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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

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 c...

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Autores principales: Maisel, Alan, Neath, Sean-Xavier, Landsberg, Judd, Mueller, Christian, Nowak, Richard M., Peacock, W. Frank, Ponikowski, Piotr, Möckel, Martin, Hogan, Christopher, Wu, Alan H.B., Richards, Mark, Clopton, Paul, Filippatos, Gerasimos S., Di Somma, Salvatore, Anand, Inder, Ng, Leong L., Daniels, Lori B., Christenson, Robert H., Potocki, Mihael, McCord, James, Terracciano, Garret, Hartmann, Oliver, Bergmann, Andreas, Morgenthaler, Nils G., Anker, Stefan D.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3284113/
https://www.ncbi.nlm.nih.gov/pubmed/22302662
http://dx.doi.org/10.1093/eurjhf/hfr177
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author Maisel, Alan
Neath, Sean-Xavier
Landsberg, Judd
Mueller, Christian
Nowak, Richard M.
Peacock, W. Frank
Ponikowski, Piotr
Möckel, Martin
Hogan, Christopher
Wu, Alan H.B.
Richards, Mark
Clopton, Paul
Filippatos, Gerasimos S.
Di Somma, Salvatore
Anand, Inder
Ng, Leong L.
Daniels, Lori B.
Christenson, Robert H.
Potocki, Mihael
McCord, James
Terracciano, Garret
Hartmann, Oliver
Bergmann, Andreas
Morgenthaler, Nils G.
Anker, Stefan D.
author_facet Maisel, Alan
Neath, Sean-Xavier
Landsberg, Judd
Mueller, Christian
Nowak, Richard M.
Peacock, W. Frank
Ponikowski, Piotr
Möckel, Martin
Hogan, Christopher
Wu, Alan H.B.
Richards, Mark
Clopton, Paul
Filippatos, Gerasimos S.
Di Somma, Salvatore
Anand, Inder
Ng, Leong L.
Daniels, Lori B.
Christenson, Robert H.
Potocki, Mihael
McCord, James
Terracciano, Garret
Hartmann, Oliver
Bergmann, Andreas
Morgenthaler, Nils G.
Anker, Stefan D.
author_sort Maisel, Alan
collection PubMed
description 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. Trial registration: NCT00537628
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spelling pubmed-32841132012-02-22 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 Maisel, Alan Neath, Sean-Xavier Landsberg, Judd Mueller, Christian Nowak, Richard M. Peacock, W. Frank Ponikowski, Piotr Möckel, Martin Hogan, Christopher Wu, Alan H.B. Richards, Mark Clopton, Paul Filippatos, Gerasimos S. Di Somma, Salvatore Anand, Inder Ng, Leong L. Daniels, Lori B. Christenson, Robert H. Potocki, Mihael McCord, James Terracciano, Garret Hartmann, Oliver Bergmann, Andreas Morgenthaler, Nils G. Anker, Stefan D. Eur J Heart Fail Diagnosis 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. Trial registration: NCT00537628 Oxford University Press 2012-03 2012-02-02 /pmc/articles/PMC3284113/ /pubmed/22302662 http://dx.doi.org/10.1093/eurjhf/hfr177 Text en Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2012. For permissions please email: journals.permissions@oup.com. http://creativecommons.org/licenses/by-nc/2.0/uk/ The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that the original authorship is properly and fully attributed; the Journal, Learned Society and Oxford University Press are attributed as the original place of publication with correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Diagnosis
Maisel, Alan
Neath, Sean-Xavier
Landsberg, Judd
Mueller, Christian
Nowak, Richard M.
Peacock, W. Frank
Ponikowski, Piotr
Möckel, Martin
Hogan, Christopher
Wu, Alan H.B.
Richards, Mark
Clopton, Paul
Filippatos, Gerasimos S.
Di Somma, Salvatore
Anand, Inder
Ng, Leong L.
Daniels, Lori B.
Christenson, Robert H.
Potocki, Mihael
McCord, James
Terracciano, Garret
Hartmann, Oliver
Bergmann, Andreas
Morgenthaler, Nils G.
Anker, Stefan D.
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
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
title_full 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
title_fullStr 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
title_full_unstemmed 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
title_short 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
title_sort 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
topic Diagnosis
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3284113/
https://www.ncbi.nlm.nih.gov/pubmed/22302662
http://dx.doi.org/10.1093/eurjhf/hfr177
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