Why the study?
It was unknown whether initiating antibiotic therapy guided by procalcitonin within 8 h of admission would improve clinical outcomes in patients presenting to the emergency department with acute heart failure and elevated natriuretic peptides.
Does a procalcitonin-guided strategy for initiating antibiotic therapy reduce 90-day all-cause mortality in patients presenting to the emergency department with acute heart failure?
Does a procalcitonin-guided strategy for initiating antibiotic therapy reduce 90-day all-cause mortality in patients presenting to the emergency department with acute heart failure?
In patients with acute heart failure, a procalcitonin-guided strategy for initiating antibiotic therapy did not improve 90-day all-cause mortality compared to standard care.
AIM: To determine whether initiation of antibiotic therapy (ABX) by procalcitonin (PCT) within 8 h of admission in patients presenting to the emergency department with symptoms and signs of acute heart failure (AHF) and elevated natriuretic peptides would improve clinical outcomes. METHODS AND RESULTS: The study was a randomized multicentre clinical trial conducted at 16 sites in Europe. Patients were randomized to either a PCT-guided strategy or standard care. Patients with PCT-guided strategy (n = 370) had ABX initiated if PCT was > 0.2 μg/L. Patients with standard care (n = 372) had AHF care in accordance with published guidelines without PCT. The primary endpoint was 90-day all-cause mortality. Pre-specified secondary endpoints included 30-day all-cause mortality and readmission and rate of pneumonia. The Data Safety and Review Committee recommended stopping the study for futility when 762 of the planned 792 patients had been enrolled. A total of 742 patients could be analysed. Patients were elderly (median age: 77 years), 38% were women, and had typical signs and symptoms of AHF. All-cause mortality at 90 days was 10.3% in the PCT-guided group vs. 8.2% in standard care (P = 0.316). Thirty-day readmission was significantly higher in the PCT-guided group vs. standard care but the difference vanished until day 90. The rate of pneumonia was overall low (7.5%) and not different between groups. CONCLUSIONS: In patients with AHF, a strategy of PCT-guided initiation of ABX was not more effective than a standard care strategy in improving clinical outcomes.
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Möckel et al. (2019) studied this question.
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