GWAS and meta-analysis identifies 49 genetic variants underlying critical COVID-19.

Critical illness in COVID-19 is an extreme and clinically homogeneous disease phenotype that we have previously shown1 to be highly efficient for discovery of genetic associations2. Despite the advanced stage of illness at presentation, we have shown that host genetics in patients who are critically ill with COVID-19 can identify immunomodulatory therapies with strong beneficial effects in this group3. Here we analyse 24,202 cases of COVID-19 with critical illness comprising a combination of microarray genotype and whole-genome sequencing data from cases of critical illness in the international GenOMICC (11,440 cases) study, combined with other studies recruiting hospitalized patients with a strong focus on severe and critical disease: ISARIC4C (676 cases) and the SCOURGE consortium (5,934 cases). To put these results in the context of existing work, we conduct a meta-analysis of the new GenOMICC genome-wide association study (GWAS) results with previously published data. We find 49 genome-wide significant associations, of which 16 have not been reported previously. To investigate the therapeutic implications of these findings, we infer the structural consequences of protein-coding variants, and combine our GWAS results with gene expression data using a monocyte transcriptome-wide association study (TWAS) model, as well as gene and protein expression using Mendelian randomization. We identify potentially druggable targets in multiple systems, including inflammatory signalling (JAK1), monocyte-macrophage activation and endothelial permeability (PDE4A), immunometabolism (SLC2A5 and AK5), and host factors required for viral entry and replication (TMPRSS2 and RAB2A).

Prospective validation of the 4C prognostic models for adults hospitalised with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol.

PURPOSE: To prospectively validate two risk scores to predict mortality (4C Mortality) and in-hospital deterioration (4C Deterioration) among adults hospitalised with COVID-19. METHODS: Prospective observational cohort study of adults (age ≥18 years) with confirmed or highly suspected COVID-19 recruited into the International Severe Acute Respiratory and emerging Infections Consortium (ISARIC) WHO Clinical Characterisation Protocol UK (CCP-UK) study in 306 hospitals across England, Scotland and Wales. Patients were recruited between 27 August 2020 and 17 February 2021, with at least 4 weeks follow-up before final data extraction. The main outcome measures were discrimination and calibration of models for in-hospital deterioration (defined as any requirement of ventilatory support or critical care, or death) and mortality, incorporating predefined subgroups. RESULTS: 76 588 participants were included, of whom 27 352 (37.4%) deteriorated and 12 581 (17.4%) died. Both the 4C Mortality (0.78 (0.77 to 0.78)) and 4C Deterioration scores (pooled C-statistic 0.76 (95% CI 0.75 to 0.77)) demonstrated consistent discrimination across all nine National Health Service regions, with similar performance metrics to the original validation cohorts. Calibration remained stable (4C Mortality: pooled slope 1.09, pooled calibration-in-the-large 0.12; 4C Deterioration: 1.00, -0.04), with no need for temporal recalibration during the second UK pandemic wave of hospital admissions. CONCLUSION: Both 4C risk stratification models demonstrate consistent performance to predict clinical deterioration and mortality in a large prospective second wave validation cohort of UK patients. Despite recent advances in the treatment and management of adults hospitalised with COVID-19, both scores can continue to inform clinical decision making. TRIAL REGISTRATION NUMBER: ISRCTN66726260.

Implementation of corticosteroids in treatment of COVID-19 in the ISARIC WHO Clinical Characterisation Protocol UK: prospective, cohort study.

