Is procalcitonin a reliable marker of bacterial community-acquired pneumonia in adults admitted to the emergency department during SARS-CoV-2 pandemic?

Malinverni, Stefano; Nuňez, Maïa; Cotton, Frédéric; Martiny, Delphine; Collot, Vincent; Konopnicki, Déborah; Alard, Serge; Bartiaux, Magali

doi:10.1097/mej.0000000000000796

Cited by 9 publications

(8 citation statements)

References 10 publications

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“…The role of PCT in ruling out co-infections in patients hospitalized with COVID-19 remains a controversial topic. Some prior studies analyzing this issue included a very low number of patients and had several methodological limitations (Heer et al, 2021;Malinverni et al, 2021;Pink et al, 2021). May et al retrospectively analyzed the role of PCT in diagnosing co-infection in a larger cohort of 2443 patients admitted with COVID-19 (May et al, 2021).…”

Section: Discussionmentioning

confidence: 99%

Bacterial co-infection at hospital admission in patients with COVID-19

Moreno-García¹,

Puerta‐Alcalde²,

Letona³

et al. 2022

International Journal of Infectious Diseases

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Section: Discussionmentioning

confidence: 99%

Bacterial co-infection at hospital admission in patients with COVID-19

Moreno-García¹,

Puerta‐Alcalde²,

Letona³

et al. 2022

International Journal of Infectious Diseases

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“…When comparing other complications, there was no significant difference among the two groups. Likewise there was no difference when comparing outcomes including ventilator days (11 days (IQR 6-18.3) versus 10 (6.5-18.5), p = 0.97), ICU length of stay (9 days (5-18) versus 9.5 (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22), p = 0.89), hospital length of stay (16 days (11-25) versus 16 (9-27.5), p = 0.80), or mortality (57 (44.9%) versus 22 (57.9%), p = 0.16).…”

Section: Resultsmentioning

confidence: 93%

“… 30 This hyper-inflammation and cytokine storm caused by COVID-19, ultimately decreases the discriminatory power of PCT. 12 …”

Section: Discussionmentioning

confidence: 99%

“…Conflicting evidence exists regarding the utility of procalcitonin in diagnosing bacterial coinfections. 10 – 14 PCT has been investigated as a tool to diagnose ventilator-associated pneumonia (VAP) 15 and secondary pulmonary infections, including both viral and bacterial infections, in patients with COVID-19. 16 , 17 Although early literature suggests that elevated PCT is associated with COVID-19 disease severity and increased mortality, there is a paucity of data specific to critically ill COVID-19 patients with concomitant bacterial pneumonia.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of Procalcitonin's Utility to Predict Concomitant Bacterial Pneumonia in Critically Ill COVID-19 Patients

Patel¹,

Adams

Brunetti

et al. 2022

J Intensive Care Med

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Background: Historically, procalcitonin(PCT) has been used as a predictor of bacterial infection and to guide antibiotic therapy in hospitalized patients. The purpose of this study was to determine PCT's diagnostic utility in predicting secondary bacterial pneumonia in critically ill patients with severe COVID-19 pneumonia. Methods: A retrospective cohort study was conducted in COVID-19 adults admitted to the ICU between March 2020, and March 2021. All included patients had a PCT level within 72 h of presentation and serum creatinine of <1.5mg/dL. A PCT threshold of 0.5ng/mL was used to compare patients with high( ≥ 0.5ng/mL) versus low(< 0.5ng/mL) PCT. Bacterial pneumonia was defined by positive respiratory culture. A receiver operating characteristics (ROC) curve was utilized to evaluate PCT as a diagnostic test for bacterial pneumonia, with an area under the curve(AUC) threshold of 0.7 to signify an accurate diagnostic test. A multivariable model was constructed to identify variables associated with in-hospital mortality. Results: There were 165 patients included: 127 low PCT versus 38 high PCT. There was no significant difference in baseline characteristics, vital signs, severity of disease, or outcomes among low versus high PCT groups (all p > 0.05). While there was no difference in bacterial pneumonia in low versus high groups (34(26.8%) versus 12(31.6%), p = 0.562), more patients in the high PCT group had bacteremia (19(15%) versus 11(28.9%), p = 0.050). Sensitivity was 26.1% and specificity was 78.2% for PCT to predict bacterial pneumonia coinfection in ICU patients with COVID-19 pneumonia. ROC yielded an AUC 0.54 ( p = 0.415). After adjusting for LDH>350U/L and creatinine in multivariable regression, PCT did not enhance performance of the regression model. Conclusions: PCT offers little to no predictive utility in diagnosing concomitant bacterial pneumonia in critically ill patients with COVID-19 nor in predicting increased severity of disease or worse outcomes including mortality.

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“…We read with interest the work by Malinverni et al . who concluded that procalcitonin concentrations measured on admission were unable to differentiate between bacterial and viral pneumonia in COVID-19 patients [ 3 ]. Our recently published study evaluated the association between procalcitonin and COVID-19 severity in a critical care setting and whether bacterial co-infection was implicated [ 4 ].…”

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confidence: 99%