Factors Leading to Elevated Cardiac Biomarkers in Severe Community-Acquired Pneumonia

Year 2025, Volume: 26 Issue: 1, 69 - 77, 20.03.2025

Betül Dumanlı Onur Yazıcı , Fisun Karadağ

https://doi.org/10.69601/meandrosmdj.1618512

Abstract

Objective: Community-acquired pneumonia (CAP) is a significant public health issue with high morbidity and mortality rates. This study aims to evaluate the risk factors contributing to the increase in cardiac biomarkers in patients with severe CAP.
Materials and Methods: The study has a retrospective and cross-sectional design. A total of 70 patients diagnosed with CAP and followed in the Pulmonology Department and Intensive Care Unit of Aydın Adnan Menderes University between September 2015 and February 2020 were included in the study. Demographic data, comorbidities, vital signs, laboratory results, and cardiac biomarker levels (troponin, Pro-BNP, CK-MB) were recorded in detail, and comparisons were made between subgroups.
Results: Of the patients, 68.6% were male, with a mean age of 73.05 ± 13.77 years. At least one comorbidity was present in 92.8% of the patients, with hypertension, COPD, and diabetes mellitus being the most frequently observed. CK-MB levels showed significant positive correlations with CURB-65 and Pneumonia Severity Index (PSI) scores. Troponin levels were significantly elevated in patients with impaired consciousness, Pro-BNP levels in those who developed arrhythmias, and CK-MB levels in patients with COPD. Additionally, LDH levels correlated positively with both troponin and Pro-BNP levels.
Conclusion: This study highlights the importance of evaluating cardiac biomarkers in patients with severe CAP. Elevated levels of troponin, Pro-BNP, and CK-MB are reflective of increased cardiovascular risk and infection severity. These findings underscore the need for early and thorough monitoring of these biomarkers to identify and manage potential complications effectively, thereby improving patient outcomes.

Keywords

Community-acquired pneumonia, Cardiac biomarkers, Troponin, Pro-BNP, CK-MB, CURB-65, PSI

Ethical Statement

This study was approved by the Non-Interventional Clinical Research Ethics Committee of Aydın Adnan Menderes University Faculty of Medicine with the decision dated April 27, 2020, and numbered 18.

Supporting Institution

No supporting institution

Ağır Toplum Kökenli Pnömonilerde Kardiyak Biyobelirteçlerde Artışa Neden Olan Faktörler

Abstract

Amaç: Toplum kaynaklı pnömoni (TKP), yüksek morbidite ve mortalite oranlarıyla önemli bir halk sağlığı sorunudur. Bu çalışma, şiddetli TKP’li hastalarda kardiyak biyomarker düzeylerindeki artışa katkıda bulunan risk faktörlerini değerlendirmeyi amaçlamaktadır.
Gereç ve Yöntemler: Çalışma retrospektif ve kesitsel bir tasarıma sahiptir. Eylül 2015 ile Şubat 2020 tarihleri arasında Aydın Adnan Menderes Üniversitesi Göğüs Hastalıkları Servisi ve Yoğun Bakım Ünitesi’nde TKP tanısı almış toplam 70 hasta çalışmaya dahil edilmiştir. Hastaların demografik verileri, eşlik eden hastalıkları, vital bulguları, laboratuvar sonuçları ve kardiyak biyomarker düzeyleri (troponin, Pro-BNP, CK-MB) detaylı bir şekilde kaydedilmiş ve alt gruplar arasında karşılaştırmalar yapılmıştır.
Bulgular: Hastaların %68,6’sı erkek olup, yaş ortalaması 73,05 ± 13,77 yıl olarak belirlenmiştir. Hastaların %92,8’inde en az bir eşlik eden hastalık mevcuttu ve en sık görülenler hipertansiyon, KOAH ve diabetes mellitus olarak tespit edilmiştir. CK-MB düzeyleri, CURB-65 ve Pnömoni Şiddet İndeksi (PSI) skorlarıyla anlamlı pozitif korelasyon göstermiştir. Bilinç bozukluğu olan hastalarda troponin düzeyleri, aritmi gelişen hastalarda Pro-BNP düzeyleri ve KOAH’lı hastalarda CK-MB düzeyleri anlamlı derecede yüksek bulunmuştur. Ayrıca, LDH düzeylerinin hem troponin hem de Pro-BNP düzeyleriyle pozitif korelasyon gösterdiği belirlenmiştir.
Sonuç: Bu çalışma, şiddetli TKP’li hastalarda kardiyak biyomarker düzeylerinin değerlendirilmesinin önemini vurgulamaktadır. Troponin, Pro-BNP ve CK-MB düzeylerindeki artış, artmış kardiyovasküler risk ve enfeksiyon şiddetini yansıtmaktadır. Bu bulgular, olası komplikasyonların erken tespiti ve yönetimi için bu biyomarkerların dikkatle ve kapsamlı bir şekilde izlenmesinin gerekliliğini ortaya koyarak hasta sonuçlarını iyileştirmeye katkıda bulunabilir.