BACKGROUND: Dexamethasone was the first intervention proven to reduce mortality in patients with COVID-19 being treated in hospital. We aimed to evaluate the adoption of corticosteroids in the treatment of COVID-19 in the UK after the RECOVERY trial publication on June 16, 2020, and to identify discrepancies in care. METHODS: We did an audit of clinical implementation of corticosteroids in a prospective, observational, cohort study in 237 UK acute care hospitals between March 16, 2020, and April 14, 2021, restricted to patients aged 18 years or older with proven or high likelihood of COVID-19, who received supplementary oxygen. The primary outcome was administration of dexamethasone, prednisolone, hydrocortisone, or methylprednisolone. This study is registered with ISRCTN, ISRCTN66726260. FINDINGS: Between June 17, 2020, and April 14, 2021, 47 795 (75·2%) of 63 525 of patients on supplementary oxygen received corticosteroids, higher among patients requiring critical care than in those who received ward care (11 185 [86·6%] of 12 909 vs 36 415 [72·4%] of 50 278). Patients 50 years or older were significantly less likely to receive corticosteroids than those younger than 50 years (adjusted odds ratio 0·79 [95% CI 0·70-0·89], p=0·0001, for 70-79 years; 0·52 [0·46-0·58], p<0·0001, for >80 years), independent of patient demographics and illness severity. 84 (54·2%) of 155 pregnant women received corticosteroids. Rates of corticosteroid administration increased from 27·5% in the week before June 16, 2020, to 75-80% in January, 2021. INTERPRETATION: Implementation of corticosteroids into clinical practice in the UK for patients with COVID-19 has been successful, but not universal. Patients older than 70 years, independent of illness severity, chronic neurological disease, and dementia, were less likely to receive corticosteroids than those who were younger, as were pregnant women. This could reflect appropriate clinical decision making, but the possibility of inequitable access to life-saving care should be considered. FUNDING: UK National Institute for Health Research and UK Medical Research Council.

Comorbidities, multimorbidity and COVID-19.

The influence of comorbidities on COVID-19 outcomes has been recognized since the earliest days of the pandemic. But establishing causality and determining underlying mechanisms and clinical implications has been challenging-owing to the multitude of confounding factors and patient variability. Several distinct pathological mechanisms, not active in every patient, determine health outcomes in the three different phases of COVID-19-from the initial viral replication phase to inflammatory lung injury and post-acute sequelae. Specific comorbidities (and overall multimorbidity) can either exacerbate these pathological mechanisms or reduce the patient's tolerance to organ injury. In this Review, we consider the impact of specific comorbidities, and overall multimorbidity, on the three mechanistically distinct phases of COVID-19, and we discuss the utility of host genetics as a route to causal inference by eliminating many sources of confounding. Continued research into the mechanisms of disease-state interactions will be crucial to inform stratification of therapeutic approaches and improve outcomes for patients.

The stability of self-control in a population-representative study

We investigate the stability of self-control at the population level. Analyzing repeated Brief Self-Control Scale scores, we demonstrate that self-control exhibits a high degree of mean-level, rank-order, and individual-level stability over the medium term. Changes in self-control are not associated with major life events, nor are they economically important. The stability of self-control is particularly striking given that our study period (2017–2020) spans the onset of the COVID-19 pandemic. © 2022

Early career researchers and predatory journals during the Covid-19 pandemic. An international analysis

Around 170 early career researchers (ECRs) from 8 countries were interviewed about the whole range of their scholarly communication attitudes/behaviours during pandemic times and this paper analyses what they said about predatory journals in a wide range of scholarly communication contexts. Because of the delicacy of the topic there was just one question exclusively directed at predatory journals, which asked about policies rather than actions, which yielded nevertheless wide-ranging comments on the topic. ECRs also volunteered information on predatory journals in another half dozen questions, most notably including one on questionable research practices. The source of data was mainly the final interview of three undertaken, with some comparisons made to rounds one and two. Findings disclose the existence of a whole raft of formal and informal assessment policies/codes that direct ECRs to legitimate journals and away from predatory ones. Despite being junior, ECRs are very accultured to the criteria of what is considered as prestige and quality and believe predatory publishing is not even conceivable. They are far more concerned about low-quality research, preprints and borderline ‘grey' journals. The pandemic has increased the level of questionable practices and low-quality research, but predatory journals were only singled out by a relatively small number of ECRs. © 2023, El Profesional de la Informacion. All rights reserved.

The Well for wellbeing

The NHS workforce is exhausted. The fallout from the COVID-19 pandemic is ever present and likely to continue for the foreseeable future. We have been utilising appreciative inquiry methodology to redress the level of negativity, and restore wellbeing and cohesiveness within our elective theatre team. Appreciative inquiry is an asset-based philosophy that can be used as a change management tool. Two of the main principles of appreciative inquiry are: 'what we choose to focus on will expand', and 'we can create our future by how we interpret our current reality'. We wanted to channel these principles to help us focus on the specific contributions from team members and how those contributions create the atmosphere in our operating theatres. Methods Our elective theatre lists usually close with a debrief session, which now incorporate The Well (see Fig. 1). The Well helps to identify moments in the working day that were effective or went well. Each team member picks discussion points and shares the story of what they noticed that was successful. We also collected feedback on the new format for the debrief session. Results All the stories were collated, and the top three themes were: making connections, shared decision-making, communication. Two examples shared during the sessions: 'There was a change to the list order, but this did not impact on the running of the list. There was a flow of communication between us - we were in sync.' and 'Decisions were shared - there was a complex patient and the decisions needed to be made early. The dialogue between the team was open.' Feedback on the session format included: 'I enjoy the stories shared during The Well session and I pay more attention to what is going on around me during the list so I can contribute more to the discussion.' 'The Well feels purposeful and it shows a level of appreciation that was not captured by the usual "thank you for your help today".' Discussion The Well has been well received and feedback shows that the appreciative inquiry methodology has helped to create and deepen connections between team members. We hope by sharing the stories of what has gone well we can encourage these behaviours to happen more often and flourish within our workplace. (Figure Presented).

