• Spoorenberg Simone M C SM Department of Internal Medicine, St Antonius Hospital, Nieuwegein, The Netherlands., Vestjens Stefan M T SM Department of Internal Medicine, St Antonius Hospital, Nieuwegein, The Netherlands., Ger T Rijkers, Bob Meek, Coline H M van Moorsel, Jan C Grutters, Willem Jan W Bos, and Ovidius Study Group.
• Department of Internal Medicine, St Antonius Hospital, Nieuwegein, The Netherlands.
• Respirology. 2017 Apr 1; 22 (3): 542-550.

Background And ObjectiveThe aim of this study was to investigate the prognostic value of four biomarkers, YKL-40, chemokine (C-C motif) ligand 18 (CCL18), surfactant protein-D (SP-D) and CA 15-3, in patients admitted with community-acquired pneumonia (CAP). These markers have been studied extensively in chronic pulmonary disease, but in acute pulmonary disease their prognostic value is unknown.MethodsA total of 289 adult patients who were hospitalized with CAP 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 (IQR): 4.7-6.1) were recorded as outcomes.ResultsMedian YKL-40 and CCL18 levels were significantly higher and levels of SP-D were significantly lower in CAP patients compared to healthy controls. Significantly higher YKL-40, CCL18 and SP-D levels were found in patients classified in pneumonia severity index classes 4-5 and with a CURB-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. CA 15-3 levels were less predictive.ConclusionYKL-40, CCL18 and SP-D levels were higher in patients with more severe pneumonia, possibly reflecting the extent of pulmonary inflammation. Of these, YKL-40 most significantly predicts mortality for CAP.© 2016 Asian Pacific Society of Respirology.

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