Serum procalcitonin level is independently associated with mechanical ventilation and case-fatality in hospitalized COVID-19-positive US veterans–A potential marker for disease severity

Abstract

The Coronavirus-19 disease (COVID-19) has claimed over 6.8 million lives since first being reported in late 2019. The virus that causes COVID-19 disease is highly contagious and spreads rapidly. To date, there are no approved prognostic tools that could predict why some patients develop severe or fatal disease outcomes. Early COVID-19 studies found an association between procalcitonin (PCT) and hospitalization or duration of mechanical ventilation and death but were limited by the cohort sizes. Therefore, this study was designed to confirm the associations of PCT with COVID-19 disease severity outcomes in a large cohort. For this retrospective data analysis study, 27,154 COVID-19-positive US veterans with post-infection PCT laboratory test data and their disease severity outcomes were accessed using the VA electronic healthcare data. Cox regression models were used to test the association between serum PCT levels and disease outcomes while controlling for demographics and relevant confounding variables. The models demonstrated increasing disease severity (ventilation and death) with increasing PCT levels. For PCT serum levels above 0.20 ng/ml, the unadjusted risk increased nearly 2.3-fold for mechanical ventilation (hazard ratio, HR, 2.26, 95%CI: 2.11–2.42) and in-hospital death (HR, 2.28, 95%CI: 2.16–2.41). Even when adjusted for demographics, diabetes, pneumonia, antibiotic use, white blood cell count, and serum C-reactive protein levels, the risks remained relatively high for mechanical ventilation (HR, 1.80, 95%CI: 1.67–1.94) and death (HR, 1.76, 95%CI: 1.66–1.87). These data suggest that higher PCT levels have independent associations with ventilation and in-hospital death in veterans with COVID-19 disease, validating previous findings. The data suggested that serum PCT level may be a promising prognostic tool for COVID-19 severity assessment and should be further evaluated in a prospective clinical trial.

Development and validation of a prognostic model based on clinical laboratory biomarkers to predict admission to ICU in Omicron variant-infected hospitalized patients complicated with myocardial injury

“…Some studies have found that elevated PCT levels are associated with the severity of infection, inflammatory response, and tissue damage in COVID-19 ( 33 – 35 ). Higher PCT levels may also indicate worsening infection and poor prognosis ( 36 , 37 ). In patients with COVID-19 infection or MI, the levels of CRP often increase ( 38 ).…”

Utility of Serum Procalcitonin and Its Clearance in Predicting Outcomes in COVID-19 Patients

“…We reported that a serum PCT cut-off value of 1.2 ng/ml on admission and 0.44 ng/ml on day 5 of hospitalization predicted mortality with a sensitivity of 72.7% and 88.9% and a specificity of 78.6% and 85.7%, respectively. Jeyapalina et al [6] reported serum PCT greater than 0.20 ng/ml to be independently associated with mechanical ventilation and mortality in hospitalized COVID-19 patients (unadjusted HR, 2.28, 95%CI: 2.16-2.41 for mortality). In a meta-analysis that included patients of various severities (nonsevere and severe), the cut-off value that predicted mortality ranged from 0.05 to 0.5 ng/mL [17].…”

“…Several clinical and laboratory parameters have been used in patients infected with SARS-CoV-2, either individually or in the form of a risk-scoring system, to predict the severity of illness, disease progression, and mortality [4,5]. Various studies have evaluated the role of serum levels of pro-calcitonin (PCT) in predicting disease severity and mortality in such patients [6][7][8]. PCT synthesis is triggered by various toxins and cytokines like interleukin-6 (IL-6) or tumor necrosis factor-alpha (TNF-ɑ).…”