Negative predictive value of procalcitonin to rule out bacterial respiratory co-infection in critical covid-19 patients.
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Carbonell Raquel, Urgelés Silvia, Salgado Melina, Rodríguez Alejandro, Reyes Luis Felipe, Fuentes Yuli V, Serrano Cristian C, Caceres Eder L, Bodí María, Martín-Loeches Ignacio, Solé-Violán Jordi, Díaz Emili, Gómez Josep, Trefler Sandra, Vallverdú Montserrat, Murcia Josefa, Albaya Antonio, Loza Ana, Socias Lorenzo, Ballesteros Juan Carlos, Papiol Elisabeth, Viña Lucía, Sancho Susana, Nieto Mercedes, Del M, Lorente Carmen, Badallo Oihane, Fraile Virginia, Arméstar Fernando, Estella Angel, Abanses Paula, Sancho Isabel, Guasch Neus, Moreno Gerard, COVID-19 SEMICYUC Working Group and the LIVEN-Covid-19 Investigators
Аннотация
METHODS: The study represents a retrospective cohort study of patients admitted for COVID-19 pneumonia to 84 ICUs from ten countries between (March 2020-January 2021). Primary outcome was to determine whether PCT or CRP at admission could predict community-acquired bacterial respiratory co-infection (BC) and its added clinical value by determining the best discriminating cut-off values. Secondary outcome was to investigate its association with mortality. To evaluate the main outcome, a binary logistic regression was performed. The area under the curve evaluated diagnostic performance for BC prediction.
RESULTS: 4635 patients were included, 7.6% fulfilled BC diagnosis. PCT (0.25[IQR 0.1-0.7] versus 0.20[IQR 0.1-0.5]ng/mL, p<0.001) and CRP (14.8[IQR 8.2-23.8] versus 13.3 [7-21.7]mg/dL, p=0.01) were higher in BC group. Neither PCT nor CRP were independently associated with BC and both had a poor ability to predict BC (AUC for PCT 0.56, for CRP 0.54). Baseline values of PCT<0.3ng/mL, could be helpful to rule out BC (negative predictive value 91.1%) and PCT≥0.50ng/mL was associated with ICU mortality (OR 1.5,p<0.001).
CONCLUSIONS: These biomarkers at ICU admission led to a poor ability to predict BC among patients with COVID-19 pneumonia. Baseline values of PCT<0.3ng/mL may be useful to rule out BC, providing clinicians a valuable tool to guide antibiotic stewardship and allowing the unjustified overuse of antibiotics observed during the pandemic, additionally PCT≥0.50ng/mL might predict worsening outcomes.