Procalcitonin and long-term prognosis after an admission for acute heart failure

• Procalcitonin (PCT) is considered a diagnostic marker of bacterial infections.
• Slightly elevated levels of PCT have also been found in patients with heart failure (HF).
• In HF, PCT has been postulated to be a proxy for infections, endotoxinemia or inflammatory activity.
• In this work PCT was associated with higher risk of mortality and recurrent readmission.
• Further studies are needed to clarify the clinical implications of the present findings.

BackgroundTraditionally, procalcitonin (PCT) is considered a diagnostic marker of bacterial infections. However, slightly elevated levels of PCT have also been found in patients with heart failure. In this context, it has been suggested that PCT may serve as a proxy for underrecognized infection, endotoxemia, or heightened proinflammatory activity. Nevertheless, the clinical utility of PCT in this setting is scarce. We aimed to evaluate the association between PCT and the risk of long-term outcomes.Methods and resultsWe measured at admission PCT of 261 consecutive patients admitted for acute heart failure (AHF) after excluding active infection. Cox and negative binomial regression methods were used to evaluate the association between PCT and the risk of death and recurrent rehospitalizations, respectively. At a median follow-up of 2 years (IQR: 1.0–2.8), 108 deaths, 170 all-cause rehospitalizations and 96 AHF-rehospitalizations were registered. In an adjusted analysis, including well-established risk factors such as natriuretic peptides and indices of renal function, the logarithm of PCT was associated with a higher risk of death (HR = 1.43, CI 95%: 1.12–1.82; p = 0.004), all-cause rehospitalizations (IRR = 1.22, CI 95% 1.02–1.44; p = 0.025) and AHF-rehospitalizations (IRR = 1.28, CI 95%: 1.02–1.61; p = 0.032). The association with these endpoints persisted after adjustment for other inflammatory biomarkers such as white blood cells, C-reactive protein and interleukins.ConclusionIn patients with AHF and no evidence of infection, PCT was independently and positively associated with the risk of long-term death and recurrent rehospitalizations.