Outcome of COVID-19 in hospitalised immunocompromised patients: An analysis of the WHO ISARIC CCP-UK prospective cohort study.

BACKGROUND: Immunocompromised patients may be at higher risk of mortality if hospitalised with Coronavirus Disease 2019 (COVID-19) compared with immunocompetent patients. However, previous studies have been contradictory. We aimed to determine whether immunocompromised patients were at greater risk of in-hospital death and how this risk changed over the pandemic. METHODS AND FINDINGS: We included patients > = 19 years with symptomatic community-acquired COVID-19 recruited to the ISARIC WHO Clinical Characterisation Protocol UK prospective cohort study. We defined immunocompromise as immunosuppressant medication preadmission, cancer treatment, organ transplant, HIV, or congenital immunodeficiency. We used logistic regression to compare the risk of death in both groups, adjusting for age, sex, deprivation, ethnicity, vaccination, and comorbidities. We used Bayesian logistic regression to explore mortality over time. Between 17 January 2020 and 28 February 2022, we recruited 156,552 eligible patients, of whom 21,954 (14%) were immunocompromised. In total, 29% (n = 6,499) of immunocompromised and 21% (n = 28,608) of immunocompetent patients died in hospital. The odds of in-hospital mortality were elevated for immunocompromised patients (adjusted OR 1.44, 95% CI [1.39, 1.50], p < 0.001). Not all immunocompromising conditions had the same risk, for example, patients on active cancer treatment were less likely to have their care escalated to intensive care (adjusted OR 0.77, 95% CI [0.7, 0.85], p < 0.001) or ventilation (adjusted OR 0.65, 95% CI [0.56, 0.76], p < 0.001). However, cancer patients were more likely to die (adjusted OR 2.0, 95% CI [1.87, 2.15], p < 0.001). Analyses were adjusted for age, sex, socioeconomic deprivation, comorbidities, and vaccination status. As the pandemic progressed, in-hospital mortality reduced more slowly for immunocompromised patients than for immunocompetent patients. This was particularly evident with increasing age: the probability of the reduction in hospital mortality being less for immunocompromised patients aged 50 to 69 years was 88% for men and 83% for women, and for those >80 years was 99% for men and 98% for women. The study is limited by a lack of detailed drug data prior to admission, including steroid doses, meaning that we may have incorrectly categorised some immunocompromised patients as immunocompetent. CONCLUSIONS: Immunocompromised patients remain at elevated risk of death from COVID-19. Targeted measures such as additional vaccine doses, monoclonal antibodies, and nonpharmaceutical preventive interventions should be continually encouraged for this patient group. TRIAL REGISTRATION: ISRCTN 66726260.

Do lung ultrasound abnormalities change during hospitalization for COVID-19?

