ABSTRACT
Background. Patients with COVID-19 disease often receive antibiotics to treat suspected bacterial coinfections. Procalcitonin (PCT) is a biomarker used for suspected bacterial infections. The objective of this study is to evaluate the association between PCT and the use of antimicrobials in COVID-19 patients. Methods. This was a retrospective, cohort study of adult patients admitted with confirmed COVID-19 from March 30, 2020 to March 30, 2021. Data collected included demographics, baseline inflammatory markers including initial PCT and C-reactive protein (CRP) values, past medical history, initiation of empiric antibiotics, mechanical ventilation, in-hospital mortality, days of antibiotic therapy, and length of hospital stay (LOS). Univariate analyses were utilized to assess for any significant differences in demographics based on predefined initial PCT groupings (< 0.25 ng/ml (group 1), 0.25-0.49 ng/ml (group 2), and >= 0.5 ng/ml (group 3)). Multivariate analyses were performed to evaluate for any differences between initial PCT values and in-hospital mortality, LOS, and days of antibiotic therapy. Results. Out of 149 patients, 61.7% had an initial PCT value < 0.25 ng/ml, 17.45% had an initial value of 0.25-0.49 ng/ml, and 20.8% had an initial value >= 0.5 ng/ml. A total of 145 patients (97%) received empiric antibiotics. Univariate analysis among the three groups displayed a difference in the initial CRP value, which was higher in groups 2 and 3 versus group 1 (p < 0.001). Regression analysis controlling for initial CRP value found that patients in groups 2 and 3 had a higher duration of antibiotic therapy compared to group 1 (12 and 11 versus 8 days) (p < 0.001) and a longer LOS (17 and 15 vs 12 days) (p = 0.009). More patients (34.6%) were mechanically ventilated in group 2 compared to group 1 (14.1%) and group 3 (22.6%) with a trend toward significance (p = 0.059). Multivariate analysis found no significant association between PCT levels and mortality. The rate of in-hospital mortality in patients receiving invasive ventilation was higher in groups 2 and 3 (78% and 86%, respectively) compared to group 1 (54%, p < 0.001). Conclusion. When controlling for CRP, an initial PCT value > 0.25 ng/ml was associated with increased days of antibiotic therapy and longer duration of hospital stay in COVID-19 patients.
ABSTRACT
Background. Limited data exists regarding the impact of coronavirus disease 2019 (COVID-19) on people living with human immunodeficiency virus (PLWH). The purpose of the study was to compare the clinical outcomes of patients hospitalized with COVID-19 and HIV versus those without HIV. Methods. This was a retrospective, cohort study of adult patients admitted with confirmed COVID-19 from March 1st to May 30th 2020 at an urban hospital in New York City. Data collected included demographics, past medical history, HIV status, baseline laboratory values, treatment and outcomes such as length of stay, mechanical ventilation, patient disposition at discharge, and in-hospital mortality. Fisher's exact test was used to compare categorical values and a t-test was used to compare continuous values. Results. Out of 983 patients, 6.9% were PLWH and 93.1% were HIV-negative. The average age in both groups was 61 vs. 62 years, respectively. There were more male patients in the PLWH than the non-HIV group (76.8% vs. 58.6%). Majority of PLWH were Black (49.3%). Forty-seven percent of PLWH were mechanically ventilated versus 33.3% of the non-HIV group. The most common comorbidity in both groups was hypertension (82.4% vs. 72.6%). When compared to HIV-negative patients, PLWH had a higher rate of kidney disease (72.1% vs. 53.6%, p=0.0086), chronic obstructive pulmonary disease (41.2% vs. 14.5%, p=0.0001), liver disease (45.6% vs. 11.5%, p=0.0001) and current smoking (14.3% vs. 5.8%, p=0.0103). In PLWH, 70.6% of patients were on an integrase-based regimen. Fifty-three percent of PLWH had a CD4 count of > 200 cells/mm3 and 35.3% had an undetectable viral load (< 20 copies/mL). Unadjusted hospital mortality was 51.4% in PLWH and 36.2% in the non-HIV cohort (p=0.0089). The average length of hospital stay was 9.1 days vs. 8.4 days in PLWH versus the non-HIV group (p=0.4493). More patients were discharged to a nursing home in the non-HIV group vs. PLWH (37.8% vs. 14.3%, p=0.0001). Conclusion. Hospitalized patients with COVID-19 and HIV had a higher in-hospital mortality compared to those without HIV during the first COVID wave in New York City.