Background Patients with a severe COVID-19 infection often require admission at an intensive care unit (ICU) when they develop acute respiratory distress syndrome (ARDS). Hyperinflammation plays an important role in the development of ARDS in COVID-19. Procalcitonin (PCT) is a biomarker which may be a predictor of hyperinflammation. When patients with COVID-19 are in the emergency department (ED), elevated PCT levels could be associated with severe COVID-19 infections. The goal of this study is to investigate the association between PCT levels and severe COVID-19 infections in the ED. Methods This was a retrospective cohort study including patients with a confirmed COVID-19 infection who visited the ED of Erasmus Medical Center in Rotterdam, the Netherlands, between March and December 2020. The primary outcome was a severe COVID-19 infection, which was defined as patients who required ICU admission, all cause in-hospital mortality and mortality within 30 days after hospital discharge. PCT levels were measured during the ED visit. We used logistic regression to calculate the odds ratio (OR) with 95% confidence interval (95% CI) and corresponding area under the curve (AUC) of PCT on a severe COVID-19 infection, adjusting for bacterial coinfections, age, sex, comorbidities, C-reactive protein (CRP) and D-dimer. Results A total of 332 patients were included in the final analysis of this study, of which 105 patients reached the composite outcome of a severe COVID-19 infection. PCT showed an unadjusted OR of 4.19 (95%CI: 2.52–7.69) on a severe COVID-19 infection with an AUC of 0.82 (95% CI: 0.76–0.87). Corrected for bacterial coinfection, the OR of PCT was 4.05 (95% CI: 2.45–7.41). Adjusted for sex, bacterial coinfection, age any comorbidity, CRP and D-dimer, elevated PCT levels were still significantly associated with a severe COVID-19 infection with an adjusted OR of 2.11 (95% CI: 1.36–3.61). The AUC of this multivariable model was 0.85 (95%CI: 0.81–0.90). Conclusion High PCT levels are associated with high rates of severe COVID-19 infections in patients with a COVID-19 infection in the ED. The routine measurement of PCT in patients with a COVID-19 infection in the ED may assist physicians in the clinical decision making process regarding ICU disposition.

IntroductionPatients with a severe COVID-19 infection often require admission at an intensive care unit (ICU) when they develop acute respiratory distress syndrome (ARDS). Hyperinflammation plays an important role in the development of ARDS in COVID-19. Procalcitonin (PCT) is a biomarker which may be a predictor of hyperinflammation. When patients with COVID-19 are in the emergency department (ED), PCT could be a predictor of severe COVID-19 infection. The goal of this study is to investigate the predictive value of PCT on severe COVID-19 infections in the ED. MethodsThis was a retrospective cohort study including patients with confirmed COVID-19 infection who visited the ED of Erasmus Medical Center in Rotterdam, the Netherlands, between March and December 2020. The primary endpoint was a severe COVID-19 infection, which was defined as patients who required ICU admission, in-hospital mortality and 30-day mortality after hospital discharge. PCT levels were measured during the ED visit. We used logistic regression to calculate the odds ratio (OR) of PCT on a severe COVID-19 infection, adjusting for bacterial coinfections, age, gender and comorbidities. ResultsA total of 332 patients were included in the final analysis of this study, of which 105 patients reached the composite endpoint of a severe COVID-19 infection. PCT showed an unadjusted OR of 4.19 (CI: 2.52-7.69) on a severe COVID-19 infection. Corrected for bacterial coinfection, the OR of PCT was 4.05 (2.45 – 7.41). Adjusted for gender, bacterial coinfection, age and comorbidities, PCT was still an independent predictor of severe COVID-19 infection with an adjusted OR of 3.82 (CI: 2.26-7.48).ConclusionPCT is a predictor of severe COVID-19 infections in patients with a COVID-19 infection in the ED. The routine measurement of PCT in patients with a COVID-19 infection in the ED may assist physicians in the clinical decision making process regarding ICU disposition when PCT levels are elevated.

IntroductionPatients with a severe COVID-19 infection often require admission at an intensive care unit (ICU) when they develop acute respiratory distress syndrome (ARDS). Hyperinflammation plays an important role in the development of ARDS in COVID-19. Procalcitonin (PCT) is a biomarker which may be a predictor of hyperinflammation. When patients with COVID-19 are in the emergency department (ED), PCT could be a predictor of severe COVID-19 infection. The goal of this study is to investigate the predictive value of PCT on severe COVID-19 infections in the ED. MethodsThis was a retrospective cohort study including patients with confirmed COVID-19 infection who visited the ED of Erasmus Medical Center in Rotterdam, the Netherlands, between March and December 2020. The primary endpoint was a severe COVID-19 infection, which was defined as patients who required ICU admission, in-hospital mortality and 30-day mortality after hospital discharge. PCT levels were measured during the ED visit. We used logistic regression to calculate the odds ratio (OR) of PCT on a severe COVID-19 infection, adjusting for bacterial coinfections, age, gender and comorbidities. ResultsA total of 332 patients were included in the final analysis of this study, of which 105 patients reached the composite endpoint of a severe COVID-19 infection. PCT showed an unadjusted OR of 4.19 (CI: 2.52-7.69) on a severe COVID-19 infection. Corrected for bacterial coinfection, the OR of PCT was 4.05 (2.45 – 7.41). Adjusted for gender, bacterial coinfection, age and comorbidities, PCT was still an independent predictor of severe COVID-19 infection with an adjusted OR of 3.82 (CI: 2.26-7.48).ConclusionPCT is a predictor of severe COVID-19 infections in patients with a COVID-19 infection in the ED. The routine measurement of PCT in patients with a COVID-19 infection in the ED may assist physicians in the clinical decision making process regarding ICU disposition when PCT levels are elevated.