Utility of a Novel Clinical Scoring System and its Association with Procalcitonin in Patients of Acute Heart Failure with Respiratory Infections: A Limited Resource Perspective

Abstract

Abstract Background: Heart failure (HF) is a global health burden that is usually simple to diagnose, but concomitant respiratory infections are difficult to distinguish clinically. Inflammatory markers can be used to differentiate between the two conditions, especially procalcitonin (PCT), one of the most specific markers for bacterial infections. PCT-guided antibiotic treatment has shown good results and could help in decreasing the indiscriminate prescription of antibiotics in HF patients. Methodology: A prospective observational study was carried out in a tertiary care hospital in Western India. Three hundred HF patients were separated into either high- or low-PCT level groups. A novel clinical score for clinically suspecting superimposed respiratory infection in acute HF patients was devised and its association with PCT level was measured. Results: 62.87 years was the average age of the study population with a male preponderance. While breathlessness was the presenting complaint in all 300 patients, the presence of fever and edema was significantly associated with raised PCT. A higher total leukocyte count and neutrophil count were seen in patients with high PCT. A higher incidence of consolidation, pulmonary edema, and pulmonary hypertension was noted in those with high PCT. A significant association was found between the clinical scoring system and the PCT level. Conclusion: The novel clinical scoring system has a satisfactory sensitivity, specificity, positive predictive value, and negative predictive value in diagnosing superimposed respiratory infections in acute HF patients. It can aid in the judicious use of the PCT test in resource-limited settings.