tetano
Editor, Senior Moderator
Am J Med Sci
. 2025 Aug 19:S0002-9629(25)01150-4.
doi: 10.1016/j.amjms.2025.08.014. Online ahead of print. Diagnostic Utility of HBP, PCT, and CRP in Identifying Bacterial Complications in Severe COVID-19
Ying Cai[SUP] 1 [/SUP], Yi-Feng Sun[SUP] 2 [/SUP], Qi-Hui Zhang[SUP] 3 [/SUP], Hong Zhang[SUP] 3 [/SUP], Ping An[SUP] 3 [/SUP], Wen-Jia Yu[SUP] 3 [/SUP], Feng-Jie Xie[SUP] 4 [/SUP]
Affiliations
Background: To address the challenge of delayed bacterial infection diagnosis in critically ill COVID-19 patients, we evaluated the performance of serum procalcitonin (PCT), C-reactive protein (CRP), and heparin-binding protein (HBP), and bronchoalveolar lavage fluid HBP as potential biomarkers for guiding antibiotic therapy.
Methods: Patients meeting the inclusion criteria for severe and critical COVID-19 were enrolled as the case group, while age- and gender-matched healthy individuals were selected as the control group. Levels of PCT, CRP, and HBP were measured. The case group was further stratified based on bacterial culture results, and differences in serum, sputum, or bronchoalveolar lavage fluid markers were subjected to statistical analysis.
Results: Plasma levels of PCT and HBP were significantly higher in patients with bacterial infection compared to both the COVID-19 group and the healthy control group, while CRP was only significant in distinguishing cases from the healthy control group. The AUC for PCT in differentiating COVID-19 patients from those with bacterial infection was 0.937 with a sensitivity of 0.828 and specificity of 0.933, while the AUC for CRP was 0.564 with a sensitivity of 0.828 and specificity of 0.400. The AUC for HBP was 0.775 with a sensitivity of 0.690 and specificity of 0.967. The combined detection of PCT+CRP+HBP exhibited the highest diagnostic performance, with an AUC of 0.978, a sensitivity of 0.966, and a specificity of 0.933.
Conclusion: The combined detection of PCT, CRP, and HBP can enable more precise classification of COVID-19 patients with concurrent bacterial infections and inform the optimal timing of antibiotic initiation.
Keywords: C-reactive protein (CRP); bacterial infection; heparin-binding protein (HBP); procalcitonin (PCT); receiver operating characteristic curve (ROC curve); severe coronavirus disease 2019 (COVID-19).
. 2025 Aug 19:S0002-9629(25)01150-4.
doi: 10.1016/j.amjms.2025.08.014. Online ahead of print. Diagnostic Utility of HBP, PCT, and CRP in Identifying Bacterial Complications in Severe COVID-19
Ying Cai[SUP] 1 [/SUP], Yi-Feng Sun[SUP] 2 [/SUP], Qi-Hui Zhang[SUP] 3 [/SUP], Hong Zhang[SUP] 3 [/SUP], Ping An[SUP] 3 [/SUP], Wen-Jia Yu[SUP] 3 [/SUP], Feng-Jie Xie[SUP] 4 [/SUP]
Affiliations
- PMID: 40840654
- DOI: 10.1016/j.amjms.2025.08.014
Background: To address the challenge of delayed bacterial infection diagnosis in critically ill COVID-19 patients, we evaluated the performance of serum procalcitonin (PCT), C-reactive protein (CRP), and heparin-binding protein (HBP), and bronchoalveolar lavage fluid HBP as potential biomarkers for guiding antibiotic therapy.
Methods: Patients meeting the inclusion criteria for severe and critical COVID-19 were enrolled as the case group, while age- and gender-matched healthy individuals were selected as the control group. Levels of PCT, CRP, and HBP were measured. The case group was further stratified based on bacterial culture results, and differences in serum, sputum, or bronchoalveolar lavage fluid markers were subjected to statistical analysis.
Results: Plasma levels of PCT and HBP were significantly higher in patients with bacterial infection compared to both the COVID-19 group and the healthy control group, while CRP was only significant in distinguishing cases from the healthy control group. The AUC for PCT in differentiating COVID-19 patients from those with bacterial infection was 0.937 with a sensitivity of 0.828 and specificity of 0.933, while the AUC for CRP was 0.564 with a sensitivity of 0.828 and specificity of 0.400. The AUC for HBP was 0.775 with a sensitivity of 0.690 and specificity of 0.967. The combined detection of PCT+CRP+HBP exhibited the highest diagnostic performance, with an AUC of 0.978, a sensitivity of 0.966, and a specificity of 0.933.
Conclusion: The combined detection of PCT, CRP, and HBP can enable more precise classification of COVID-19 patients with concurrent bacterial infections and inform the optimal timing of antibiotic initiation.
Keywords: C-reactive protein (CRP); bacterial infection; heparin-binding protein (HBP); procalcitonin (PCT); receiver operating characteristic curve (ROC curve); severe coronavirus disease 2019 (COVID-19).