The long Pentraxin PTX3 serves as an early predictive biomarker of co-infections in COVID-19
Francesco Scavello, Enrico Brunetta, Sarah N Mapelli, Emanuele Nappi, Ian David García Martín, Marina Sironi, Roberto Leone, Simone Solano, Giovanni Angelotti, Domenico Supino, Silvia Carnevale, Hang Zhong, Elena Magrini, Matteo Stravalaci, Alessandro Protti, Alessandro Santini, Elena Costantini, Victor Savevski, Antonio Voza, Barbara Bottazzi, Michele Bartoletti, Maurizio Cecconi, Alberto Mantovani, Paola Morelli, Federica Tordato, Cecília Garlanda, Stefano Accornero, Alessio Aghemo, Hussam Ali, Claudio Angelini, Ivan Arcari, Paola Arosio, Elena Azzolini, Alessandra Baccarin, Salvatore Badalamenti, Sara Baggio, Michela Barbagallo, Caterina Barberi, Franca Barbic, Viviana Barbieri, Alessandro Barbone, Alessio Basciu, Monica Bocciolone, Federica Borea, Mario Borroni, Gianluigi Bresciani, Enrico Brunetta, Cinzia Bulletti, Cristina Cadonati, Lorenzo Calabro', Marta Calatroni, Antonietta Calvetta Albania, Francesco Cannata, Lorenzo Canziani, Luigi Capretti Giovanni, Elisa Carlani, Flaminia Carrone, Maddalena Casana, Maurizio Cecconi, Carlo Ceriotti, Michele Ciccarelli, Matteo Cimino, Leonardo Ciuffini, Chiara Colaizzi, Francesca Colapietro, Guido Costa, Ottavia Cozzi, Vincenzo Craviotto, Chiara Crespi, Massimo Crippa, Leonardo Da Rio, Sara Dal Farra, Federica D'Antonio, Guido De Ambroggi, Massimo De Donato, Francesca De Lucia, Maria De Santis, Giacomo Delle Rose, Marina Di Pilla, Franca Dipaola, Andrea Dipasquale, Angelo Dipasquale, Ginevra Droandi, Roberta Fazio, Giuseppe Ferrante, Chiara Ferrara Elisa, Carlo Ferrari Matteo, Sebastian Ferri, Marco Folci, Sara Foresti, Eloisa Franchi, Elia Fraolini, Alessandro Fugazza, Federica Furfaro, Paola Galimberti, Piera Galtieri Alessia, Francesca Gavazzi, Elena Generali, Benedetta Goletti, Giacomo Guidelli
Abstract
BACKGROUND: COVID-19 clinical course is highly variable and secondary infections contribute to COVID-19 complexity. Early detection of secondary infections is clinically relevant for patient outcome. Procalcitonin (PCT) and C-reactive protein (CRP) are the most used biomarkers of infections. Pentraxin 3 (PTX3) is an acute phase protein with promising performance as early biomarker in infections. In patients with COVID-19, PTX3 plasma concentrations at hospital admission are independent predictor of poor outcome. In this study, we assessed whether PTX3 contributes to early identification of co-infections during the course of COVID-19. METHODS: We analyzed PTX3 levels in patients affected by COVID-19 with (n = 101) or without (n = 179) community or hospital-acquired fungal or bacterial secondary infections (CAIs or HAIs). FINDINGS: PTX3 plasma concentrations at diagnosis of CAI or HAI were significantly higher than those in patients without secondary infections. Compared to PCT and CRP, the increase of PTX3 plasma levels was associated with the highest hazard ratio for CAIs and HAIs (aHR 11.68 and 24.90). In multivariable Cox regression analysis, PTX3 was also the most significant predictor of 28-days mortality or intensive care unit admission of patients with potential co-infections, faring more pronounced than CRP and PCT. INTERPRETATION: PTX3 is a promising predictive biomarker for early identification and risk stratification of patients with COVID-19 and co-infections. FUNDING: Dolce & Gabbana fashion house donation; Ministero della Salute for COVID-19; EU funding within the MUR PNRR Extended Partnership initiative on Emerging Infectious Diseases (Project no. PE00000007, INF-ACT) and MUR PNRR Italian network of excellence for advanced diagnosis (Project no. PNC-E3-2022-23683266 PNC-HLS-DA); EU MSCA (project CORVOS 860044).