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Negative predictive value of procalcitonin to rule out bacterial respiratory co-infection in critical covid-19 patients.
Carbonell, Raquel; Urgelés, Silvia; Salgado, Melina; Rodríguez, Alejandro; Reyes, Luis Felipe; Fuentes, Yuli V; Serrano, Cristian C; Caceres, Eder L; Bodí, María; Martín-Loeches, Ignacio; Solé-Violán, Jordi; Díaz, Emili; Gómez, Josep; Trefler, Sandra; Vallverdú, Montserrat; Murcia, Josefa; Albaya, Antonio; Loza, Ana; Socias, Lorenzo; Ballesteros, Juan Carlos; Papiol, Elisabeth; Viña, Lucía; Sancho, Susana; Nieto, Mercedes; Del, M; Lorente, Carmen; Badallo, Oihane; Fraile, Virginia; Arméstar, Fernando; Estella, Angel; Abanses, Paula; Sancho, Isabel; Guasch, Neus; Moreno, Gerard.
  • Carbonell R; Critical Care Department, Hospital Universitari Joan XXIII, Tarragona, Spain.. Electronic address: raquelviok7@gmail.com.
  • Urgelés S; Critical Care Department, Hospital Universitari Joan XXIII, Tarragona, Spain.
  • Salgado M; Critical Care Department, Hospital Universitari Joan XXIII, Tarragona, Spain.
  • Rodríguez A; Critical Care Department, URV/IISPV/CIBERES, Hospital Universitari Joan XXIII, Tarragona, Spain.
  • Reyes LF; Universidad de La Sabana, Chia, Colombia; Clinica Universidad de La Sabana, Chia, Colombia.
  • Fuentes YV; Universidad de La Sabana, Chia, Colombia; Clinica Universidad de La Sabana, Chia, Colombia.
  • Serrano CC; Universidad de La Sabana, Chia, Colombia; Clinica Universidad de La Sabana, Chia, Colombia.
  • Caceres EL; Universidad de La Sabana, Chia, Colombia; Clinica Universidad de La Sabana, Chia, Colombia.
  • Bodí M; Critical Care Department, URV/IISPV/CIBERES, Hospital Universitari Joan XXIII, Tarragona, Spain.
  • Martín-Loeches I; Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital, Dublin, Ireland.
  • Solé-Violán J; Critical Care Department, Hospital Universitario Doctor Negrín, Gran Canaria, Spain.
  • Díaz E; Critical Care Department, Hospital Universitari Parc Taulí, Universitat Autonoma Barcelona, Sabadell, Spain.
  • Gómez J; Critical Care Department, URV/IISPV/CIBERES, Hospital Universitari Joan XXIII, Tarragona, Spain.
  • Trefler S; Critical Care Department, URV/IISPV/CIBERES, Hospital Universitari Joan XXIII, Tarragona, Spain.
  • Vallverdú M; Critical Care Department, Hospital Universitari Arnau de Vilanova, Lleida, Spain.
  • Murcia J; Critical Care Deparment, Hospital Santa Lucía, Cartagena, Spain.
  • Albaya A; Critical Care Department, Hospital Universitario de Guadalajara, Guadalajara, Spain.
  • Loza A; Critical Care Department, Hospital Universitario Virgen del Valme, Sevilla, Spain.
  • Socias L; Critical Care Department, Hospital Universitari Son Llàtzer, Palma de Mallorca, Spain.
  • Ballesteros JC; Critical Care Department, Hospital de Salamanca, Salamanca, Spain.
  • Papiol E; Critical Care Department, Hospital Universitari Vall d'Hebrón, Barcelona, Spain.
  • Viña L; Critical Care Department, Hospital Universitario Central de Asturias, Oviedo, Spain.
  • Sancho S; Critical Care Department, Hospital Universitario y Politecnico de La Fe, Valencia, Spain.
  • Nieto M; Critical Care Department, Hospital Clínico San Carlos, Madrid, Spain.
  • Del M; Critical Care Department, Hospital Universitari Joan XXIII, Tarragona, Spain.
  • Lorente C; Critical Care Department, Hospital Rafael Mendez, Lorca, Spain.
  • Badallo O; Critical Care Department, Hospital Universitario de Burgos, Burgos, Spain.
  • Fraile V; Critical Care Department, Hospital Universitario Rio Hortega, Valladolid, Spain.
  • Arméstar F; Critical Care Department, Hospital Germans Trias i Pujol, Universitat Autonoma Barcelona, Badalona, Spain.
  • Estella A; Critical Care Department, Hospital Universitario de Jerez, Jerez de la Frontera, Spain.
  • Abanses P; Critical Care Department, Hospital Clinico de Zaragoza, Zaragoza, Spain.
  • Sancho I; Critical Care Department, Hospital Universitario Miguel Servet, Zaragoza, Spain.
  • Guasch N; Critical Care Department, Hospital Nostra Senyora de Meritxell, Escaldes-Engordany, Andorra.
  • Moreno G; Critical Care Department, Hospital Universitari Joan XXIII, Tarragona, Spain.
J Infect ; 2022 Jun 30.
Article in English | MEDLINE | ID: covidwho-1914623
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.
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Full text: Available Collection: International databases Database: MEDLINE Type of study: Observational study / Prognostic study / Risk factors Language: English Year: 2022 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Observational study / Prognostic study / Risk factors Language: English Year: 2022 Document Type: Article