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Diagnostic and prognostic properties of procalcitonin in patients with acute dyspnea: Data from the ACE 2 Study.
Clin Biochem. 2018 Jul 17;:
Authors: Berge K, Lyngbakken MN, Einvik G, Winther JA, Brynildsen J, Røysland R, Strand H, Christensen G, Høiseth AD, Omland T, Røsjø H
Abstract
BACKGROUND: Procalcitonin (PCT) concentrations increase during bacterial infections and could improve diagnosis of pneumonia and risk stratification in patients with acute dyspnea.
METHODS: PCT concentrations were measured <24 h of admission in 310 patients with acute dyspnea and compared to C-reactive protein (CRP) and white blood cells (WBC) in the total cohort and the subset of patients with concomitant acute heart failure (HF).
RESULTS: We diagnosed pneumonia in 16 out of 140 patients with acute HF (11%) and in 45 out of 170 patients with non-HF-related dyspnea (27%). PCT concentrations were higher in patients with pneumonia vs. patients without pneumonia, both among acute HF patients (median 2.79 [Q1-3 0.18-5.80] vs. 0.10 [0.07-0.14]) ng/mL, p < .001) and non-HF patients (0.22 [Q1-3 0.13-0.77] vs. 0.07 [0.05-0.10] ng/mL, p < .001). CRP and WBC were also higher in patients with pneumonia in both groups, but among acute HF patients, only PCT concentrations were associated with pneumonia in multivariate analysis. In patients with acute HF, receiver-operating statistics area under the curve (ROC-AUC) to diagnose pneumonia was 0.90 (95% CI 0.81-0.98) for PCT, 0.84 (0.73-0.94) for CRP, and 0.72 (0.57-0.87) for WBC. The corresponding ROC-AUCs among patients with non-HF-related dyspnea were 0.88 (0.82-0.93), 0.94 (0.90-0.98), and 0.79 (0.72-0.87), respectively. During a median follow-up of 823 days (Q1-3471-998) 114 patients died, and PCT and CRP, but not WBC concentrations were associated with all-cause mortality.
CONCLUSION: In acute HF patients, PCT concentrations were superior to CRP and WBC to diagnose concurrent pneumonia.
PMID: 30028971 [PubMed - as supplied by publisher]