New Biomarkers Predict Mortality, Clinical Features of Infective Endocarditis

Procalcitonin (PCT), pro-adrenomedullin (pro-ADM) copeptin, and C reactive protein (CRP), can predict mortality, embolic risk, and bacterial etiology of infective endocarditis (IE), according to a retrospective study published in BMC Infectious Diseases.

Researchers analyzed data from 196 hospitalized adult patients with a recent diagnosis of who did not need emergent surgery and for whom a plasma sample obtained in the acute phase of IE was available. PCT, pro-ADM, and copeptin levels in the patient samples were correlated with clinical (age, sex, embolism, involved valves, comorbidities) and laboratory (CRP, white blood cells, creatinine, glycemia, alanine transferase, isolated microorganism) parameters.

The median patient age was 62.3 years and 71% were men. Investigators found that elevated pro-ADM was an independent predictor of in-hospital mortality (odds ratio [OR], 3.29; 95% CI, 1.04-11.5; P =.042) and elevated copeptin was an independent predictor of 1-year mortality (OR, 2.55; 95% CI, 1.18-5.54; P =.017). CRP was the only biomarker associated with embolic events (P =.003). There was a strong association between S. aureus etiology and elevated PCT and CRP (P <.001), while enterococcal IE was associated with elevated copeptin (P =.002).

Investigators found an association between high levels of pro-ADM and patients with a history of congestive heart failure (CHF; P =.004) and chronic kidney disease (CKD; P <.001), and higher levels of copeptin were associated with CKD alone (P <.001). CHF was also associated higher CRP levels (P =.05). When investigators stratified the data by comorbidities, CKD and diabetes were associated with in-hospital mortality, while CKD and CHF were associated with 1-year mortality.

One of the study limitations was the authors’ inability to confirm these findings in a prospective validation cohort.

The study authors noted that their analysis clarified the role of PCT in IE diagnosis, predictive of S aureus etiology, which allows for more targeted clinical treatment.

“Different IE etiology may be associated with diverse risk factors, disease course, treatment response and time of referral,” the authors wrote.

Disclosure: several study authors declared receiving funding from the pharmaceutical industry. Please see the original reference for a full list of the authors’ disclosures.

Reference

Zampino R, Iossa D, Ursi MP, et al. Prognostic value of pro-adrenomedullin and copeptin in acute infective endocarditis. BMC Infect Dis. Published online January 7, 2021. doi:10.1186/s12879-020-0565