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Journal of Infection

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Negative predictive value of procalcitonin to rule out bacterial respiratory co-infection in critical covid-19 patients - 06/09/22

Doi : 10.1016/j.jinf.2022.06.024 
Raquel Carbonell a, ⁎ , Silvia Urgelés a, Melina Salgado a, Alejandro Rodríguez b, Luis Felipe Reyes c, d, Yuli V. Fuentes c, d, Cristian C. Serrano c, d, Eder L. Caceres c, d, María Bodí b, Ignacio Martín-Loeches e, Jordi Solé-Violán f, Emili Díaz g, Josep Gómez b, Sandra Trefler b, Montserrat Vallverdú h, Josefa Murcia i, Antonio Albaya j, Ana Loza k, Lorenzo Socias l, Juan Carlos Ballesteros m, Elisabeth Papiol n, Lucía Viña o, Susana Sancho p, Mercedes Nieto q, M del a, Carmen Lorente r, Oihane Badallo s, Virginia Fraile t, Fernando Arméstar u, Angel Estella v, Paula Abanses w, Isabel Sancho x, Neus Guasch y, Gerard Moreno a
on behalf of the

COVID-19 SEMICYUC Working Group and the LIVEN-Covid-19 Investigators

a Critical Care Department, Hospital Universitari Joan XXIII, Tarragona, Spain. 
b Critical Care Department, URV/IISPV/CIBERES, Hospital Universitari Joan XXIII, Tarragona, Spain 
c Universidad de La Sabana, Chia, Colombia 
d Clinica Universidad de La Sabana, Chia, Colombia 
e Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital, Dublin, Ireland. 
f Critical Care Department, Hospital Universitario Doctor Negrín, Gran Canaria, Spain. 
g Critical Care Department, Hospital Universitari Parc Taulí, Universitat Autonoma Barcelona, Sabadell, Spain. 
h Critical Care Department, Hospital Universitari Arnau de Vilanova, Lleida, Spain. 
i Critical Care Deparment, Hospital Santa Lucía, Cartagena, Spain. 
j Critical Care Department, Hospital Universitario de Guadalajara, Guadalajara, Spain. 
k Critical Care Department, Hospital Universitario Virgen del Valme, Sevilla, Spain. 
l Critical Care Department, Hospital Universitari Son Llàtzer, Palma de Mallorca, Spain. 
m Critical Care Department, Hospital de Salamanca, Salamanca, Spain. 
n Critical Care Department, Hospital Universitari Vall d'Hebrón, Barcelona, Spain. 
o Critical Care Department, Hospital Universitario Central de Asturias, Oviedo, Spain. 
p Critical Care Department, Hospital Universitario y Politecnico de La Fe, Valencia, Spain. 
q Critical Care Department, Hospital Clínico San Carlos, Madrid, Spain. 
r Critical Care Department, Hospital Rafael Mendez, Lorca, Spain. 
s Critical Care Department, Hospital Universitario de Burgos, Burgos, Spain. 
t Critical Care Department, Hospital Universitario Rio Hortega, Valladolid, Spain. 
u Critical Care Department, Hospital Germans Trias i Pujol, Universitat Autonoma Barcelona, Badalona, Spain. 
v Critical Care Department, Hospital Universitario de Jerez, Jerez de la Frontera, Spain. 
w Critical Care Department, Hospital Clinico de Zaragoza, Zaragoza, Spain. 
x Critical Care Department, Hospital Universitario Miguel Servet, Zaragoza, Spain. 
y Critical Care Department, Hospital Nostra Senyora de Meritxell, Escaldes-Engordany, Andorra. 

⁎Corresponding Auther. Raquel Carbonell MD, Dr Mallafrè Guasch Street, nº 4, Postal code 43007, Tarragona, SpainDr Mallafrè Guasch Street, nº 4TarragonaPostal code 43007Spain
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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.

Le texte complet de cet article est disponible en PDF.

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.

Le texte complet de cet article est disponible en PDF.

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


Plan


☆ The COVID-19 SEMICYUC Working Group and the LIVEN-Covid-19 Investigators member list is available in the Supplementary material.


© 2022  The British Infection Association. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 85 - N° 4

P. 374-381 - octobre 2022 Retour au numéro
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