Early procalcitonin to predict mortality in critically ill COVID-19 patients: a multicentric cohort study

Zattera, Luigi; Veliziotis, Ioannis; Benítez-Cano, Adela; Ramos, Isabel; Larrañaga, Leire; Núñez, María; Román, L.; Adalid, Irina; Ferrando, Carlos; Muñoz, Guido; Arruti, Egoitz; Minini, Andrea; Bassas, E.; Hernández, M.D. Jiménez; Taccone, Fabio Silvio; Peluso, Lorenzo; Adàlia, R.

doi:10.23736/s0375-9393.22.15942-0

Cited by 2 publications

(1 citation statement)

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“…A number of small case-series support that PCT is not elevated in COVID-19 patients, in contrast to other inflammation markers like CRP and ferritin [87][88][89]. The largest of these observational studies, conducted in New York, reports that only 16.9% of patients have PCT levels 0.5 ng/mL or more at hospital admission [90] and such high levels are associated with development of critical disease, admission in the ICU and increased risk for death [91][92][93]. A recent meta-analysis of 10 cohort studies including a total of 7716 patients estimated a pooled risk of 1.77 (95% CI, 1.38 to 2.29) for severe and critical COVID-19 by elevated PCT levels at admission, although results are highly heterogenous (I 2 :85.6%) [94].…”

Section: Antimicrobial Stewardship Using Biomarkers In the Covid-19 Eramentioning

confidence: 99%

Antimicrobial Stewardship Using Biomarkers: Accumulating Evidence for the Critically Ill

Kyriazopoulou

Giamarellos‐Bourboulis

2022

Antibiotics

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This review aims to summarize current progress in the management of critically ill, using biomarkers as guidance for antimicrobial treatment with a focus on antimicrobial stewardship. Accumulated evidence from randomized clinical trials (RCTs) and observational studies in adults for the biomarker-guided antimicrobial treatment of critically ill (mainly sepsis and COVID-19 patients) has been extensively searched and is provided. Procalcitonin (PCT) is the best studied biomarker; in the majority of randomized clinical trials an algorithm of discontinuation of antibiotics with decreasing PCT over serial measurements has been proven safe and effective to reduce length of antimicrobial treatment, antibiotic-associated adverse events and long-term infectious complications like infections by multidrug-resistant organisms and Clostridioides difficile. Other biomarkers, such as C-reactive protein and presepsin, are already being tested as guidance for shorter antimicrobial treatment, but more research is needed. Current evidence suggests that biomarkers, mainly procalcitonin, should be implemented in antimicrobial stewardship programs even in the COVID-19 era, when, although bacterial coinfection rate is low, antimicrobial overconsumption remains high.

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