Biomarker bei ambulant erworbener Pneumonie – was haben wir aus CAPNETZ gelernt?

Zusammenfassung

Hintergrund: Bei der ambulant erworbenen Pneumonie (community acquired pneumonia = CAP) wurden in den letzten Jahren Biomarker intensiv untersucht. Im Rahmen der CAPNETZ-Studie hatten wir die einmalige Gelegenheit, multizentrisch an einer großen Patientenzahl den Wert alter und neuer Biomarker für die CAP zu untersuchen.

Ergebnisse: In mehreren Substudien konnten wir Folgendes herausfinden: Die Werte für Procalcitonin, CRP und Leukozyten sind am höchsten bei typischer bakterieller Ätiologie, erlauben jedoch keinen Rückschluss auf die individuelle Ätiologie eines einzelnen Patienten. Die Serumspiegel der Biomarker sind oftmals höher bei Patienten ohne antibiotische Vortherapie, verglichen mit Patienten mit antibiotischer Vortherapie. Kardiovaskuläre neuere Biomarker sind gute Prädiktoren für die Kurz- und Langzeitmortalität der CAP, dabei den rein inflammatorischen Markern Procalcitonin, CRP und Leukozyten überlegen und dem klinischen CRB-65-Score mindestens vergleichbar. Pro-Adrenomedullin ist unter den neuen Biomarkern derjenige mit der besten prognostischen Wertigkeit.

Schlussfolgerungen: Biomarker korrelieren mit dem Schweregrad der CAP, erlauben aber keine individuelle Prädiktion der Ätiologie. Neuere kardiovaskuläre Biomarker sind geeignet für die Prognosebeurteilung der Kurz- und Langzeitmortalität der CAP. Die Kombination mehrerer Biomarker, die jeweils andere pathophysiologische Signalwege abbilden, hat das Potenzial, zukünftig das Management der CAP zu verbessern.

Abstract

Background: Biomarkers have been intensively studied in community-acquired pneumonia (CAP) in recent years. In the context of the CAPNETZ study we had the unique opportunity to evaluate old and new biomarkers in a multicentre study with a high number of patients.

Results: In several substudies we found the following results: procalcitonin, CRP and leukocytes show highest values in patients with typical bacterial etiology of CAP, but do not allow individual prediction of etiology. Patients without antibiotic pre-treatment show higher values of biomarkers compared to patients with antibiotic pre-treatment. New cardiovascular biomarkers are good predictors for short- and long-term mortality in CAP, superior to the inflammatory markers procalcitonin, CRP and leukocytes and at least comparable to the clinical CRB-65 score. Pro-Adrenomedullin is among the new biomarkers the one with the best prognostic value.

Conclusions: Biomarkers correlate with the severity of CAP but do not allow individual prediction of etiology. New cardiovascular biomarkers are suitable for the evaluation of short- and long-term prognosis in CAP. The combination of several biomarkers reflecting different pathophysiological pathways has the potential to improve management of CAP in the future.

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