Searching for a role of procalcitonin determination in COVID-19: a study on a selected cohort of hospitalized patients

Dolci, Alberto; Robbiano, Cristina; Aloisio, Elena; Chibireva, Mariia; Serafini, Ludovica; Falvella, Felicia Stefania; Pasqualetti, Sara; Panteghini, Mauro

doi:10.1515/cclm-2020-1361

Cited by 36 publications

(25 citation statements)

References 35 publications

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“…Previous studies have demonstrated that although PCT is not a reliable indicator of the presence of concomitant bacterial pneumonia in COVID-19 patients, its absence is assured with a negative predictive value (NPV) of 91.7% or higher. 13 , 14 This was not demonstrated in our critically ill population, where NPV was only 73.2%. Prior research in this area has not targeted ICU patients with COVID-19, likely accounting for the discrepant predictivity of PCT.…”

Section: Discussioncontrasting

confidence: 56%

“… 6 , 7 , 9 , 21 , 29 Cutoff values of 0.1, 0.25, and 0.5 ng/mL have been used in high quality studies to assess the correlation between PCT and bacterial PNA. 5 , 14 , 22 …”

Section: Discussionmentioning

confidence: 99%

“… 11 Similar results were demonstrated by Dolci, et al They found that a PCT of greater than 6.7 ug/L had moderate strength in predicting in-hospital death, but did not add value as a diagnostic or prognostic biomarker compared to other more common markers of infection such as blood lymphocyte percentage and neutrophil count. 14 …”

Section: Discussionmentioning

confidence: 99%

“…Conflicting evidence exists regarding the utility of procalcitonin in diagnosing bacterial coinfections. 10 – 14 PCT has been investigated as a tool to diagnose ventilator-associated pneumonia (VAP) 15 and secondary pulmonary infections, including both viral and bacterial infections, in patients with COVID-19. 16 , 17 Although early literature suggests that elevated PCT is associated with COVID-19 disease severity and increased mortality, there is a paucity of data specific to critically ill COVID-19 patients with concomitant bacterial pneumonia.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of Procalcitonin's Utility to Predict Concomitant Bacterial Pneumonia in Critically Ill COVID-19 Patients

Patel¹,

Adams

Brunetti

et al. 2022

J Intensive Care Med

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Background: Historically, procalcitonin(PCT) has been used as a predictor of bacterial infection and to guide antibiotic therapy in hospitalized patients. The purpose of this study was to determine PCT's diagnostic utility in predicting secondary bacterial pneumonia in critically ill patients with severe COVID-19 pneumonia. Methods: A retrospective cohort study was conducted in COVID-19 adults admitted to the ICU between March 2020, and March 2021. All included patients had a PCT level within 72 h of presentation and serum creatinine of <1.5mg/dL. A PCT threshold of 0.5ng/mL was used to compare patients with high( ≥ 0.5ng/mL) versus low(< 0.5ng/mL) PCT. Bacterial pneumonia was defined by positive respiratory culture. A receiver operating characteristics (ROC) curve was utilized to evaluate PCT as a diagnostic test for bacterial pneumonia, with an area under the curve(AUC) threshold of 0.7 to signify an accurate diagnostic test. A multivariable model was constructed to identify variables associated with in-hospital mortality. Results: There were 165 patients included: 127 low PCT versus 38 high PCT. There was no significant difference in baseline characteristics, vital signs, severity of disease, or outcomes among low versus high PCT groups (all p > 0.05). While there was no difference in bacterial pneumonia in low versus high groups (34(26.8%) versus 12(31.6%), p = 0.562), more patients in the high PCT group had bacteremia (19(15%) versus 11(28.9%), p = 0.050). Sensitivity was 26.1% and specificity was 78.2% for PCT to predict bacterial pneumonia coinfection in ICU patients with COVID-19 pneumonia. ROC yielded an AUC 0.54 ( p = 0.415). After adjusting for LDH>350U/L and creatinine in multivariable regression, PCT did not enhance performance of the regression model. Conclusions: PCT offers little to no predictive utility in diagnosing concomitant bacterial pneumonia in critically ill patients with COVID-19 nor in predicting increased severity of disease or worse outcomes including mortality.

