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

Alan Maisel, Sean Xavier Neath, Judd Landsberg, Christian Mueller, Richard M. Nowak, W. Frank Peacock, Piotr Ponikowski, Martin Möckel, Christopher Hogan, Alan H B Wu, Mark Richards, Paul Clopton, Gerasimos S. Filippatos, Salvatore Di Somma, Inder Anand, Leong L. Ng, Lori B. Daniels, Robert H. Christenson, Mihael Potocki, James McCordGarret Terracciano, Oliver Hartmann, Andreas Bergmann, Nils G. Morgenthaler, Stefan D. Anker

Research output: Contribution to journalArticle

Abstract

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 (

Original languageEnglish
Pages (from-to)278-286
Number of pages9
JournalEuropean Journal of Heart Failure
Volume14
Issue number3
DOIs
Publication statusPublished - Mar 2012

Fingerprint

Calcitonin
Dyspnea
Pneumonia
Heart Failure
Biomarkers
Hospital Emergency Service
Obstructive Lung Diseases
Area Under Curve
Prospective Studies
Guidelines
Anti-Bacterial Agents
Physicians

Keywords

  • Acute heart failure
  • Diagnosis
  • Pneumonia
  • Procalcitonin
  • Survival

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

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.

In: European Journal of Heart Failure, Vol. 14, No. 3, 03.2012, p. 278-286.

Research output: Contribution to journalArticle

Maisel, A, Neath, SX, Landsberg, J, Mueller, C, Nowak, RM, Peacock, WF, Ponikowski, P, Möckel, M, Hogan, C, Wu, AHB, Richards, M, Clopton, P, Filippatos, GS, Di Somma, S, Anand, I, Ng, LL, Daniels, LB, Christenson, RH, Potocki, M, McCord, J, Terracciano, G, Hartmann, O, Bergmann, A, Morgenthaler, NG & Anker, SD 2012, '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', European Journal of Heart Failure, vol. 14, no. 3, pp. 278-286. https://doi.org/10.1093/eurjhf/hfr177
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. In: European Journal of Heart Failure. 2012 ; Vol. 14, No. 3. pp. 278-286.
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T2 - Results from the BACH (Biomarkers in Acute Heart Failure) trial

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AU - Neath, Sean Xavier

AU - Landsberg, Judd

AU - Mueller, Christian

AU - Nowak, Richard M.

AU - Peacock, W. Frank

AU - Ponikowski, Piotr

AU - Möckel, Martin

AU - Hogan, Christopher

AU - Wu, Alan H B

AU - Richards, Mark

AU - Clopton, Paul

AU - Filippatos, Gerasimos S.

AU - Di Somma, Salvatore

AU - Anand, Inder

AU - Ng, Leong L.

AU - Daniels, Lori B.

AU - Christenson, Robert H.

AU - Potocki, Mihael

AU - McCord, James

AU - Terracciano, Garret

AU - Hartmann, Oliver

AU - Bergmann, Andreas

AU - Morgenthaler, Nils G.

AU - Anker, Stefan D.

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N2 - 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 (

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