Procalcitonin testing for diagnosis and short-term prognosis in bacterial infection complicated by congestive heart failure: a multicenter analysis of 4,698 cases

Abstract

IntroductionProcalcitonin (PCT) is a biomarker for the clinical diagnosis of bacterial infection that is more specific and earlier than fever, changes in white blood cell count, and blood cultures. Congestive heart failure is an important cause of endotoxin resorption from the intestine, which significantly increases PCT expression in noninfected patients with heart failure. The diagnostic performance and cut-off value of PCT in patients with bacterial infection complicated by congestive heart failure needs to be confirmed.MethodsA total of 4,698 cases from different cities in China, including those with different classes of congestive heart failure, bacterial infection, bacterial infection complicated by heart failure and healthy individuals, were chosen for the diagnostic value analysis of PCT and screening candidate predictors of mortality in subjects with bacterial infection complicated by congestive heart failure.ResultsPatients with simple heart failure had significantly higher PCT levels than normal controls (P < 0.01), whereas patients with bacterial infection complicated by congestive heart failure had significantly higher PCT levels than those with simple infection (P < 0.01). Although it was useful for the diagnosis of infection (area under the receiver operating characteristic curve >80%), the positive predictive value of PCT decreased significantly with increasing severity of heart failure (P < 0.05), and the cut-off value of PCT concentrations for infection complicated by classes II, III and IV heart failure were 0.086, 0.192 and 0.657 μg/L, respectively. Heart failure degree, PCT level, and age were the candidate predictors of mortality in patients with bacterial infection complicated by congestive heart failure.ConclusionsThese data suggest that complicated heart failure elevates the PCT level in patients with bacterial infection. Thus, the results of the PCT test must be analyzed correctly in consideration of the severity of heart failure. Close attention should be paid to cardiac function and PCT expression in aged patients with infection complicated by congestive heart failure.

Procalcitonin and long-term prognosis after an admission for acute heart failure

“…From a clinical point of view, a recent study showed that in patients presenting to the emergency department with shortness of breath, PCT was more accurate than any other individual clinical variable for the diagnosis of pneumonia in all patients, in those with obstructive lung disease, and in those with AHF [5]. Similar results have been confirmed in a more recent study [7]. Regarding its prognostic implications in patients with diagnosis of AHF, results from the BACH (Biomarkers in Acute Heart Failure) trial reported that PCT was associated with a higher non-adjusted risk of 90-day mortality [5].…”

“…At the same time, PCT elevation has been reported in some non-infective inflammatory conditions [4]. Along this line, patients with heart failure (HF) had significantly higher plasma PCT concentration than normal controls, and some reports have related PCT levels with severity of the disease [5][6][7]. In this context, it has been postulated that PCT may be a proxy for underrecognized infection, endotoxemia or even heightened proinflammatory activity [8,9].…”

Novel heart failure biomarkers: why do we fail to exploit their potential?

“…PCT levels are strongly elevated in bacterial infections and it is an early marker for systemic inflammation, infection, and sepsis; potentially it could be used to monitor patients and guide antibiotic therapy [135]. The half-life of PCT is about 24 h, and the molecule is stable both in vivo and in vitro [136]. PCT was originally postulated to be a proxy for unrecognized infection in acute HF [135].…”

The role of procalcitonin in acute heart failure patients

“…A more rapid rise and fall in blood with a very strong signal with 10 5 ‐fold increase as compared with other molecules like C‐reactive proteine showing only a 10‐ to 100‐fold increase is observed. The half‐life is around 24 h, and the molecule is stable in vivo and in vitro 11. Therefore, PCT is a marker of bacterial infection, and recent evidence suggests that it can be used to guide decision‐making with respect to antibiotic therapy in patients with AHF by identifying patients with concomitant or triggering bacterial infection.…”