Prognostic Utility of Procalcitonin, Presepsin, and the VACO Index for Predicting 30-day Mortality in Hospitalized COVID-19 Patients

Abstract

Background: Biomarkers and clinical indices have been investigated for predicting mortality in patients with coronavirus disease (COVID-19). We explored the prognostic utility of procalcitonin (PCT), presepsin, and the Veterans Health Administration COVID-19 (VACO) index for predicting 30-day-mortality in COVID-19 patients.

Methods: In total, 54 hospitalized COVID-19 patients were enrolled. PCT and presepsin levels were measured using the Elecsys BRAHMS PCT assay (Roche Diagnostics GmbH, Mannheim, Germany) and HISCL Presepsin assay (Sysmex, Kobe, Japan), respectively. The VACO index was calculated based on age, sex, and comorbidities. PCT and presepsin levels and the VACO index were compared using ROC curve, Kaplan-Meier method, and reclassification analysis for the 30-day mortality.

Results: ROC curve analysis was used to measure PCT and presepsin levels and the VACO index to predict 30-day mortality; the optimal cut-off values were 0.138 ng/mL for PCT, 717 pg/mL for presepsin, and 12.1% for the VACO index. On Kaplan-Meier survival analysis, hazard ratios (95% confidence interval) were 15.9 (4.1-61.3) for PCT, 26.3 (6.4-108.0) for presepsin, and 6.0 (1.7-21.1) for the VACO index. On reclassification analysis, PCT and presepsin in addition to the VACO index significantly improved the prognostic value of the index.

Conclusions: This study demonstrated the prognostic utility of measuring PCT and presepsin levels and the VACO index in COVID-19 patients. The biomarkers in addition to the clinical index were more useful than the index alone for predicting clinical outcomes in COVID-19 patients.

Keywords: 30-Day mortality; COVID-19; Prediction; Presepsin; Procalcitonin; VACO index.

Fig. 1

Flowchart for patient enrollment. Abbreviation: COVID-19, coronavirus disease.

Fig. 2

ROC curve analysis of PCT, presepsin, the SOFA score, WHO disease severity, the VACO index, and multimarker approaches for predicting 30-day mortality. (A) PCT, presepsin, the SOFA score, WHO disease severity, and the VACO index. (B) Multimarker approaches using the above optimal cut-off values of PCT, presepsin, and the VACO index. Abbreviations: PCT, procalcitonin; SOFA, sequential organ failure assessment; VACO, Veterans Health Administration COVID-19; AUC, area under the ROC curve; CI, confidence interval.

Fig. 3

Kaplan–Meier survival curves of PCT, presepsin, the SOFA score, WHO disease severity, and the VACO index for predicting 30-day mortality. (A) PCT. (B) Presepsin. (C) SOFA score. (D) WHO disease severity. (E) VACO index. Abbreviations: PCT, procalcitonin; SOFA, sequential organ failure assessment; VACO, Veterans Health Administration COVID-19; HR, hazard ratio; CI, confidence interval.