Keywords

Toplum kaynaklı pnömoni, kardiyak biyomarkerlar, Troponin, Pro-BNP, CK-MB, CURB-65, PSI.

References

• 1. Acar A, Öncül O. Toplum kökenli pnömoniler. Klimik Dergisi. 2007;20(1):3–16.
• 2. Jain S, Self WH, Wunderink RG, Fakhran S, Balk R, Bramley AM, et al. Community-acquired pneumonia requiring hospitalization among US adults. N Engl J Med. 2015;373(5):415–27.
• 3. Wunderink RG, Waterer GW. Community-acquired pneumonia. N Engl J Med. 2014;370(6):543–51.
• 4. Shah BA, Ahmed W, Dhobi GN, Shah NN, Khursheed SQ, Haq I. Validity of pneumonia severity index and CURB-65 severity scoring systems in community-acquired pneumonia in an Indian setting. Indian J Chest Dis Allied Sci. 2010;52(1):9.
• 5. Aujesky D, Fine MJ. The pneumonia severity index: a decade after the initial derivation and validation. Clin Infect Dis. 2008;47(Suppl_3):S133–9.
• 6. Lim W, Van der Eerden M, Laing R, Boersma W, Karalus N, Town G, et al. Defining community-acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax. 2003;58(5):377–82.
• 7. Musher DM, Abers MS, Corrales-Medina VF. Pneumonia-related cardiac complications: development and impact. Chest. 2019;156(4):690–705. doi:10.1016/j.chest.2019.05.002.
• 8. Vestjens SMT, Spoorenberg SMC, Rijkers GT, Grutters JC, ten Berg JM, Noordzij PG, et al. High-sensitivity cardiac troponin T predicts mortality after hospitalization for community-acquired pneumonia. Respirology. 2017;22(6):1000–6. doi:10.1111/resp.12996.
• 9. Lee YJ, Lee H, Park J, Kim SJ, Cho YJ, Yoon HI, et al. Cardiac troponin I as a prognostic factor in critically ill pneumonia patients in the absence of acute coronary syndrome. J Crit Care. 2015;30(2):390–4. doi:10.1016/j.jcrc.2014.12.001.
• 10. Christ-Crain M, Breidthardt T, Stolz D, Zobrist K, Bingisser R, Miedinger D, et al. Use of B-type natriuretic peptide in the risk stratification of community-acquired pneumonia. J Intern Med. 2008;264(2):166–76. doi:10.1111/j.1365-2796.2008.01941.x.
• 11. Metlay JP, Waterer GW, Long AC, Anzueto A, Brozek J, Crothers K, et al. Diagnosis and treatment of adults with community-acquired pneumonia: an official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-e67. doi:10.1164/rccm.201908-1581ST.
• 12. Cheng GS, Crothers K, Aliberti S, Bergeron A, Boeckh M, Chien JW, et al. Immunocompromised host pneumonia: definitions and diagnostic criteria: an official American Thoracic Society workshop report. Ann Am Thorac Soc. 2023;20(3):341-53. doi:10.1513/AnnalsATS.202212-1019ST.
• 13. Niederman MS, Mandell LA, Anzueto A, Bass JB, Broughton WA, Campbell GD, et al.; American Thoracic Society. Guidelines for the management of adults with community-acquired pneumonia. Am J Respir Crit Care Med. 2001;163(7):1730–54. doi:10.1164/ajrccm.163.7.at1010. PMID: 11401897.
• 14. Menéndez R, Méndez R, Aldás I, Reyes S, Gonzalez-Jimenez P, España PP, et al. Community-acquired pneumonia patients at risk for early and long-term cardiovascular events are identified by cardiac biomarkers. Chest. 2019;156(6):1080–91.
• 15. Violi F, Cangemi R, Falcone M, Taliani G, Pieralli F, Vannucchi V, et al.; SIXTUS (Thrombosis-Related Extrapulmonary Outcomes in Pneumonia) Study Group. Cardiovascular complications and short-term mortality risk in community-acquired pneumonia. Clin Infect Dis. 2017;64(11):1486–93. doi:10.1093/cid/cix164.