Background. While point-of-care ultrasound (POCUS) has been used to track disease resolution, temporal trends in lung ultrasound (LUS) findings among hospitalized patients with COVID-19 is not well-characterized. Methods. We studied 413 LUS scans in 244 participants >= 18 years of age hospitalized for COVID-19 pneumonia within 28 days of symptom onset from April, 2020 until September, 2021 at the Johns Hopkins Hospital, Baltimore Maryland. All patients were scanned using a 12-lung zone protocol and repeat scans were obtained in 3 days (N=114), 7 days (N=53), and weekly (N=9) from the initial scan. Participants were followed to determine clinical outcomes until hospital discharge and vital status at 28-days. Ultrasounds were independently reviewed for lung artifacts, and the composite mean LUS score (ranging from 0 to 3) across lung zones was determined. Trends of mean LUS scores and%lung fields with A-lines (indicating proportion of normal lung fields) were plotted by peak severity (mild, moderate, and severe defined by the World Health Organization Ordinal Scale) over time from symptom onset. Differences in mean LUS score or % A-lines changes over time between peak severity levels were evaluated using a Kruskal-Wallis test and linear mixed-effected models with an exchangeable correlation structure. Results. Among 244 patients in our cohort (mean age of 58.2 (SD 15.0) years, and 55.7% female) (Table 1), there was no change in average mean LUS scores between the first two visits by severity groups (Figure 1;Kruskal-Wallis p=0.63). Mean LUS scores were elevated by 0.22 (p< 0.001) in a dose-response manner regardless of duration of illness, but there was no change over time associated with peak severity (p=0.73). Similarly, percentage of A-lines were in 13.9% less lung fields for each increase in peak severity (p< 0.001;Figure 2) regardless of duration of illness. However, a change in mean LUS score did not differ significantly among peak severity levels (p=0.36). Conclusion. Mean LUS scores correlated with clinical severity among hospitalized adults when assessed cross-sectionally, however mean LUS score did not change or differ between peak severity levels over the time course of hospitalization. These results do not support serial LUS scans to monitor disease progression.

Associations of Incomplete SARS-CoV-2 Vaccination among Patients with Unstable Housing in Houston

Vaccination is a safe and effective way to protect against SARS-CoV-2. Two of the three authorized SARS-CoV-2 vaccines require two doses, presenting logistical challenges. Those with unstable housing face barriers that amplify these challenges. In this study, we utilized a database maintained by Healthcare for the Homeless-Houston to determine the rates of partial vaccination among those with unstable housing in Houston (n=294). We then performed post-hoc analyses to identify predictors of partial vaccination. Our key finding was that 30% of those with unstable housing missed their second dose, a proportion far higher than the national average. Those with permanent supportive housing and those who had a Harris County Gold Card (financial assistance for health care costs) were more likely to return for dose two, while those who were younger, living on the streets, or staying in a temporary homeless shelter were more likely to miss the second dose.

Systematic comparison of ranking aggregation methods for gene lists in experimental results.

MOTIVATION: A common experimental output in biomedical science is a list of genes implicated in a given biological process or disease. The gene lists resulting from a group of studies answering the same, or similar, questions can be combined by ranking aggregation methods to find a consensus or a more reliable answer. Evaluating a ranking aggregation method on a specific type of data before using it is required to support the reliability since the property of a dataset can influence the performance of an algorithm. Such evaluation on gene lists is usually based on a simulated database because of the lack of a known truth for real data. However, simulated datasets tend to be too small compared to experimental data and neglect key features, including heterogeneity of quality, relevance and the inclusion of unranked lists. RESULTS: In this study, a group of existing methods and their variations that are suitable for meta-analysis of gene lists are compared using simulated and real data. Simulated data were used to explore the performance of the aggregation methods as a function of emulating the common scenarios of real genomic data, with various heterogeneity of quality, noise level and a mix of unranked and ranked data using 20 000 possible entities. In addition to the evaluation with simulated data, a comparison using real genomic data on the SARS-CoV-2 virus, cancer (non-small cell lung cancer) and bacteria (macrophage apoptosis) was performed. We summarize the results of our evaluation in a simple flowchart to select a ranking aggregation method, and in an automated implementation using the meta-analysis by information content algorithm to infer heterogeneity of data quality across input datasets. AVAILABILITY AND IMPLEMENTATION: The code for simulated data generation and running edited version of algorithms: https://github.com/baillielab/comparison_of_RA_methods. Code to perform an optimal selection of methods based on the results of this review, using the MAIC algorithm to infer the characteristics of an input dataset, can be downloaded here: https://github.com/baillielab/maic. An online service for running MAIC: https://baillielab.net/maic. SUPPLEMENTARY INFORMATION: Supplementary data are available at Bioinformatics online.

ISARIC-COVID-19 dataset: A Prospective, Standardized, Global Dataset of Patients Hospitalized with COVID-19.

