• 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 McCord, Garret Terracciano, Oliver Hartmann, Andreas Bergmann, Nils G Morgenthaler, and Stefan D Anker.
• VA San Diego Healthcare System, San Diego, CA, USA.
• Eur. J. Heart Fail. 2012 Mar 1;14(3):278-86.

AimsBiomarkers 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 ResultsThe 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).ConclusionProcalcitonin 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.

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