Procalcitonin and C-reactive protein to rule out early bacterial coinfection in COVID-19 critically ill patients

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• dc.contributor.author Galli, Flavia
• dc.contributor.author Marín Corral, Judith
• dc.contributor.author CIBERESUCICOVID Project investigators (COV20/00110, ISCIII)
• dc.date.accessioned 2024-05-17T05:45:19Z
• dc.date.available 2024-05-17T05:45:19Z
• dc.date.issued 2023
• dc.description.abstract Purpose: Although the prevalence of community-acquired respiratory bacterial coinfection upon hospital admission in patients with coronavirus disease 2019 (COVID-19) has been reported to be < 5%, almost three-quarters of patients received antibiotics. We aim to investigate whether procalcitonin (PCT) or C-reactive protein (CRP) upon admission could be helpful biomarkers to identify bacterial coinfection among patients with COVID-19 pneumonia. Methods: We carried out a multicentre, observational cohort study including consecutive COVID-19 patients admitted to 55 Spanish intensive care units (ICUs). The primary outcome was to explore whether PCT or CRP serum levels upon hospital admission could predict bacterial coinfection among patients with COVID-19 pneumonia. The secondary outcome was the evaluation of their association with mortality. We also conducted subgroups analyses in higher risk profile populations. Results: Between 5 February 2020 and 21 December 2021, 4076 patients were included, 133 (3%) of whom presented bacterial coinfection. PCT and CRP had low area under curve (AUC) scores at the receiver operating characteristic (ROC) curve analysis [0.57 (95% confidence interval (CI) 0.51-0.61) and 0.6 (95% CI, 0.55-0.64), respectively], but high negative predictive values (NPV) [97.5% (95% CI 96.5-98.5) and 98.2% (95% CI 97.5-98.9) for PCT and CRP, respectively]. CRP alone was associated with bacterial coinfection (OR 2, 95% CI 1.25-3.19; p = 0.004). The overall 15, 30 and 90 days mortality had a higher trend in the bacterial coinfection group, but without significant difference. PCT ≥ 0.12 ng/mL was associated with higher 90 days mortality. Conclusion: Our study suggests that measurements of PCT and CRP, alone and at a single time point, are not useful for ruling in or out bacterial coinfection in viral pneumonia by COVID-19.
• dc.format.mimetype application/pdf
• dc.identifier.citation Galli F, Bindo F, Motos A, Fernández-Barat L, Barbeta E, Gabarrús A, et al. Procalcitonin and C-reactive protein to rule out early bacterial coinfection in COVID-19 critically ill patients. Intensive Care Med. 2023 Aug;49(8):934-45. DOI: 10.1007/s00134-023-07161-1
• dc.identifier.doi http://dx.doi.org/10.1007/s00134-023-07161-1
• dc.identifier.issn 0342-4642
• dc.identifier.uri http://hdl.handle.net/10230/60173
• dc.language.iso eng
• dc.publisher Springer
• dc.relation.ispartof Intensive Care Med. 2023 Aug;49(8):934-45
• dc.rights © 2023 The Author(s). Open Access This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/.
• dc.rights.accessRights info:eu-repo/semantics/openAccess
• dc.rights.uri http://creativecommons.org/licenses/by-nc/4.0/
• dc.subject.keyword Bacterial coinfection
• dc.subject.keyword C-reactive protein
• dc.subject.keyword COVID-19
• dc.subject.keyword Critically ill
• dc.subject.keyword Intensive care
• dc.subject.keyword Procalcitonin
• dc.title Procalcitonin and C-reactive protein to rule out early bacterial coinfection in COVID-19 critically ill patients
• dc.type info:eu-repo/semantics/article
• dc.type.version info:eu-repo/semantics/publishedVersion