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Procalcitonin and C-reactive protein to rule out early bacterial coinfection in COVID-19 critically ill patients

2023; Springer Science+Business Media; Volume: 49; Issue: 8 Linguagem: Inglês

10.1007/s00134-023-07161-1

1432-1238

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, Cristobal Galbán‐Malagón, Ana López Lago, Víctor D. Gumucio-Sanguino, María del Carmen de la Torre, Emilio Díaz, Ángel Estella, Elena 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-Meneses, Ángel Sánchez-Miralles, Susana Sancho Chinesta, Ferran Roche‐Campo, Lorenzo Socías, Jordi Solé‐Violán, Fernando Suárez-Sipmann, Luis Tamayo Lomas, Josep Trenado, Alejandro Úbeda, Luis Jorge Valdivia, Pablo Vidal, María Victoria Boado, Alejandro Rodríguez, Massimo Antonelli, Francesco Blasi, Ferrán Barbé, Antoní Torres, Rafael Máñez, Felipè Rodríguez 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, Dulce Morales, Andrés Pujol, Àngels Furro, Beatriz García, Gerard Torres, Javier Vengoechea, Sílvia Gómez, Lorena Forcelledo Espina, Emilio García Prieto, Paula Martín Vicente, Cecilia del Busto Martínez, María Aguilar Cabello, Carmen Eulalia Martínez Fernández, María Luisa Blasco, Ainhoa Serrano, Mar Juan Díaz, María Teresa Bouza Vieiro, Inés Esmorís Arijón, David Campi Hermoso, Rafaela Nogueras Salinas, Teresa Farre Monjo, Ramón Nogué Bou, Gregorio Marco Naya, Núria Ramon Coll, Juan Carlos Montejo, Gloria Renedo Sánchez‐Girón, Juan Bustamante‐Munguira, Ramón Cicuéndez Avila, Nuria Mamolar Herrera, Alexander Agrifoglio, Lucía Cachafeiro, Emilio Maseda, Albert Figueras, Maria Teresa Janer, Laura Soliva, Marta Ocón, Luisa Clar, Ignacio Ayestarán, Sandra Campos Fernández, Eva Forcadell-Ferreres, Immaculada Salvador-Adell, Neus Bofill, Berta Adell-Serrano, Josep Pedregosa Díaz, Núria Casacuberta-Barberà, Luis Urrelo-Cerrón, Àngels Piñol-Tena, Pablo Ryan, Covadonga Rodríguez Ruíz, Laura Carrión García, Juan I. Lazo Álvarez, Desire Macias Guerrero, Daniel Tognetti, Carlos García Redruello, David Mosquera Rodríguez, Eva María Menor Fernández, Sabela Vara Adrio, Vanesa Gómez Casal, Marta Segura Pensado, María Digna Rivas Vilas, Amaia García Sagastume, Raúl de Pablo, David Pestaña Laguna, Tommaso Bardi, Carmen Gómez González, Maria Luisa Gascón Castillo, José Garnacho‐Montero, Joan Ramón Masclans, Ana Salazar Degracia, Judit Bigas, Rosana Muñoz-Bermúdez, C. Vilà, F. Gómez, Irene Dot, Ana Zapatero, Yolanda Díaz, M.P. Gracia, Purificación Pérez, Andrea Castellví, Cristina Climent, Lidia Serra, Laura Barbena, Iosune Cano, Alba Herraiz, Pilar Marcos, Laura Rodríguez, María Teresa Sariñena, Ana Sánchez, J.F. Masa Jiménez, Gemma Gomà, Mercedes Ibarz, Diego de Mendoza, Victoria Alcaraz-Serrano, Joan R. Badia, Manuel Castellá, Leticia Bueno, Catia Cillóniz, Pamela Conde, Javier Fernández, Karsa Kiarostami, Alexandre López-Gavín, Cecilia L. Mantellini, Carla Speziale, Nil Vázquez, Hua Yang, Minlan Yang, Carlos Ferrando, Pedro Castro, Marta Arrieta, José M. Nicolás, Rut Andrea, Marta Barroso, Sergio Álvarez, Dario García-Gasulla, Adrián Tormos, César Aldecoa, Rubén Herrán‐Monge, José Ángel Berezo García, Pedro Enríquez Giraudo, Pablo Cardinal Fernández, Alberto Rubio-López, Orville Báez Pravia, Leire Pérez Bastida, Antonjo Álvarez Ruiz, Anna Pous, Ana López Lago, Eva Saborido Paz, Patricia Barral Segade, Manuel Valledor Mendez, Luciano Aguilera, Esther López-Ramos, Ángela Leonor Ruiz-García, Belén Beteré, Rafael Blancas, Cristina Dólera, Gloria Pérez Planelles, Enrique Marmol Peis, Maria Dolores Martínez Juan, Miriam Ruiz Miralles, Eva Pérez Rubio, Maria Van der Hofstadt Martin-Montalvo, Tatiana Villada Warrington, Sara Guadalupe Moreno Cano, Federico Gordo, Basilisa Martínez Palacios, Maria Teresa Nieto, Sergio Ossa, Ana Ortega, Miguel Sánchez, Bitor Santacoloma,

Pneumonia and Respiratory Infections

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. 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. 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. 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.