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Clin Chem Lab Med . Searching for a role of procalcitonin determination in COVID-19: a study on a selected cohort of hospitalized patients

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  • Clin Chem Lab Med . Searching for a role of procalcitonin determination in COVID-19: a study on a selected cohort of hospitalized patients


    Clin Chem Lab Med


    . 2020 Nov 19;59(2):433-440.
    doi: 10.1515/cclm-2020-1361.
    Searching for a role of procalcitonin determination in COVID-19: a study on a selected cohort of hospitalized patients


    Alberto Dolci 1 2 , Cristina Robbiano 1 , Elena Aloisio 1 , Mariia Chibireva 1 , Ludovica Serafini 1 , Felicia Stefania Falvella 1 , Sara Pasqualetti 1 , Mauro Panteghini 1 2



    Affiliations

    Abstract

    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 in-hospital 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 μg/L) is applied.

    Keywords: COVID-19; bacterial infection; procalcitonin; severe acute respiratory syndrome coronavirus 2.

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