Negative predictive value of procalcitonin to rule out bacterial respiratory co-infection in critical covid-19 patients. Issue 4 (October 2022)

• Record Type: Journal Article
• Authors: 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;
• Is Part Of: Journal of infection. Volume 85:Issue 4(2022)
• Page Start: 374
• Page End: 381
• Publication Date: 2022-10
• Subjects: Procalcitonin -- C-reactive protein -- Covid-19 pneumonia -- Bacterial co-infection -- Mortality; Infection -- Periodicals; Bacterial Infections -- Periodicals; Communicable Diseases -- Periodicals; Electronic journals; 616.905
• DOI: 10.1016/j.jinf.2022.06.024
• Languages: English
• ISSNs: 0163-4453

Abstract

Highlights: Pandemic due to SARS CoV-2 is in few cases associated with bacterial co-infection. A threshold of procalcitonin <0.3 ng/ml may be helpful to rule out bacterial co-infection, and therefore to reduce antibiotics misuse in the context of COVID-19 pneumonia. Procalcitonin levels on admission are useful to predict prognosis. ABSTRACT: Background: : 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. Methods: : 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. Results: : 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, p<0.001) 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 PCT<0.3ng/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, p<0.001). Conclusions: : These biomarkers at ICU admission led to a poor ability to predict BC among patients with COVID-19 pneumonia. Baseline values of PCT<0.3ng/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.