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Section: Discussioncontrasting

confidence: 56%

“… 6 , 7 , 9 , 21 , 29 Cutoff values of 0.1, 0.25, and 0.5 ng/mL have been used in high quality studies to assess the correlation between PCT and bacterial PNA. 5 , 14 , 22 …”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Evaluation of Procalcitonin's Utility to Predict Concomitant Bacterial Pneumonia in Critically Ill COVID-19 Patients

Patel¹,

Adams

Brunetti

et al. 2022

J Intensive Care Med

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“…A procalcitonin (PCT)guided algorithm could be used to trigger watchful waiting or aid in decreasing prolonged antimicrobial courses [28,29]. However, PCT-based strategies for outcome prognostication and prediction of ICU-acquired infections have not yet been adequately validated in COVID-19 [30,31].…”

Section: Discussionmentioning

confidence: 99%

Antimicrobial prescription in severe COVID-19 and CAP: a matched case-control study

Fierens

Bus

Colpaert

et al. 2021

Acta Clinica Belgica

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Background:In severe coronavirus diseases 2019 (COVID-19), a high and potentially excessive use of antimicrobials for suspected bacterial co-infection and intensive care unit (ICU)-acquired infections has been repeatedly reported. Objectives: To compare an ICU cohort of community-acquired pneumonia (CAP) with a cohort of severe COVID-19 pertaining to co-infections, ICU-acquired infections and associated antimicrobial consumption. Methods: We retrospectively compared a cohort of CAP patients with a cohort of COVID-19 patients matched according to organ failure, ICU length of stay (LOS) and ventilation days. Patient data such as demographics, infection focus, probability and severity, ICU severity scores and ICU and in-hospital mortality, days of antimicrobial therapy (DOT) and number of antimicrobial prescriptions, using an incremental scale, were registered and analysed. The total number of cultures (sputum, urinary, blood cultures) was collected and corrected for ICU LOS. Findings: CAP patients (n = 148) were matched to COVID-19 patients (n = 74). Significantly less sputum cultures (68.2% versus 18.9%, P < 0.05) and bronchoalveolar lavages (BAL) (73.7% versus 36.5%, P < 0.05) were performed in COVID-19 patients. Six (8.1%) COVID-19 patients were diagnosed with a co-infection. Respectively, 58 of 148 (39.2%) CAP and 38 of 74 (51.4%) COVID-19 patients (P = 0.09) developed ICU-acquired infections. Antimicrobial distribution, both in the number of prescriptions and DOT, was similar in both cohorts. Conclusions: We found a low rate of microbiologically confirmed bacterial co-infection and a high rate of ICU-acquired infections in COVID-19 patients. Infection probabilities, antimicrobial prescriptions and DOT were comparable with a matched CAP cohort.

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Sources and clinical significance of aspartate aminotransferase increases in COVID-19

Aloisio

Colombo

Arrigo

et al. 2021

Clinica Chimica Acta

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Background Aspartate aminotransferase (AST) is often increased in COVID-19 and, in some studies, AST abnormalities were associated with mortality risk. Methods 2054 hospitalized COVID-19 patients were studied. To identify sources of AST release, correlations between AST peak values and other biomarkers of tissue damage, i.e., alanine aminotransferase (ALT) for hepatocellular damage, creatine kinase (CK) for muscle damage, lactate dehydrogenase for multiorgan involvement, alkaline phosphatase and γ-glutamyltransferase for cholestatic injury, and C-reactive protein (CRP) for systemic inflammation, were performed and coefficients of determination estimated. The role of AST to predict death and intensive care unit admission during hospitalization was also evaluated. All measurements were performed using standardized assays. Results AST was increased in 69% of patients. Increases could be fully explained by summing the effects of hepatocellular injury [AST dependence from ALT, 66.8% [95% confidence interval (CI): 64.5-69.1)] and muscle damage [AST dependence from CK, 42.6% (CI: 39.3-45.8)]. We were unable to demonstrate an independent association of AST increases with worse outcomes. Conclusion The mechanisms for abnormal AST in COVID-19 are likely multifactorial and a status related to tissue suffering could play a significant role. The clinical significance of AST elevations remains unclear.

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Searching for a role of procalcitonin determination in COVID-19: a study on a selected cohort of hospitalized patients

Cited by 36 publications

References 35 publications

Evaluation of Procalcitonin's Utility to Predict Concomitant Bacterial Pneumonia in Critically Ill COVID-19 Patients

Evaluation of Procalcitonin's Utility to Predict Concomitant Bacterial Pneumonia in Critically Ill COVID-19 Patients

Antimicrobial prescription in severe COVID-19 and CAP: a matched case-control study

Sources and clinical significance of aspartate aminotransferase increases in COVID-19

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