The International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) COVID-19 dataset is one of the largest international databases of prospectively collected clinical data on people hospitalized with COVID-19. This dataset was compiled during the COVID-19 pandemic by a network of hospitals that collect data using the ISARIC-World Health Organization Clinical Characterization Protocol and data tools. The database includes data from more than 705,000 patients, collected in more than 60 countries and 1,500 centres worldwide. Patient data are available from acute hospital admissions with COVID-19 and outpatient follow-ups. The data include signs and symptoms, pre-existing comorbidities, vital signs, chronic and acute treatments, complications, dates of hospitalization and discharge, mortality, viral strains, vaccination status, and other data. Here, we present the dataset characteristics, explain its architecture and how to gain access, and provide tools to facilitate its use.

Attitudes about police and race in the United States 2020-2021: Mean-level trends and associations with political attitudes, psychiatric problems, and COVID-19 outcomes.

The murder of George Floyd and subsequent mass protest movement in the summer of 2020 brought policing, race, and police brutality to the forefront of American political discourse. We examined mean-levels of attitudes about police and race using online surveys administered at five time points from June 2020 to October 2021 (n ~ 1000 at each wave) to adults living in the United States. There was a small increase in pro-police attitudes over this time (d = .24), and some evidence that mean-levels of pro-police attitudes increased more for Black participants (d = .51) than White participants (d = .20), and more for Democrats (d = .40) than Republicans (d = .15). Pro-police attitudes were much lower among Black participants than White participants (mean d = -1.04), and-relative to political independents-lower among Democrats (mean d = -.66) and higher among Republicans (mean d = .72). Pro-police attitudes had large associations with a variety of conservative or right-wing political attitudes (e.g., approval of Donald Trump) and COVID-19 variables (e.g., disapproval of government mandates and restrictions), but were unrelated to psychiatric problems and substance use. These results validate a new measure of police attitudes, provide information on trends in police attitudes over the 15 months following the largest mass protests against police brutality in American history, and begin to establish the nomological network of police attitudes, finding that pro-police attitudes are firmly within the right-wing coalition of American politics.

Outcome of COVID-19 in hospitalised immunocompromised patients: an analysis of the WHO ISARIC CCP-UK prospective cohort study. (preprint)

Background Immunocompromised patients may be at higher risk of mortality if hospitalised with COVID-19 compared with immunocompetent patients. However, previous studies have been contradictory. We aimed to determine whether immunocompromised patients were at greater risk of in-hospital death, and how this risk changed over the pandemic. Methods We included patients >=19yrs with symptomatic community-acquired COVID-19 recruited to the ISARIC WHO Clinical Characterisation Protocol UK. We defined immunocompromise as: immunosuppressant medication preadmission, cancer treatment, organ transplant, HIV, or congenital immunodeficiency. We used logistic regression to compare the risk of death in both groups, adjusting for age, sex, deprivation, ethnicity, vaccination and co-morbidities. We used Bayesian logistic regression to explore mortality over time. Findings Between 17/01/2020 and 28/02/2022 we recruited 156,552 eligible patients, of whom 21,954 (14%) were immunocompromised. 29% (n=6,499) of immunocompromised and 21% (n=28,608) of immunocompetent patients died in hospital. The odds of inhospital mortality were elevated for immunocompromised patients (adjOR 1.44, 95% CI 1.39-1.50, p<0.001). As the pandemic progressed, in-hospital mortality reduced more slowly for immunocompromised patients than for immunocompetent patients. This was particularly evident with increasing age: the probability of the reduction in hospital mortality being less for immunocompromised patients aged 50-69yrs was 88% for men and 83% for women, and for those >80yrs was 99% for men, and 98% for women. Conclusions Immunocompromised patients remain at elevated risk of death from COVID-19. Targeted measures such as additional vaccine doses and monoclonal antibodies should be considered for this group.

