Early Pneumonia Diagnosis with B·R·A·H·M·S PCT (Procalcitonin)

Heart Failure and/or Pneumonia?

Diagnostic uncertainty in Acute Heart Failure (AHF)

Overlapping clinical picture and radiological findings

Even in patients with a history of Congestive Heart Failure (CHF) presenting with acute respiratory symptoms such as cough, sputum production, shortness of breath, tachypnea, or pleuritic pain, differentiating AHF from Lower Respiratory Tract Infection (LRTI) is challenging due to the overlapping clinical picture and radiological findings.Ref-1


Elevated levels of B·R·A·H·M·S PCT (Procalcitonin) indicate probable infection in Heart Failure (HF) patients

In AHF patients, significantly elevated PCT levels indicate probable undiagnosed/untreated bacterial infection.

ahf-association-pct-level-post-discharge-outcomesAssociation between significantly elevated PCT levels and post-discharge outcomes; 180-day all-cause mortality (n=1781)Ref-2


Infection is a major risk factor for mortality in Acute Heart Failure

AHF precipitated by ACS or infection is independently associated with higher 90-day risk of death.

infection-mortality-heart-failureRisk of 90-day mortality expressed as hazard ratio (HR) and 95% confidence interval (CI) in the presence of precipitating factors of acute heart failure compared with absence of identified precipitating factors. Adjustment was performed for age, gender, history of heart failure, coronary artery disease, diabetes, systolic blood pressure at admission, heart rate at admission, left ventricular ejection fraction, estimated glomerular filtration rate at admission, and plasma sodium at admission.Ref-3


Including B·R·A·H·M·S PCT (Procalcitonin) in clinical diagnosis increases diagnostic certainty of pneumonia in AHF patients

PCT rises only in cases of pneumonia, thus distinguishing these patients from AHF or identifying concomitant infection in AHF. In cases of diagnostic uncertainty, a PCT value of 0.1 μg/L has a negative predictive value of 96% to rule out pneumonia.Ref-4

Reduction of uncertainty by 82% if pneumonia is ruled out by PCT <0.25 μg/L

ahf-probability-pneumonia-pctEstimated probability of pneumonia in patients (n=1641) in the Emergency Department (ED) presenting with shortness of breathRef-5

References Early Pneumonia Diagnosis with B·R·A·H·M·S PCT (Procalcitonin)

Ref-1: Tsuyuki et al., Arch Intern Med 2001; 161: 2337-42

Ref-2: Demissei et al., Int J Cardiol 2016; 204: 164-171

Ref-3: Arrigo et al., Eur J Heart Fail 2017 Feb; 19(2): 201-208. doi: 10.1002/ejhf.682. Epub 2016 Oct 28

Ref-4: Alba et al. Am J Med 2016;129 (1): 96-104 e7

Ref-5: Maisel et al., Eur J Heart Fail 2012; 14: 278-86


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