Application of B·R·A·H·M·S PCT-guided algorithm could improve outcome
B·R·A·H·M·S PCT (Procalcitonin) level >0.25 μg/L is indicative of infection and antibiotic treatment is recommended in patients with dyspnea
Secondary analysis of 233 patients with a history of Chronic Heart Failure (CHF), formerly included in a multicenter randomized-controlled trial, to compare antibiotic guidance with and without PCT algorithm. In 110 patients with low initial PCT value (<0.25 μg/L)
- 30 day adverse outcome was significantly decreased (-16%) in PCT-guided group
- Significant reduction of antibiotic exposure in PCT-guided group (-2.8 days)
Time to the first adverse outcome by randomization group in patients with low initial PCT levels (<0.25 μg/L); adverse outcome included all-cause mortality or intensive care unit (ICU) admission Ref-1
B·R·A·H·M·S PCT (Procalcitonin) can quickly identify Heart Failure (HF) patients who might benefit from antibiotics
Results of the BACH trial
Prospective, observational, international trial; 1641 patients with dyspnea presenting to Emergency Department (ED); patient outcomes assessed at 90 days Ref-2
- PCT was the most accurate individual clinical variable in the diagnosis of pneumonia (AUC 72.3%)
- Combining physician estimates of the probability of pneumonia with PCT values increased the accuracy of pneumonia diagnosis to >86%
- AHF patients with elevated PCT level (>0.21 μg/L) had a worse outcome if not treated with antibiotics (Figure A)
- AHF patients with low PCT level (<0.05 g μg/L) had a better outcome if they did not receive antibiotic therapy (Figure C)
Survival and antibiotic treatment of Heart Failure patients with different PCT levels
A. PCT >0.21 μg/L
Survival and antibiotic treatment of heart failure patients with different PCT levels (A. n=113) Ref-2
AHF patients with elevated PCT level (>0.21 μg/L) had a worse outcome if not treated with antibiotics (Figure A)
