Procalcitonin as a predictive marker in COVID-19: A systematic review and meta-analysis

Abstract

Background Coronavirus disease 2019 has emerged as a global pandemic causing millions of critical cases and deaths. Early identification of at-risk patients is crucial for planning triage and treatment strategies. Methods and findings We performed this systematic review and meta-analysis to determine the pooled prognostic significance of procalcitonin in predicting mortality and severity in patients with COVID-19 using a robust methodology and clear clinical implications. Design We used Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Cochrane Handbook for Systematic Reviews of Interventions guidelines. We included thirty-two prospective and retrospective cohort studies involving 13,154 patients. Results The diagnostic odds ratio of procalcitonin for predicting mortality were estimated to be 11 (95% CI: 7 to 17) with sensitivity, specificity, and summary area under the curveof 0.83 (95% CI: 0.70 to 0.91), 0.69 (95% CI: 0.58 to 0.79), and 0.83 (95% CI: 0.79 to 0.86) respectively. While for identifying severe cases of COVID-19, the odds ratio was 8.0 (95% CI 5.0 to 12.0) with sensitivity, specificity, and summary area under the curve of 0.73 (95% CI 0.67 to 0.78), 0.74 (0.66 to 0.81), and 0.78 (95% CI 0.74 to 0.82) respectively. Conclusion Procalcitonin has good discriminatory power for predicting mortality and disease severity in COVID-19 patients. Therefore, procalcitonin measurement may help identify potentially severe cases and thus decrease mortality by offering early aggressive treatment.

PROCAL: A SHap-based approach to explain Random Forest predictions of COVID-19- Procalcitonin levels

“…Studies suggest that procalcitonin can be used as a prognostic marker in patients with infection [32,33]. PCT measurement can help identify potentially severe cases and reduce mortality by offering early aggressive treatment [30]. LDH levels are also associated with mortality and organ dysfunction in COVID-19 patients [34].…”

“…The lymphoid cell line in the bone marrow is the source of lymphocytes, a subtype of agranular leukocytes essential to the immune system. They produce certain antibodies, activate cytotoxic T cells, and manage the immune response to mediate adaptive immunity against viral infections [30]. In COVID-19 patients, the lymphocyte count is usually low and inversely proportional to disease severity [38].…”

Hematological Parameters and Procalcitonin as Discriminants between Bacterial Pneumonia-Induced Sepsis and Viral Sepsis Secondary to COVID-19: A Retrospective Single-Center Analysis

“…Although observed in both types of sepsis, the stronger correlation between procalcitonin and disease severity in the viral sepsis group was an interesting finding of our study. In COVID-19 patients, higher procalcitonin levels are correlated with the degree of organ damage and subsequently, disease severity [ 51 , 52 ]. Moreover, higher procalcitonin values predict the development of secondary infections during ICU stay [ 49 , 50 ].…”

Identification of Clinical Response Predictors of Tocilizumab Treatment in Patients with Severe COVID-19 Based on Single-Center Experience

“…BUN and D-dimer levels assessed early after TCZ administration were also predictive of a good response. All the abovementioned biomarkers have been confirmed to influence prognosis in COVID-19 [ 89 , 90 , 91 ].…”