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Clinical Chemistry and Laboratory Medicine (CCLM)

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Volume 54, Issue 11


Prospective evaluation of biomarkers for prediction of quality of life in community-acquired pneumonia

Manuela Nickler
  • Division of General Internal and Emergency Medicine, Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
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/ Daniela Schaffner
  • Division of General Internal and Emergency Medicine, Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
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/ Mirjam Christ-Crain
  • Department of Internal Medicine, Division of Endocrinology, Diabetes and Clinical Nutrition, University Hospital Basel, Basel, Switzerland
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/ Manuel Ottiger
  • Division of General Internal and Emergency Medicine, Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
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/ Robert Thomann / Claus Hoess / Christoph Henzen / Beat Mueller
  • Division of General Internal and Emergency Medicine, Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
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/ Philipp Schuetz
  • Corresponding author
  • Division of General Internal and Emergency Medicine, Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
  • Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard School of Public Health, Boston, MA, United States of America
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Published Online: 2016-04-21 | DOI: https://doi.org/10.1515/cclm-2016-0001



Most clinical research investigated prognostic biomarkers for their ability to predict cardiovascular events or mortality. It is unknown whether biomarkers allow prediction of quality of life (QoL) after survival of the acute event. Herein, we investigated the prognostic potential of well-established inflammatory/cardiovascular blood biomarkers including white blood cells (WBC), C-reactive protein (CRP), procalcitonin (PCT), pro-adrenomedullin (proADM) and pro-atrial natriuretic peptide (proANP) in regard to a decline in QoL in a well-defined cohort of patients with community-acquired pneumonia (CAP).


Within this secondary analysis including 753 patients with a final inpatient diagnosis of CAP from a multicenter trial, we investigated associations between admission biomarker levels and decline in QoL assessed by the EQ-5D health questionnaire from admission to day 30 and after 6 years.


Admission proADM and proANP levels significantly predicted decline of the weighted EQ-5D index after 30 days (n=753) with adjusted odds ratios (ORs) of 2.0 ([95% CI 1.1–3.8]; p=0.027) and 3.7 ([95% CI 2.2–6.0]; p<0.001). Results for 6-year outcomes (n=349) were similar with ORs of 3.3 ([95% CI 1.3–8.3]; p=0.012) and 6.2 ([95% CI 2.7–14.2]; p<0.001). The markers were associated with most of the different QoL dimensions including mobility, self-care, and usual activities, but not pain/discomfort and to a lesser degree anxiety/depression and the visual analogue scale (VAS). Initial WBC, PCT and CRP values did not well predict QoL at any time point.


ProADM and proANP accurately predict short- and long-term decline in QoL across most dimensions in CAP patients. It will be interesting to reveal underlying physiopathology in future studies.

Keywords: anxiety; community-acquired pneumonia; C-reactive protein; depression; discomfort; EQ-5D index; mobility; pain; pro-adrenomedullin; pro-atrial natriuretic peptide; procalcitonin; quality of life; self-care; usual activities; VAS; white blood cells


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About the article

Corresponding author: Prof Dr. med. Philipp Schuetz, MD, MPH, Division of General Internal and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Tellstrasse, 5001 Aarau, Switzerland, Phone: +41 (0)62 838 4141, Fax: +41 (0)62 838 4100

aManuela Nickler and Daniela Schaffner contributed equally to this work.

Received: 2016-01-01

Accepted: 2016-03-10

Published Online: 2016-04-21

Published in Print: 2016-11-01

Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

Research funding: The main sources of funding for the investigator-initiated ProHOSP study were the Swiss National Science Foundation (grant SNF 3200BO-116177/1), Santé Suisse and the Gottfried and Julia Bangerter-Rhyner Foundation.

Employment or leadership: MC-C, BM and PS have received grants from B·R·A·H·M·S/Thermo and bioMérieux; in addition, BM has served as a consultant to these companies. None of the other authors has any relevant industrial relationships.

Honorarium: None declared.

Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

Citation Information: Clinical Chemistry and Laboratory Medicine (CCLM), Volume 54, Issue 11, Pages 1831–1846, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: https://doi.org/10.1515/cclm-2016-0001.

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