow prediction of quality of life (QoL) after survival of the acute event. Herein, we investigated the prognostic potential of well-established inflammatory/cardiovascular blood biomarkers including white blood cells (WBC), C-reactive protein (CRP), procalcitonin (PCT), pro-adrenomedullin (proADM) and pro-atrial natriuretic peptide (proANP) in regard to a decline in QoL in a well-defined cohort of patients with community-acquired pneumonia (CAP).
Methods:
Within this secondary analysis including 753 patients with a final inpatient diagnosis of CAP from a multicenter trial, we investigated associations between admission biomarker levels and decline in QoL assessed by the EQ-5D health questionnaire from admission to day 30 and after 6 years.
Results:
Admission proADM and proANP levels significantly predicted decline of the weighted EQ-5D index after 30 days (n=753) with adjusted odds ratios (ORs) of 2.0 ([95% CI 1.1–3.8]; p=0.027) and 3.7 ([95% CI 2.2–6.0]; p<0.001). Results for 6-year outcomes (n=349) were similar with ORs of 3.3 ([95% CI 1.3–8.3]; p=0.012) and 6.2 ([95% CI 2.7–14.2]; p<0.001). The markers were associated with most of the different QoL dimensions including mobility, self-care, and usual activities, but not pain/discomfort and to a lesser degree anxiety/depression and the visual analogue scale (VAS). Initial WBC, PCT and CRP values did not well predict QoL at any time point.
Conclusions:
ProADM and proANP accurately predict short- and long-term decline in QoL across most dimensions in CAP patients. It will be interesting to reveal underlying physiopathology in future studies.
Acknowledgments:
We are grateful to the emergency department, medical clinic, and central laboratory staff of the University Hospital Basel and the Cantonal Hospitals Aarau, Liestal, Lucerne, and Muensterlingen, and the ‘Buergerspital’ Solothurn for their assistance and technical support. In particular, we thank all patients, their relatives and all local general practitioners who participated in this study. Finally, we acknowledge the ProHOSP Study Group for their important support. The ProHOSP study group included the following persons: Ursula Schild, RN, Katharina Regez, RN, Rita Bossart, RN, Robert Thomann, MD, Claudine Falconnier, MD, Marcel Wolbers, PHD, Stefanie Neidert, MD, Thomas Fricker, MD, Claudine Blum, MD, Thomas Bregenzer, MD, Claus Hoess, MD, Heiner C. Bucher, MD, Fabian Mueller, Jeannine Haeuptle, Roya Zarbosky, Rico Fiumefreddo, MD, Melanie Wieland, RN, Charly Nusbaumer, MD, Andres Christ, MD, Roland Bingisser, MD, Kristian Schneider, RN, Brigitte Walz, PhD, Verena Briner, MD, Dieter Conen, MD, Andreas Huber, MD, Jody Staehelin, MD, Aarau, Chantal Bruehlhardt, RN, Ruth Luginbuehl, RN, Agnes Muehlemann, PhD, Ineke Lambinon, Werner Zimmerli, MD, and Max Zueger, MD.
Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: The main sources of funding for the investigator-initiated ProHOSP study were the Swiss National Science Foundation (grant SNF 3200BO-116177/1), Santé Suisse and the Gottfried and Julia Bangerter-Rhyner Foundation.
Employment or leadership: MC-C, BM and PS have received grants from B·R·A·H·M·S/Thermo and bioMérieux; in addition, BM has served as a consultant to these companies. None of the other authors has any relevant industrial relationships.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
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