Prognostic value of five serum markers predicting in-hospital mortality among adults with community acquired pneumonia

Abstract

Introduction: To evaluate the prognostic value of serum markers predicting in-hospital mortality among community acquired pneumonia patients.

Methodology: Total 134 patients admitted in Sir Ganga Ram Hospital Lahore Pakistan during 2014-16 included. Serum markers recorded upon admission included blood urea nitrogen, albumin, creatinine, blood urea nitrogen/albumin ratio and blood urea nitrogen/creatinine ratio. Patients were observed for the incidence of mortality during hospitalization. Comparison between survivors and non-survivors for means by t test; odds ratios by contingency tables; and effectiveness of predictors by receiver operating characteristic curve analyses were assessed.

Results: Overall mean age was 50 ± 21 years; males 45.5%; and in-hospital mortality 9.7%. For in-hospital mortality, creatinine ≥ 2.8 mg/dL showed the highest odds (OR = 7.656, 95% CI = 2.281-25.692; p = 0.001); followed by CURB-65 score ≥ 4 (OR = 4.958, 95% CI = 0.418-58.784; p = 0.266); and blood urea nitrogen ≥ 24.7 mg/dL (OR = 3.364, 95% CI = 1.033-10.954; p = 0.062). Serum creatinine was a fair predictor of in-hospital mortality (AUC = 0.721) showed 53.0% sensitivity and 87.0% specificity at cut-off 2.8 mg/dL. Blood urea nitrogen (AUC = 0.691) and blood urea nitrogen/albumin ratio (AUC = 0.675) were poor predictors; whereas albumin (AUC = 0.424) and blood urea nitrogen/creatinine ratio (AUC = 0.403) failed to predict in-hospital mortality.

Conclusions: Among five serum markers, raised serum creatinine was a better predictor of in-hospital mortality in adults with community acquired pneumonia.

Keywords: Biomarkers; Creatinine; Hospital mortality; Pneumonia; Prognosis.