Thread by @FrailtyMD

ADHF +/- PNA

Acute Decompensated Heart Failure and Pneumonia are an increasingly concerning duo nowadays. How to distinguish one vs. the other vs. both? A mini #tweetorial

Q: Prevalence of PNA in ADHF?
A: 21% (published range 15-30%)

Retrospective study of 1939 ADHF patients from 🇩🇪
- 21% had concomitant PNA (ICD-10 + CXR infiltrate)
- COPD and CKD were independent predictors
- PNA associated with 2x in-hospital mortality

journals.sagepub.com/doi/full/10.11…

Q: Real PNA or overcalled?
A: At least 1/3 real, 2/3 low grade or viral or overcalled

- CRP in community acquired PNA typically >50-100
- CRP in ADHF+PNA was 25 (IQR 11-60)
- Only 29% had CRP >50
- Only 35% had WBC >N

Q: How likely is a bacterial PNA?
A: Check procalcitonin (PCT) + clinical history

<0.1 ... very unlikely
0.1-0.25 ... unlikely
0.25-0.5 ... likely
0.5-2.0 ... very likely: moderate SIRS
2.0-10.0 ... very likely: severe SIRS
>10.0 ... very likely: septic shock

Q: Does PCT-guided therapy improve outcomes?
A: No

RCT of 742 ADHF patients in 🇪🇺 ("IMPACT-EU")
- No difference in ABX initiated (16%)
- No difference in PNA diagnosed (8%)
- No difference in 90 day mortality (9%)

onlinelibrary.wiley.com/doi/full/10.10…