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Financial support was provided by the Instituto de Salud Carlos III de Madrid (COV20/00110, ISCIII); Fondo Europeo de Desarrollo Regional (FEDER); Una manera de hacer Europa; Centro de Investigacion Biomedica En Red-Enfermedades Respiratorias (CIBERES); and Donation program estar preparados UNESPA, Madrid, Spain. DdGC has received financial support from the Instituto de Salud Carlos III (Miguel Servet 2020: CP20/00041), co-funded by European Social Fund (ESF)/ Investing in your future. Adrian Ceccato acknowledges receiving financial support from Instituto de Salud Carlos III (ISCIII; Sara Borrell 2021: CD21/00087).

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Procalcitonin and C-reactive protein to rule out early bacterial coinfection in COVID-19 critically ill patients

Publicat a:Intensive Care Medicine. 49 (8): 934-945 - 2023-08-01 49(8), DOI: 10.1007/s00134-023-07161-1

Autors: Galli, Flavia; Bindo, Francesco; Motos, Anna; Fernandez-Barat, Laia; Barbeta, Enric; Gabarrus, Albert; Ceccato, Adrian; Bermejo-Martin, Jesus F; Ferrer, Ricard; Riera, Jordi; Penuelas, Oscar; Lorente, Jose Angel; de Gonzalo-Calvo, David; Menendez, Rosario; Gonzalez, Jessica; Misuraca, Sofia; Palomeque, Andrea; Amaya-Villar, Rosario; Anon, Jose Manuel; Balan Marino, Ana; Barbera, Carme; Barberan, Jose; Blandino Ortiz, Aaron; Bustamante-Munguira, Elena; Caballero, Jesus; Canton-Bulnes, Maria Luisa; Carbajales Perez, Cristina; Carbonell, Nieves; Catalan-Gonzalez, Mercedes; de Frutos, Raul; Franco, Nieves; Galban, Cristobal; Lopez Lago, Ana; Gumucio-Sanguino, Victor D; de la Torre, Maria del Carmen; Diaz, Emilio; Estella, Angel; Gallego Curto, Elena; Garcia-Garmendia, Jose Luis; Gomez, Jose Manuel; Huerta, Arturo; Jorge Garcia, Ruth Noemi; Loza-Vazquez, Ana; Marin-Corral, Judith; Martin Delgado, Maria Cruz; Martinez de la Gandara, Amalia; Martinez Varela, Ignacio; Lopez Messa, Juan; M Albaiceta, Guillermo; Nieto, Maria Teresa; Novo, Mariana Andrea; Penasco, Yhivian; Perez-Garcia, Felipe; Pozo-Laderas, Juan Carlos; Ricart, Pilar; Sagredo, Victor; Sanchez-Miralles, Angel; Sancho Chinesta, Susana; Roche-Campo, Ferran; Socias, Lorenzo; Sole-Violan, Jordi; Suarez-Sipmann, Fernando; Tamayo Lomas, Luis; Trenado, Jose; Ubeda, Alejandro; Valdivia, Luis Jorge; Vidal, Pablo; Boado, Maria Victoria; Rodriguez, Alejandro; Antonelli, Massimo; Blasi, Francesco; Barbe, Ferran; Torres, Antoni

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Resum

Although the prevalence of community-acquired respiratory bacterial coinfection upon hospital admission in patients with coronavirus disease 2019 (COVID-19) has been reported to be < 5%, almost three-quarters of patients received antibiotics. We aim to investigate whether procalcitonin (PCT) or C-reactive protein (CRP) upon admission could be helpful biomarkers to identify bacterial coinfection among patients with COVID-19 pneumonia.We carried out a multicentre, observational cohort study including consecutive COVID-19 patients admitted to 55 Spanish intensive care units (ICUs). The primary outcome was to explore whether PCT or CRP serum levels upon hospital admission could predict bacterial coinfection among patients with COVID-19 pneumonia. The secondary outcome was the evaluation of their association with mortality. We also conducted subgroups analyses in higher risk profile populations.Between 5 February 2020 and 21 December 2021, 4076 patients were included, 133 (3%) of whom presented bacterial coinfection. PCT and CRP had low area under curve (AUC) scores at the receiver operating characteristic (ROC) curve analysis [0.57 (95% confidence interval (CI) 0.51-0.61) and 0.6 (95% CI, 0.55-0.64), respectively], but high negative predictive values (NPV) [97.5% (95% CI 96.5-98.5) and 98.2% (95% CI 97.5-98.9) for PCT and CRP, respectively]. CRP alone was associated with bacterial coinfection (OR 2, 95% CI 1.25-3.19; p = 0.004). The overall 15, 30 and 90 days mortality had a higher trend in the bacterial coinfection group, but without significant difference. PCT ≥ 0.12 ng/mL was associated with higher 90 days mortality.Our study suggests that measurements of PCT and CRP, alone and at a single time point, are not useful for ruling in or out bacterial coinfection in viral pneumonia by COVID-19.© 2023. The Author(s).

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