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. 2022 Oct;85(4):374-381.
doi: 10.1016/j.jinf.2022.06.024. Epub 2022 Jun 30.

Negative predictive value of procalcitonin to rule out bacterial respiratory co-infection in critical covid-19 patients

Raquel Carbonell  1 , Silvia Urgelés  2 , Melina Salgado  2 , Alejandro Rodríguez  3 , Luis Felipe Reyes  4 , Yuli V Fuentes  4 , Cristian C Serrano  4 , Eder L Caceres  4 , María Bodí  3 , Ignacio Martín-Loeches  5 , Jordi Solé-Violán  6 , Emili Díaz  7 , Josep Gómez  3 , Sandra Trefler  3 , Montserrat Vallverdú  8 , Josefa Murcia  9 , Antonio Albaya  10 , Ana Loza  11 , Lorenzo Socias  12 , Juan Carlos Ballesteros  13 , Elisabeth Papiol  14 , Lucía Viña  15 , Susana Sancho  16 , Mercedes Nieto  17 , M Del  2 , Carmen Lorente  18 , Oihane Badallo  19 , Virginia Fraile  20 , Fernando Arméstar  21 , Angel Estella  22 , Paula Abanses  23 , Isabel Sancho  24 , Neus Guasch  25 , Gerard Moreno  2 ; COVID-19 SEMICYUC Working Group and the LIVEN-Covid-19 Investigators
Affiliations

Negative predictive value of procalcitonin to rule out bacterial respiratory co-infection in critical covid-19 patients

Raquel Carbonell et al. J Infect. 2022 Oct.

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.

Keywords: Bacterial co-infection; C-reactive protein; Covid-19 pneumonia; Mortality; Procalcitonin.

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Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Figure 1
Figure 1
Flow chart of patient enrolment. ICU, Intensive Care Unit; PCT, procalcitonin; CRP, C-Reactive protein.
See this image and copyright information in PMC

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