Study identifies NMI as novel biomarker of severity in community-acquired pneumonia

CHINA: According to a study published in BMJ Open Respiratory Research, NMI (N-myc and STAT interactor) can serve as a novel predictive biomarker for 30-day mortality and ICU hospitalization and is a valuable indicator for initial risk categorization and precise clinical decision-making in community-acquired pneumonia.

Community-acquired pneumonia (CAP) is a respiratory illness that poses a substantial risk to human health and may be followed by acute and severe lung inflammation. Although previous research has indicated that moderate pneumonia has a fair prognosis, 21% of hospitalized CAP patients require admission to the intensive care unit (ICU). Recent studies have shown that a delay in the identification of severe CAP results in the improper therapeutic care of patients, increasing length of stay (LOS) and mortality. Therefore, it is critical to identify patients with severe CAP as soon as possible. A transcriptional regulator of several nuclear signaling pathways is N-myc and STAT interactor (NMI).

In order to determine whether the NMI may be utilized as a novel biomarker to stratify CAP severity and predict the prognosis of CAP, the authors of this study obtained blood samples and bronchoalveolar lavage fluid (BALF) from CAP patients. They also assessed NMI expression in these samples.

For this research, individuals with CAP underwent prospective observational analysis. From January 2019 through November 2020, the study was conducted at the Second Affiliated Hospital of Zhejiang University in Hangzhou, Zhejiang, China. Serum was taken from 394 adult CAP patients and 40 uninfected controls, whereas BALF was taken from 37 adult CAP patients and 23 uninfected controls.Upon arrival, 394 CAP patients had their serum NMI levels determined using an immunoassay. Patient outcomes were determined to be 30-day mortality and ICU hospitalization. Logistic regression analysis and the receiver operating characteristic curve were used to establish the predictive value of NMI for clinical outcomes. Cross-validation with bootstrap resampling was used to evaluate the internal validity.

Key points of the analysis:

• NMI was a standalone risk factor for CAP patients' 30-day death as well as ICU admission.
• In comparison to other biomarkers like procalcitonin and C-reactive protein, NMI had an area under the curve (AUC) for mortality prediction of 0.91 and for ICU admission prediction of 0.92 that was considerably higher.
• As NMI levels increased, the percentage of clinical outcomes increased noticeably.
• The new score systems, which included NMI (N-PSI and N-CURB65 score), had much higher AUCs for outcome prediction than the old score systems.

"When compared to the serum biomarkers, the measurement of NMI concentration upon admission was more accurate in our study in determining the severity and risk of death of CAP. In CAP patients, we discovered that NMI performed more comprehensively than CRP and PCT in predicting 30-day death and ICU admission," the researchers wrote.

Therefore, the NMI may be employed in the future not only as a predictor of severity, but also as a treatment target for CAP patients, they concluded.

REFERENCE

Zhang W, Zhou H, Cen M, Ouyang W, Chen J, Xia L, Lin X, Liu J, He T, Xu F. N-myc and STAT interactor is a novel biomarker of severity in community-acquired pneumonia: a prospective study. Respir Res. 2022 Sep 19;23(1):253. doi: 10.1186/s12931-022-02139-x. PMID: 36123652; PMCID: PMC9483521.