Demissei Biniyam G, Cleland John G, O'Connor Christopher M, Metra Marco, Ponikowski Piotr, Teerlink John R, Davison Beth, Givertz Michael M, Bloomfield Daniel M, Dittrich Howard, van Veldhuisen Dirk J, Hillege Hans L, Voors Adriaan A, Cotter Gad
Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Imperial College, London, UK.
Int J Cardiol. 2016 Feb 1;204:164-71. doi: 10.1016/j.ijcard.2015.11.141. Epub 2015 Nov 26.
Bacterial infections in patients hospitalized with acute heart failure are related to worse prognosis, but they can be difficult to diagnose. In this study we evaluated the prevalence, clinical correlates and association with outcomes of significantly elevated procalcitonin levels in patients hospitalized for acute heart failure without clear signs of bacterial infection.
1781 patients from the PROTECT trial were included. Patients with a body temperature >38°C, sepsis or active infection requiring IV antibiotics were excluded. Significant elevation of procalcitonin was considered present when levels exceeded 0.20 ng/mL. In-hospital and post-discharge outcomes were compared between groups of patients with and without elevated procalcitonin levels.
Procalcitonin ≥ 0.20 ng/mL was seen in 6.0% of patients (N=104). This group of patients had lower serum albumin, lower hemoglobin, higher leukocyte count, higher C-reactive protein, higher blood urea nitrogen, higher heart rate and more pulmonary rales. Interestingly, no significant differences were observed between the two groups in terms of severity of heart failure evidenced by left ventricular ejection fraction (LVEF) or B-type natriuretic peptide (BNP) levels. Patients with significantly elevated procalcitonin levels were more often classified as treatment failure or unchanged status, and had an increased risk of 30-day all-cause mortality even after adjustment for established prognosticators; HR=2.3 (95% CI, 1.3-4.2), (P=0.005).
Patients with acute heart failure and significantly elevated procalcitonin levels, indicating probable undiagnosed/untreated bacterial infection, had poorer in-hospital and post-discharge outcomes, despite similar severity of heart failure.
急性心力衰竭住院患者的细菌感染与较差的预后相关，但可能难以诊断。在本研究中，我们评估了因急性心力衰竭住院且无明确细菌感染迹象的患者中降钙素原水平显著升高的患病率、临床相关性及其与预后的关联。
纳入了来自PROTECT试验的1781例患者。排除体温>38°C、脓毒症或需要静脉使用抗生素的活动性感染患者。当降钙素原水平超过0.20 ng/mL时，认为存在显著升高。比较降钙素原水平升高和未升高的患者组的住院期间及出院后结局。
6.0%的患者（n = 104）降钙素原≥0.20 ng/mL。该组患者血清白蛋白较低、血红蛋白较低、白细胞计数较高、C反应蛋白较高、血尿素氮较高、心率较高且肺部啰音较多。有趣的是，两组在左心室射血分数（LVEF）或B型利钠肽（BNP）水平所证实的心力衰竭严重程度方面未观察到显著差异。降钙素原水平显著升高的患者更常被归类为治疗失败或病情无变化，并且即使在对既定的预后因素进行调整后，30天全因死亡率风险仍增加；HR = 2.3（95%CI，1.3 - 4.2），（P = 0.005）。
急性心力衰竭且降钙素原水平显著升高提示可能存在未诊断/未治疗细菌感染的患者，尽管心力衰竭严重程度相似，但住院期间及出院后结局较差。
