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Background: We evaluated whether the serum procalcitonin (PCT) level could predict death in severe and critical coronavirus disease 2019 (COVID-19) patients. Methods: This study included 129 COVID-19 patients. PCT levels on admission, treatment, and death were collected. The outcomes were compared. Results: The optimum cutoff value of the PCT level determined by receiver operator characteristic curve analysis to predict all-cause death was 0.085 ng/mL, with sensitivity of 95.7% and specificity of 72.6%. Overall, 78 patients had a PCT level below 0.085 ng/mL and 51 patients had a PCT level of 0.085 ng/mL or greater. High-PCT-level patients had lower levels of lymphocytes (P = 0.001) and albumin (P = 0.002) and higher levels of creatinine (P = 0.024), D-dimer (P = 0.002), and white blood cells, neutrocytes (P < 0.001), high-sensitivity C-reactive protein (P < 0.001), interleukin-6 (P < 0.001), interleukin-8 (P = 0.001), interleukin-10 (P = 0.001), tumor necrosis factor (P < 0.001), erythrocyte sedimentation rate (P = 0.001), and ferritin (P = 0.001). During the 30-day observation period, 23 patients died. Mortality was significantly higher in high-PCT-level patients than in patients with low PCT levels (43.1% vs. 1.3%; P < 0.001). The risks of death (P < 0.0001) and ventilator use (P < 0.0001) were increased in patients with PCT levels of 0.085 ng/mL or greater. Conclusions: A PCT level of 0.085 ng/mL or greater on admission could effectively predict death and ventilator use in severe and critical COVID-19 patients. [ABSTRACT FROM AUTHOR]