Searching for a role of procalcitonin determination in COVID-19: a study on a selected cohort of hospitalized patients

被引:28
作者
Dolci, Alberto [1 ,2 ]
Robbiano, Cristina [1 ]
Aloisio, Elena [1 ]
Chibireva, Mariia [1 ]
Serafini, Ludovica [1 ]
Falvella, Felicia Stefania [1 ]
Pasqualetti, Sara [1 ]
Panteghini, Mauro [1 ,2 ]
机构
[1] ASST Fatebenefratelli Sacco, Clin Pathol Unit, Via GB Grassi 74, I-20157 Milan, Italy
[2] Univ Milan, Dept Biomed & Clin Sci Luigi Sacco, Milan, Italy
关键词
bacterial infection; COVID-19; procalcitonin; severe acute respiratory syndrome coronavirus 2; CORONAVIRUS DISEASE 2019; CLINICAL CHARACTERISTICS; SEPSIS;
D O I
10.1515/cclm-2020-1361
中图分类号
R446 [实验室诊断]; R-33 [实验医学、医学实验];
学科分类号
1001 ;
摘要
Objectives: Procalcitonin (PCT) has been proposed for differentiating viral vs. bacterial infections. In COVID-19, some preliminary results have shown that PCT testing could act as a predictor of bacterial co-infection and be a useful marker for assessment of disease severity. Methods: We studied 83 COVID-19 hospitalized patients in whom PCT was specifically ordered by attending physicians. PCT results were evaluated according to the ability to accurately predict bacterial co-infections and death in comparison with other known biomarkers of infection and with major laboratory predictors of COVID-19 severity. Results: Thirty-three (39.8%) patients suffered an inhospital bacterial co-infection and 44 (53.0%) patients died. In predicting bacterial co-infection, PCT showed a relatively low accuracy (area under receiver-operating characteristic [ROC] curve [AUC]: 0.757; 95% confidence interval [CI]: 0.651-0.845), with a strength for detecting the outcome not significantly different from that of white blood cell count and C-reactive protein (CRP). In predicting patient death, PCT showed an AUC of 0.815 (CI: 0.714-0.892), not better than those of other more common laboratory tests, such as blood lymphocyte percentage (AUC: 0.874, p=0.19), serum lactate dehydrogenase (AUC: 0.860, p=0.47), blood neutrophil count (AUC: 0.845, p= 0.59), and serum albumin (AUC: 0.839, p=0.73). Conclusions: Procalcitonin (PCT) testing, even when appropriately ordered, did not provide a significant added value in COVID-19 patients when compared with more consolidated biomarkers of infection and poor clinical outcome. The major application of PCT in COVID-19 is its ability, associated with a negative predictive value >90%, to exclude a bacterial co-infection when a rule-out cut-off (<0.25 mu g/L) is applied.
引用
收藏
页码:433 / 440
页数:8
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