• 16. Peake SL, Moran JL, Leppard PI. Serum troponin concentrations in patients with sepsis: their predictive value for myocardial depression and mortality. Crit Care Med. 2006;34(3):962–70. doi:10.1097/01.CCM.0000201878.44810.7E.
• 17. Simmons LR, Patel AA, Hartman ME. Severe pneumonia, sepsis, and cardiovascular complications: an evolving paradigm. J Intensive Care Med. 2016;31(2):114–20. doi:10.1177/0885066615572496.
• 18. Ver Elst KM, Spapen HD, De Waele JJ. Myocardial dysfunction in sepsis: the role of cytokines. Chest. 2013;143(5):1168–75. doi:10.1378/chest.12-1980.
• 19. Parikh SM, Karmpaliotis D. Myocardial ischemia in the critically ill patient: mechanisms and clinical management. Crit Care Med. 2007;35(5 Suppl):S411–7. doi:10.1097/01.CCM.0000260623.26167.BB.
• 20. Lyon AR, Rees PS. Mechanisms of stress-induced cardiomyopathy. J Am Coll Cardiol. 2008;52(24):1886–94. doi:10.1016/j.jacc.2008.08.043.
• 21. Jenkins WS, Vesely MR, Ottolini E. Hemodynamic changes in critically ill patients with severe sepsis. Crit Care Clin. 2015;31(3):541–58. doi:10.1016/j.ccc.2015.03.011.
• 22. Mojón-Álvarez D, Giralt T, Carreras-Mora J, Calvo-Fernández A, Izquierdo A, Soler C, et al. Baseline NT-proBNP levels as a predictor of short- and long-term prognosis in COVID-19 patients: a prospective observational study. BMC Infect Dis. 2024;24:58. doi:10.1186/s12879-024-08980-3.
• 23. Apple FS, Quist HE, Doyle PJ, Otto AP, Murakami MM. Plasma 99th percentile reference limits for cardiac troponin and creatine kinase MB mass for use with European Society of Cardiology/American College of Cardiology consensus recommendations. Clin Chem. 2003;49(8):1331–6. doi:10.1373/49.8.1331.
• 24. Melli G, Chaudhry V, Cornblath DR. Rhabdomyolysis: an evaluation of 475 hospitalized patients. Medicine (Baltimore). 2005;84(6):377–85. doi:10.1097/01.md.0000188565.48918.41.
• 25. Blanco JR, Zabalza M, Salcedo J, et al. Rhabdomyolysis of infectious and noninfectious causes. South Med J. 2002;95(5):542–4. doi:10.1097/00007611-200295050-00012.
• 26. Fan Q, Meng J, Li P, Liu Z, Sun Y, Yan P. Pathogenesis and association of Mycoplasma pneumoniae infection with cardiac and hepatic damage. Microbiol Immunol. 2015;59(7):375–80.
• 27. Seedat MA, Feldman C, Skoularigis J, Promnitz DA, Smith C, Zwi S. A study of acute community-acquired pneumonia, including details of cardiac changes. Q J Med. 1993;86:669–75. PMID: 8255965. doi:10.1093/qjmed/86.10.669.
• 28. Yamaguchi S, Abe M, Arakaki T, Arasaki O, Shimabukuro M. Prognostic value of lactate dehydrogenase for mid-term mortality in acute decompensated heart failure: a comparison to established biomarkers and brain natriuretic peptide. Heart Lung Circ. 2020;29(9):1318–27.
• 29. Sin DD, Man SF. Chronic obstructive pulmonary disease as a risk factor for cardiovascular morbidity and mortality. Proc Am Thorac Soc. 2005;2(1):8–11. doi:10.1513/pats.2306020. 30. Labaki WW, Xia M, Murray S, Curtis JL, Barr RG, Bhatt SP, et al. NT-proBNP in stable COPD and future exacerbation risk: Analysis of the SPIROMICS cohort. Respir Med. 2018 Jul;140:87-93. doi: 10.1016/j.rmed.2018.06.005.