1. Negative predictive value of procalcitonin to rule out bacterial respiratory co-infection in critical covid-19 patients
- Author
-
Carbonell, Raquel, Urgelés, Silvia, Salgado, Melina, Rodríguez, Alejandro, Reyes, Luis Felipe, Fuentes, Yuli V, Serrano, Cristian C, Caceres, Eder L, Bodí, María, Martín-Loeches, Ignacio, Solé-Violán, Jordi, Díaz, Emili, Gómez, Josep, Trefler, Sandra, Vallverdú, Montserrat, Murcia, Josefa, Albaya, Antonio, Loza, Ana, Socias, Lorenzo, Ballesteros, Juan Carlos, Papiol, Elisabeth, Viña, Lucía, Sancho, Susana, Nieto, Mercedes, Del, M, Lorente, Carmen, Badallo, Oihane, Fraile, Virginia, Arméstar, Fernando, Estella, Angel, Abanses, Paula, Sancho, Isabel, Guasch, Neus, Moreno, Gerard, and COVID-19 SEMICYUC Working Group and the LIVEN-Covid-19 Investigators
- Subjects
Microbiology (medical) ,Coinfection ,Bacterial co-infection ,COVID-19 ,Bacterial Infections ,C-reactive protein ,C-Reactive Protein ,Infectious Diseases ,ROC Curve ,Predictive Value of Tests ,Humans ,Mortality ,Covid-19 pneumonia ,Procalcitonin ,Respiratory Tract Infections ,Biomarkers ,Retrospective Studies - Abstract
Procalcitonin (PCT) and C-Reactive Protein (CRP) are useful biomarkers to differentiate bacterial from viral or fungal infections, although the association between them and co-infection or mortality in COVID-19 remains unclear.The study represents a retrospective cohort study of patients admitted for COVID-19 pneumonia to 84 ICUs from ten countries between (March 2020-January 2021). Primary outcome was to determine whether PCT or CRP at admission could predict community-acquired bacterial respiratory co-infection (BC) and its added clinical value by determining the best discriminating cut-off values. Secondary outcome was to investigate its association with mortality. To evaluate the main outcome, a binary logistic regression was performed. The area under the curve evaluated diagnostic performance for BC prediction.4635 patients were included, 7.6% fulfilled BC diagnosis. PCT (0.25[IQR 0.1-0.7] versus 0.20[IQR 0.1-0.5]ng/mL, p0.001) and CRP (14.8[IQR 8.2-23.8] versus 13.3 [7-21.7]mg/dL, p=0.01) were higher in BC group. Neither PCT nor CRP were independently associated with BC and both had a poor ability to predict BC (AUC for PCT 0.56, for CRP 0.54). Baseline values of PCT0.3ng/mL, could be helpful to rule out BC (negative predictive value 91.1%) and PCT≥0.50ng/mL was associated with ICU mortality (OR 1.5,p0.001).These biomarkers at ICU admission led to a poor ability to predict BC among patients with COVID-19 pneumonia. Baseline values of PCT0.3ng/mL may be useful to rule out BC, providing clinicians a valuable tool to guide antibiotic stewardship and allowing the unjustified overuse of antibiotics observed during the pandemic, additionally PCT≥0.50ng/mL might predict worsening outcomes.
- Published
- 2022
- Full Text
- View/download PDF