Procalcitonin and C-reactive protein to rule out early bacterial coinfection in COVID-19 critically ill patients
Flavia Galli, Francesco Bindo, Ana Motos, Laia Fernández‐Barat, Enric Barbeta, Albert Gabarrús, Adrián Ceccato, Jesús F. Bermejo-Martín, Ricard Ferrer, Jordi Riera, Óscar Peñuelas, José Ángel Lorente, David de Gonzalo-Calvo, Rosario Menéndez, Jessica González, Sofia Misuraca, Andrea Palomeque, Rosario Amaya‐Villar, José M. Añón, Ana Balan Mariño, Carme Barberà, José Barberán, Aaron Blandino Ortíz, Elena Bustamante‐Munguira, Jesús Caballero, María Luisa Cantón‐Bulnes, Cristina Carbajales Pérez, Nieves Carbonell, Mercedes Catalán-González, Raúl de Frutos, Nieves Franco, Cristóbal Galbán‐Malagón, Ana López Lago, Víctor D. Gumucio-Sanguino, María del Carmen de la Torre, Emilio Díaz, Ángel Estella, Elena Gallego Curto, J.L. García Garmendia, José Manuel Gómez, Arturo Huerta, Ruth Noemí Jorge García, Ana Loza-Vázquez, Judith Marín‐Corral, M.C. Martín Delgado, Amalia Martínez de la Gándara, Ignacio Martínez Varela, Juan López Messa, Guillermo M. Albaiceta, María Teresa García Nieto, Mariana Andrea Novo, Yhivian Peñasco, Felipe Pérez‐García, Juan Carlos Pozo Laderas, Pilar Ricart, Víctor Sagredo, Ángel Sánchez-Miralles, Susana Sancho Chinesta, Ferran Roche‐Campo, Lorenzo Socías, Jordi Solé‐Violán, Fernando Suárez-Sipmann, Luis Tamayo Lomas, José Trenado, Alejandro Úbeda, Luis Jorge Valdivia, Pablo Vidal, María Victoria Boado, Alejandro Rodríguez, Massimo Antonelli, Francesco Blasi, Ferrán Barbé, Antoní Torres, on behalf of the CIBERESUCICOVID Project investigators (COV20/00110, ISCIII), Rafael Máñez, Felipe Rodrı́guez de Castro, María Mora Aznar, Mateu Torres, María Martínez-Martínez, Cynthia Alegre, Sofía Contreras, Javier Trujillano, Montse Vallverdú, Miguel Leonardo García León, Mariona Badía, Begoña Balsera, Luis Serviá, Judit Vilanova, Silvia Rodríguez, Neus Montserrat, Sílvia Iglesias, Javier Prados, Sula Carvalho, Mar Miralbés, Josman Monclou, Gabriel Jiménez, Jordi Codina, Estela Val, Pablo Pagliarani, Jorge Rubio
Abstract
PURPOSE: Although the prevalence of community-acquired respiratory bacterial coinfection upon hospital admission in patients with coronavirus disease 2019 (COVID-19) has been reported to be < 5%, almost three-quarters of patients received antibiotics. We aim to investigate whether procalcitonin (PCT) or C-reactive protein (CRP) upon admission could be helpful biomarkers to identify bacterial coinfection among patients with COVID-19 pneumonia. METHODS: We carried out a multicentre, observational cohort study including consecutive COVID-19 patients admitted to 55 Spanish intensive care units (ICUs). The primary outcome was to explore whether PCT or CRP serum levels upon hospital admission could predict bacterial coinfection among patients with COVID-19 pneumonia. The secondary outcome was the evaluation of their association with mortality. We also conducted subgroups analyses in higher risk profile populations. RESULTS: Between 5 February 2020 and 21 December 2021, 4076 patients were included, 133 (3%) of whom presented bacterial coinfection. PCT and CRP had low area under curve (AUC) scores at the receiver operating characteristic (ROC) curve analysis [0.57 (95% confidence interval (CI) 0.51-0.61) and 0.6 (95% CI, 0.55-0.64), respectively], but high negative predictive values (NPV) [97.5% (95% CI 96.5-98.5) and 98.2% (95% CI 97.5-98.9) for PCT and CRP, respectively]. CRP alone was associated with bacterial coinfection (OR 2, 95% CI 1.25-3.19; p = 0.004). The overall 15, 30 and 90 days mortality had a higher trend in the bacterial coinfection group, but without significant difference. PCT ≥ 0.12 ng/mL was associated with higher 90 days mortality. CONCLUSION: Our study suggests that measurements of PCT and CRP, alone and at a single time point, are not useful for ruling in or out bacterial coinfection in viral pneumonia by COVID-19.