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Background Blood procalcitonin (PCT) levels usually increase during infectious diseases and might be helpful to differentiate bacterial from non-bacterial origin. COVID-19 patients could present co-infections at initial presentation in the Emergency Department and nosocomial infections during stay in the ICU. However, the published literature has n...
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Context 1
... 0.22 ng/ml (0.06-0.63) and mean (SD) estimated GFR was 69 ml/min/1.73 m2 (48-89). The general characteristics of the study population with and without ICU admission are shown in Table 1. Patients admitted to ICU differed significantly blood PCT levels (0.30 ng/ml vs 0.06 ng/ml) ( Fig. 1) and estimated GFR (88 ml/min/1.73 m2 vs 57 ml/min/1.73 m2) (Fig. 2) from those who entered general ...
Context 2
... mechanical ventilation). Renal failure is associated with a high risk of mortality [35] and acts as a marker of worse prognosis [36]. Our ICU patients had worse oxygenation (82% underwent mechanical ventilation during the first 24 h of admission) and renal function in comparison to patients admitted at the general ward (57 vs 88 ml/min/1.73m 2 ) (Fig. 2). In our series, 7 patients (20%) required dialysis. High blood PCT levels are described in patients undergoing chronic hemodialysis in relation to a chronic systemic inflammatory state (monocytes activation and subsequent inflammatory cytokines release) [37]. We did not find any differences in renal function parameters between patients ...
Context 3
... 0.22 ng/ml (0.06-0.63) and mean (SD) estimated GFR was 69 ml/min/1.73 m2 (48-89). The general characteristics of the study population with and without ICU admission are shown in Table 1. Patients admitted to ICU differed significantly blood PCT levels (0.30 ng/ml vs 0.06 ng/ml) ( Fig. 1) and estimated GFR (88 ml/min/1.73 m2 vs 57 ml/min/1.73 m2) (Fig. 2) from those who entered general ...
Context 4
... mechanical ventilation). Renal failure is associated with a high risk of mortality [35] and acts as a marker of worse prognosis [36]. Our ICU patients had worse oxygenation (82% underwent mechanical ventilation during the first 24 h of admission) and renal function in comparison to patients admitted at the general ward (57 vs 88 ml/min/1.73m 2 ) (Fig. 2). In our series, 7 patients (20%) required dialysis. High blood PCT levels are described in patients undergoing chronic hemodialysis in relation to a chronic systemic inflammatory state (monocytes activation and subsequent inflammatory cytokines release) [37]. We did not find any differences in renal function parameters between patients ...
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Background Timely intervention can alter outcome in patients of infected pancreatic necrosis (IPN) but lacks adequate biomarker. Role of serum procalcitonin (PCT) in the management of IPN is understudied, and hence, this study was planned.
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Citations
... Martins-Filo et al. showed that procalcitonin levels were associated with the severity of the disease in the COVID-19 pandemic [16]. Importantly, it was shown that the frequency of coinfection was only 20% and 50% in severe and critically ill COVID-19 patients, while elevated procalcitonin levels were 50% and 80%, respectively [17,18]. As a result, we believe that choosing antibiotics based on procalcitone should be done with caution. ...
Background
The inappropriate and excessive use of antibiotics during the coronavirus pandemic has become an important issue.
Objective
Our primary aim is to ascertain the attitudes of physicians toward the antibiotics prescribing for the treatment of COVID-19 in Turkey. Our secondary aim was to identify factors affecting to physicians’ decisions regarding antibiotic therapy for the treatment of COVID-19 and risk factors associated with antibiotic overprescribing.
Methods
It was a multicenter cross-sectional survey. Physicians from 63 different cities were invited to survey through social media (Facebook, Instagram, WhatsApp). Data were collected from respondents through an online questionnaires during November-December 2021.
