Prognostic Value of Procalcitonin in Patients with Chronic Heart Failure: Comparison with C-reactive Protein

Background: Procalcitonin (PCT), a peptide precursor of calcitonin, level rises in a response to a proimmflammatory stimulus. PCT is more sensitive for the diagnosis of sepsis than C-reactive protein (CRP). Several reports have shown that CRP is a prognostic predictor in patients with chronic heart failure (CHF). We previously reported that PCT was elevated in CHF. The purpose of the present study is to compare the prognostic values between PCT and CRP in CHF. Methods: We measured serum levels of PCT and CRP simultaneously in 69 patients with CHF (age 72 ± 14 years) and compared them with prognosis. Results: During the follow-up period (36 months), 27 patients developed cardiac events (CE) (death or rehospitalization due to worsening CHF). Cox univariate analyses showed that PCT>0.04 ng/ml (median) (hazard raio [HR] 2.77, P = .01) and BNP>114.4 pg/ml (median) (HR 2.52, P = .02) were significant predictors of CE, but CRP>0.141 mg/dl (median) (HR 1.12, P = .78) was not. Cox multivariate analysis including PCT, CRP and BNP revealed that PCT>0.04 ng/ml (HR 2.77, P = .02) and BNP>114.4 pg/ml (HR 2.67, P = .03) were independent predictors of CE. The area under the receiving operating characteristic curve was larger for PCT than for CRP (0.65 vs 0.49, P < .05) Conclusion: These results suggest that PCT is a novel prognostic predictor and more sensitive than CRP for the prediction of future CE in CHF patients.