Diagnostic and Prognostic Utility of Procalcitonin in Patients Presenting to the Emergency Department with Dyspnea George A. Alba, MD, Quynh A. Truong,

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Diagnostic and Prognostic Utility of Procalcitonin in Patients Presenting to the Emergency Department with Dyspnea George A. Alba, MD, Quynh A. Truong, MD, MPH, Hanna K. Gaggin, MD, MPH, Parul U. Gandhi, MD, Benedetta De Berardinis, MD, Laura Magrini, MD, Ednan K. Bajwa, MD, MPH, Salvatore Di Somma, MD, PhD, James L. Januzzi, MD The American Journal of Medicine Volume 129, Issue 1, Pages 96-104.e7 (January 2016) DOI: 10.1016/j.amjmed.2015.06.037 Copyright © 2016 Elsevier Inc. Terms and Conditions

Figure 1 Flow diagram of the present study, including final diagnoses. ACS = acute coronary syndrome; ADHF = acutely decompensated heart failure; BIONICS = Biomonitoring and Cardiorenal Syndrome in Heart Failure; COPD = chronic obstructive pulmonary disease; PE = pulmonary embolism; PNA = pnuemonia; PRIDE = ProBNP Investigation of Dyspnea in the Emergency Department. The American Journal of Medicine 2016 129, 96-104.e7DOI: (10.1016/j.amjmed.2015.06.037) Copyright © 2016 Elsevier Inc. Terms and Conditions

Figure 2 Cumulative hazard for death at (A) 90 days and (B) 1 year as a function of procalcitonin (PCT) concentrations. The American Journal of Medicine 2016 129, 96-104.e7DOI: (10.1016/j.amjmed.2015.06.037) Copyright © 2016 Elsevier Inc. Terms and Conditions

Supplemental Figure 1 Box and whisker plots of procalcitonin (PCT) as a function of pneumonia (PNA) vs alternative diagnosis. Median concentrations of procalcitonin were higher in those with pneumonia; boxes refer to the 25th and 75th percentiles, and whiskers the 5th and 95th percentiles. Outliers are shown as open circles, extremes as stars. The American Journal of Medicine 2016 129, 96-104.e7DOI: (10.1016/j.amjmed.2015.06.037) Copyright © 2016 Elsevier Inc. Terms and Conditions

Supplemental Figure 2 Median concentrations of procalcitonin as a function of various diagnoses in the cohort. Values for procalcitonin were considerably higher in those with a diagnosis of pneumonia (PNA). Boxes refer to the 25th and 75th percentiles, and whiskers the 5th and 95th percentiles. Outliers are shown as open circles, extremes as stars. ADHF = acutely decompensated heart failure; COPD = chronic obstructive pulmonary disease; MI = myocardial infarction; UAP = unstable angina pectoris. The American Journal of Medicine 2016 129, 96-104.e7DOI: (10.1016/j.amjmed.2015.06.037) Copyright © 2016 Elsevier Inc. Terms and Conditions

Supplemental Figure 3 Suggested diagnostic strategy for use of procalcitonin (PCT) in acute dyspnea, combining measurement with (A) amino-terminal pro-B type natriuretic peptide (NT-proBNP) or (B) mid-regional pro-atrial natriuretic peptide (MR-proANP). Using either natriuretic peptide, added use of procalcitonin allowed for even more refined identification or exclusion of heart failure (ADHF), pneumonia (PNA), or both diagnoses. Diagnostic cut-offs for NT-proBNP and MR-proANP are as previously defined.15,27,28 The American Journal of Medicine 2016 129, 96-104.e7DOI: (10.1016/j.amjmed.2015.06.037) Copyright © 2016 Elsevier Inc. Terms and Conditions

Supplemental Figure 4 Cumulative hazard for death at 1 year as a function of procalcitonin (PCT) and mid-regional pro-atrial natriuretic peptide (MR-proANP) concentrations. The 2 biomarkers provided additive prognostic value, reclassifying in time to first event analyses. The American Journal of Medicine 2016 129, 96-104.e7DOI: (10.1016/j.amjmed.2015.06.037) Copyright © 2016 Elsevier Inc. Terms and Conditions