title: Procalcitonin and long-term prognosis after an admission for acute heart failure.
abstract: BACKGROUND
  Traditionally, 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.
  
  
  RESULTS
  We 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 2years (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.
  
  
  CONCLUSIONS
  In patients with AHF and no evidence of infection, PCT was independently and positively associated with the risk of long-term death and recurrent rehospitalizations.
authors.affiliation: Servicio de Bioquímica Clínica, Hospital Clínico Universitario, Valencia, Spain.
authors.forename: Maria Pilar
authors.initials: MP
authors.lastname: Villanueva
authors.affiliation: Servicio de Cardiología, Hospital Clínico Universitario, Universitat de Valencia, Valencia, Spain.
authors.forename: Anna
authors.initials: A
authors.lastname: Mollar
authors.affiliation: Servicio de Cardiología, Hospital de la Plana, Villarreal, Spain.
authors.forename: Patricia
authors.initials: P
authors.lastname: Palau
authors.affiliation: Servicio de Bioquímica Clínica, Hospital Clínico Universitario, Valencia, Spain.
authors.forename: Arturo
authors.initials: A
authors.lastname: Carratalá
authors.affiliation: Servicio de Cardiología, Hospital Clínico Universitario, Universitat de Valencia, Valencia, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Núñez
authors.affiliation: Servicio de Cardiología, Hospital Clínico Universitario, Universitat de Valencia, Valencia, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Santas
authors.affiliation: Servicio de Cardiología, Hospital Clínico Universitario, Universitat de Valencia, Valencia, Spain.
authors.forename: Vicent
authors.initials: V
authors.lastname: Bodí
authors.affiliation: Servicio de Cardiología, Hospital Clínico Universitario, Universitat de Valencia, Valencia, Spain.
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Chorro
authors.affiliation: Servicio de Cardiología, Hospital de Manises, Valencia, Spain.
authors.forename: Gema
authors.initials: G
authors.lastname: Miñana
authors.affiliation: Servicio de Medicina Intensiva, Hospital Clínico Universitario, Valencia, Spain.
authors.forename: Maria L
authors.initials: ML
authors.lastname: Blasco
authors.affiliation: Servicio de Cardiología, Hospital Clínico Universitario, Universitat de Valencia, Valencia, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Sanchis
authors.affiliation: Servicio de Cardiología, Hospital Clínico Universitario, Universitat de Valencia, Valencia, Spain.
authors.forename: Julio
authors.initials: J
authors.lastname: Núñez
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D015331:Cohort Studies; D016207:Cytokines / Q000097:blood; D004731:Endotoxins / Q000097:blood*; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000401:mortality; D006760:Hospitalization; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010359:Patient Readmission / Q000706:statistics & numerical data*; D010446:Peptide Fragments / Q000097:blood; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D012307:Risk Factors
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D016207:Cytokines; D004731:Endotoxins; D010446:Peptide Fragments; D011498:Protein Precursors; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide
keywords: Heart failure; Procalcitonin; Prognosis