Results
The survey was completed by 571 participants from 63 cities. Pulmonologists comprised the majority (35.20%), followed by internal medical specialists (27.85%) and general practitioners (23.29%). The rates of participants who started empirical antibiotics in the outpatient, ward, and ICU (intensive care unit) were 70.2%, 85.5%, and 74.6%, respectively. When the practice of prescribing antibiotics by physicians for the treatment of COVID-19 in outpatients was compared according to the healthcare setting (primary, secondary, tertiary care hospitals) no significant difference was found. Sputum purulence (68.2%) was recognized as the most important factor for the decision of antibiotic therapy, followed by procalcitonin levels (64.9%) and abnormal radiological findings (50.3%). The most prescribed antibiotics were respiratory quinolones. (48%, 65.9%, 62.7% outpatient, ward, ICU respectively)
Conclusions
In this study, we found that physicians frequently had irrational attitudes toward antibiotic prescription to COVID-19 patients, including those with minor diseases. Our findings underline that the necessity of particular, workable interventions to guarantee the prudent use of antibiotics in COVID-19.
... In a study conducted in 2021 on patients with COVID-19 treated in the ICU (n: 205) and in the non-ICU (n: 809), the AST, ALT, LDH and ferritin levels of the patients treated in the ICU were significantly higher than those of the patients treated in the non-ICU (p<0.0005) 17 . In a study of 56 patients, of whom 35 were treated in the ICU and 29 in the service, procalcitonin, urea and creatinine levels were found to be significantly higher in the ICU patients than in service patients (p < 0.05) 18 . There are studies reporting that uncontrolled inflammation in COVID-19 increases ferritin levels and that elevated ferritin levels are associated with ICU admission and high mortality. ...
Purpose: The aim of this study was to evaluate kallistatin levels in patients diagnosed with COVID-19 and compare them with healthy controls.
Materials and Methods: A total of 40 patients diagnosed with COVID-19, and 45 healthy controls were included in the study. The patient group was divided into 2 groups: patients treated in the service (n:20) and patients treated in the intensive care unit (n:20). Kallistatin levels were measured using the ELISA method.
Results: There was a significant difference in kallistatin levels between the patient group (n:40) and the control group (n:45). There was no significant difference in kallistatin between COVID-19 patients treated in the service and those treated in the intensive care unit. We found that the AUC for kallistatin was 0.856 in the ROC analysis performed between the patient and control groups. When comparing service and ICU patients in terms of laboratory parameters, there was a significant difference between the groups due to elevated potassium, AST, creatinine, ferritin, HGB and LDH in ICU patients.
Conclusion: As a result, kallistatin levels were significantly higher in the patient group than in the control group. Comprehensive studies with more patients are needed to understand whether kallistatin is elevated in COVID-19 patients due to the effects of COVID-19 or to eliminate oxidative stress.
... Furthermore, the most effective laboratory indicators of severe prognosis appear to be a reduction in the percentage of large unstained cells, as well as rises in D-dimer, neutrophil-to-lymphocyte ratio, and CRP [14]. Recent investigations have found an association between increased PCT levels and COVID-19 severity [2,[16][17][18][19][20] and mortality [21,22]. In addition, it was found that initial blood PCT levels were higher in non-survivors than in survivors at intensive unit care (ICU) admission [20,21]. ...
... Recent investigations have found an association between increased PCT levels and COVID-19 severity [2,[16][17][18][19][20] and mortality [21,22]. In addition, it was found that initial blood PCT levels were higher in non-survivors than in survivors at intensive unit care (ICU) admission [20,21]. Another clinical study reported that significant change in serum CRP level is also linked with the degree of disease lethality and mortality of patients with COVID-19 [23]. ...
... 6 Garrido et al have also observed elevated blood PCT values in both deceased patients and COVID-19 patients admitted to the ICU compared to those in the general ward at the hospital. 20 These findings showcase the value of using initial PCT serum levels as an indicator of mortality. Although a study by Heer et al did not support the claim that PCT concentrations are a predictor of bacterial coinfection in COVID-19 patients, it had still demonstrated that raised serum values are associated with respiratory failure with prolonged mechanical ventilation and a greater risk of inpatient death. ...
