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Title: Use of procalcitonin for the diagnosis of pneumonia in patients presenting with a chief complaint of dyspnoea: Results from the BACH (Biomarkers in Acute Heart Failure) trial
Authors: Maisel, A.
Landsberg, J.
Clopton, P.
Maisel, A.
Neath, S-X.
Landsberg, J.
Terracciano, G.
Mueller, C.
Potocki, M.
Nowak, R. M.
McCord, J.
Peacock, W. F.
Ponikowski, P.
Möckel, M.
Morgenthaler, N. G.
Anker, S. D.
Hogan, C.
Wu, A. H. B.
Daniels, L. B.
Richards, M.
Filippatos, G. S.
Di Somma, S.
Anand, I.
Ng, Leong L.
Christenson, R. H.
Hartmann, O
Bergmann, A.
Anker, S. D.
First Published: 18-Feb-2012
Publisher: Oxford University Press (OUP) for European Society of Cardiology
Citation: European Journal of Heart Failure, 2012, 14 (3), pp. 278-286
Abstract: Aims Biomarkers have proven their ability in the evaluation of cardiopulmonary diseases. We investigated the utility of concentrations of the biomarker procalcitonin (PCT) alone and with clinical variables for the diagnosis of pneumonia in patients presenting to emergency departments (EDs) with a chief complaint of shortness of breath. Methods and results The BACH trial was a prospective, international, study of 1641 patients presenting to EDs with dyspnoea. Blood samples were analysed for PCT and other biomarkers. Relevant clinical data were also captured. Patient outcomes were assessed at 90 days. The diagnosis of pneumonia was made using strictly validated guidelines. A model using PCT was more accurate [area under the curve (AUC) 72.3%] than any other individual clinical variable for the diagnosis of pneumonia in all patients, in those with obstructive lung disease, and in those with acute heart failure (AHF). Combining physician estimates of the probability of pneumonia with PCT values increased the accuracy to >86% for the diagnosis of pneumonia in all patients. Patients with a diagnosis of AHF and an elevated PCT concentration (>0.21 ng/mL) had a worse outcome if not treated with antibiotics (P = 0.046), while patients with low PCT values (<0.05 ng/mL) had a better outcome if they did not receive antibiotic therapy (P = 0.049). Conclusion Procalcitonin may aid in the diagnosis of pneumonia, particularly in cases with high diagnostic uncertainty. Importantly, PCT may aid in the decision to administer antibiotic therapy to patients presenting with AHF in which clinical uncertainty exists regarding a superimposed bacterial infection.
DOI Link: 10.1093/eurjhf/hfr177
ISSN: 1388-9842
eISSN: 1879-0844
Type: Journal Article
Rights: Published on behalf of the European Society of Cardiology. All rights reserved. © 2012 the Authors This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
Appears in Collections:Published Articles, Dept. of Cardiovascular Sciences

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