Pentraxin-3 level at admission is a strong predictor of short-term mortality in a community-based hospital setting

TY - JOUR

T1 - Pentraxin-3 level at admission is a strong predictor of short-term mortality in a community-based hospital setting

AU - Bastrup-Birk, S

AU - Munthe-Fog, L

AU - Skjødt, Mikkel-Ole

AU - Ma, Y J

AU - Nielsen, H

AU - Køber, L

AU - Nielsen, O W

AU - Iversen, K

AU - Garred, P

N1 - © 2014 The Association for the Publication of the Journal of Internal Medicine.

PY - 2015/5/1

Y1 - 2015/5/1

N2 - Background: The pattern recognition molecule pentraxin-3 (PTX3) is a novel potential marker of prognosis, as elevated levels are associated with both disease severity and mortality in patients with a wide range of conditions. However, the usefulness of PTX3 as a prognostic biomarker in a general hospital setting is unknown. Patients and methods: The study cohort consisted of 1326 unselected, consecutive patients (age >40 years) admitted to a community hospital in Copenhagen, Denmark. Patients were followed until death or for a median of 11.5 years after admission. The main outcome measure was all-cause mortality. Serum samples collected from patients at admission and from 192 healthy control subjects were quantified for PTX3 level by enzyme-linked immunosorbent assay. Results: PTX3 was elevated in patients (median 3.7 ng mL-1, range 0.5-209.8) compared with healthy nonhospitalized subjects (median 3.5 ng mL-1, range 0.0-8.3; P = 0.0003). Elevated PTX3 levels, defined as above the 95th percentile of the concentration in healthy subjects, were associated with increased overall mortality during the study (P < 0.0001). This increase in mortality was greatest in the short term, with an unadjusted hazard ratio (HR) of 6.4 [95% confidence interval (CI) 3.8-11.0] at 28 days after admission, compared to 1.7 (95% CI 1.4-2.0) at the end of follow-up. These results were still significant after adjustment for age, gender and glomerular filtration rate: adjusted HR of 5.0 (95% CI 2.9-8.8) and 1.4 (95% CI 1.2-1.8), respectively. Conclusion: These results suggest that PTX3 could be a widely applicable marker of short-term mortality in hospitalized patients and may be useful in the initial risk stratification.

AB - Background: The pattern recognition molecule pentraxin-3 (PTX3) is a novel potential marker of prognosis, as elevated levels are associated with both disease severity and mortality in patients with a wide range of conditions. However, the usefulness of PTX3 as a prognostic biomarker in a general hospital setting is unknown. Patients and methods: The study cohort consisted of 1326 unselected, consecutive patients (age >40 years) admitted to a community hospital in Copenhagen, Denmark. Patients were followed until death or for a median of 11.5 years after admission. The main outcome measure was all-cause mortality. Serum samples collected from patients at admission and from 192 healthy control subjects were quantified for PTX3 level by enzyme-linked immunosorbent assay. Results: PTX3 was elevated in patients (median 3.7 ng mL-1, range 0.5-209.8) compared with healthy nonhospitalized subjects (median 3.5 ng mL-1, range 0.0-8.3; P = 0.0003). Elevated PTX3 levels, defined as above the 95th percentile of the concentration in healthy subjects, were associated with increased overall mortality during the study (P < 0.0001). This increase in mortality was greatest in the short term, with an unadjusted hazard ratio (HR) of 6.4 [95% confidence interval (CI) 3.8-11.0] at 28 days after admission, compared to 1.7 (95% CI 1.4-2.0) at the end of follow-up. These results were still significant after adjustment for age, gender and glomerular filtration rate: adjusted HR of 5.0 (95% CI 2.9-8.8) and 1.4 (95% CI 1.2-1.8), respectively. Conclusion: These results suggest that PTX3 could be a widely applicable marker of short-term mortality in hospitalized patients and may be useful in the initial risk stratification.

KW - Aged

KW - Biomarkers

KW - C-Reactive Protein

KW - Case-Control Studies

KW - Denmark

KW - Female

KW - Hospital Mortality

KW - Hospitalization

KW - Hospitals, Community

KW - Humans

KW - Kaplan-Meier Estimate

KW - Male

KW - Prognosis

KW - Serum Amyloid P-Component

U2 - 10.1111/joim.12294

DO - 10.1111/joim.12294

M3 - Journal article

C2 - 25143177

SN - 0955-7873

VL - 277

SP - 562

EP - 572

JO - Acta Medica Scandinavica

JF - Acta Medica Scandinavica

IS - 5

ER -