PRE-PANDEMIC CIRCADIAN PHASE PREDICTS PANDEMIC SLEEP, DEPRESSION, AND ALCOHOL USE AMONG ADOLESCENTS

Growing evidence links later circadian rhythm timing during adolescence to worse sleep, more symptoms of depression, and greater alcohol involvement, perhaps due to circadian misalignment and sleep restriction imposed by early school start times. School schedules shifted later during the initial phase of the COVID-19 pandemic, which hypothetically should reduce circadian misalignment and sleep restriction for adolescents with later circadian timing, and thus may mitigate any problems with sleep, depression, and alcohol. Here we used the pandemic as a natural experiment to test whether adolescent drinkers with later circadian timing, relative to those with earlier circadian timing, showed improved sleep, depressive symptoms, and alcohol involvement. We studied 42 high school juniors and seniors reporting alcohol use (aged 16-18;27 female participants), assessing circadian phase via the dim light melatonin onset (DLMO) during pre-pandemic conditions, and then following them over four remote assessments every 3 months during the pandemic. Sleep characteristics were assessed via the Munich Chronotype Questionnaire, depressive symptoms were assessed via the Quick Inventory of Depressive Symptomatology, and alcohol use was assessed via a 90-day Timeline Followback. Mixed-effect models focused on the pre-pandemic baseline, COVID baseline (Apr/ May 2020), and COVID-9-mo (Jan/Feb 2021) timepoints, and covaried for age, time between prepandemic and COVID baselines, and whether or not individuals were currently in school or working. In the pre-pandemic period, compared with those with earlier circadian timing, individuals with later circadian timing (later DLMO) got relatively less sleep (shorter total sleep time) on school nights. During the pandemic, earlier and later groups no longer differed on school night sleep. Over the course of the pandemic, compared with the earlier group, individuals with later circadian timing also reported larger increases in alcohol use (number of drinks, drinking days, and maximum drinks). Individuals with later circadian timing reported relatively greater depressive symptoms both pre-pandemic and 9-months into the pandemic. While individuals with later circadian timing benefitted in terms of more school night sleep during the pandemic, this did not translate to mitigating depression or alcohol use. These findings suggest that later circadian timing may contribute to risk for depression and alcohol use over and above effects due to insufficient sleep.

PRE-PANDEMIC CIRCADIAN PHASE PREDICTS PANDEMIC SLEEP, DEPRESSION, AND ALCOHOL USE AMONG ADOLESCENTS

Introduction: Growing evidence links later circadian timing during adolescence to worse sleep, more severe depression, and greater alcohol involvement, perhaps due to circadian misalignment and sleep restriction imposed by early school start times. School schedules initially shifted later during the COVID-19 pandemic, which hypothetically should reduce circadian misalignment and sleep restriction for adolescents with later circadian timing, and thus may mitigate any problems with sleep, depression, and alcohol. Here we used the pandemic as a natural experiment to test whether adolescent drinkers with later circadian timing, relative to those with earlier circadian timing, showed improved sleep, depressive symptoms, and alcohol involvement. Methods: We studied 42 high school students reporting alcohol use (aged 16-18;27 female participants), assessing circadian phase via the dim light melatonin onset (DLMO) during prepandemic conditions, and then following them over four remote assessments every 3 months during the pandemic. Sleep characteristics were assessed via the Munich Chronotype Questionnaire, depressive symptoms were assessed via the Quick Inventory of Depressive Symptomatology, and alcohol use was assessed via a 90-day Timeline Followback. Mixed-effect models focused on the pre-pandemic baseline, COVID baseline (Apr/May 2020), and COVID-9-mo (Jan/Feb 2021) timepoints, and covaried for age, time between pre-pandemic and COVID baselines, and current school/work status. Results: In the pre-pandemic period, compared to those with earlier circadian timing, individuals with later circadian timing (later DLMO) got relatively less sleep (shorter total sleep time) on school nights. During the pandemic, earlier and later groups no longer differed on school night sleep. Over the course of the pandemic, compared to the earlier group, individuals with later circadian timing also reported larger increases in alcohol use (number of drinks, drinking days, and maximum drinks). Individuals with later circadian timing reported relatively greater depressive symptoms both pre-pandemic and 9-months into the pandemic. Conclusion: While individuals with later circadian timing benefitted in terms of more school night sleep during the pandemic, this did not translate to mitigating depression or alcohol use. These findings suggest that later circadian timing may contribute to risk for depression and alcohol use over and above effects due to insufficient sleep.

Procalcitonin Is Not a Reliable Biomarker of Bacterial Coinfection in People With Coronavirus Disease 2019 Undergoing Microbiological Investigation at the Time of Hospital Admission.

Admission procalcitonin measurements and microbiology results were available for 1040 hospitalized adults with coronavirus disease 2019 (from 48 902 included in the International Severe Acute Respiratory and Emerging Infections Consortium World Health Organization Clinical Characterisation Protocol UK study). Although procalcitonin was higher in bacterial coinfection, this was neither clinically significant (median [IQR], 0.33 [0.11-1.70] ng/mL vs 0.24 [0.10-0.90] ng/mL) nor diagnostically useful (area under the receiver operating characteristic curve, 0.56 [95% confidence interval, .51-.60]).