Procalcitonin is an inflammatory marker that had shown marked potential as an antimicrobial stewardship tool for administering antibiotics when needed in patients with pneumonia as it raises concurrently with other inflammatory markers, yet no systematic review has assessed its potential in COVID-19 patients. This systematic review aimed to assess the potential appropriateness of procalcitonin as an antimicrobial stewardship tool in COVID-19 patients with superimposed bacterial and non-bacterial infections. All study designs published after 2019 were included in this systematic review. We included all studies that had reported procalcitonin levels in COVID-19 patients with suspected superimposed secondary infection(s). We searched MEDLINE, Scopus, and the Directory for Open Access Journal from April 2022 to May 2022 and retrieved all related articles for screening with no restrictions on language. We conducted risk of bias assessment according to the Critical Appraisal Skills Programme (CASP) criteria for cohort and case–control studies. Results were presented according to procalcitonin cut-off values, gold standard test used to confirm infection, and overall study conclusion(s), among other variables. This systematic review included 18 articles with 7196 patients in 8 countries. Despite different cut-off values of procalcitonin used, thirteen studies had indicated the appropriateness of using procalcitonin as antimicrobial stewardship tool in COVID-19 patients. We urge physicians to take this into account when treating COVID-19 patients suspected of superimposed infections and we look forward to further studies with standardized procalcitonin cut-off values that may provide appropriate quantitative data that can contribute to clinical guidelines.
Registration (PROSPERO)
CRD42022315013.
... According to a meta-analysis by Stegeman et al in 2020 (21), PCT has low sensitivity ranging (0-48%) and specificity from 26-95% in diagnosing COVID-19. By contrast, a number of studies show that PCT levels are significantly associated with the severity and potential complications of the disease (22)(23)(24). ...
The future waves of COVID 19 infections will continue to raise serious problems in patients with severe forms of the disease. Bacterial infections associated with SARS-CoV-2 disease may complicate the progress of hospitalized patients with COVID-19. The present study aimed to evaluate the etiological spectrum of superinfection in adult patients with COVID-19 and to investigate the correlation between superinfection with multidrug-resistant (MDR) bacteria and serum procalcitonin (PCT). A total of 82 COVID-19 hospitalized patients with COVID-19 and bacterial superinfection were included. The superinfections were classified into early infections (3-7 days from admission) and late infections (>7 days from admission). Bacterial superinfection etiological spectrum, MDR bacteria profile and levels of serum PCT were studied. The most frequently isolated bacteria were Klebsiella pneumoniae, Acinetobacter baumannii and Enterococcus spp. MDR bacteria were involved in 73.17% of COVID-19 patients with bacterial superinfections. Most MDR bacteria superinfections (73.52%) occurred in the late infection period. Klebsiella pneumoniae, Enterococcus spp. and Methicillin-resistant Staphylococcus aureus were the most common MDR bacteria identified in late infections after hospitalization in 20.43, 4.30 and 4.30% of all infections, respectively. Serum PCT values were significantly higher in patients with MDR bacteria superinfection compared with patients with sensitive bacteria superinfection (P=0.009). The principal findings of the present study were the high prevalence of superinfection with MDR bacteria among the COVID-19 patients with bacterial superinfections and the presence of a statistically significant association between serum PCT levels and the presence of superinfection with MDR bacteria. The most effective way to fight against microbial resistance to antibiotics, whether it occurs independently or overlaps with viral infections, is to pursue a national policy for the rational use of antibiotics.
... In severe infections (bacterial, parasitic and fungal), PCT levels may exceed 100 ng/mL. In viral infections and non-specific inflammatory processes, the PCT level is normal or slightly elevated [10,[63][64][65]. ...
... Patients with severe forms of COVID-19 showed a statistically significantly higher increase in PCT compared to patients with non-severe forms [5,7,10,11,13,15,17,19,22,26,42,63]. Patients with non-surviving COVID-19 had higher initial PCT levels upon ICU admission compared to surviving patients [18,65]. ...
Introduction: The recorded studies suggest that there is clear evidence-based association between various laboratory biomarkers and COVID-19 disease severity. These marker levels reflect the intensity of the cytokine-mediated hyperinflammatory response, which is strongly associated with a poor outcome of SARS-CoV-2 infection. Conclusions: C-reactive protein is not only a systemic inflammatory marker, but also an important regulator of inflammatory processes. The level of this protein is positively correlated and can be widely used to predict the severity, prognosis and mortality in COVID-19 patients, additionally to vital signs monitoring, supportive care, oxygen therapy, ventilation and circulatory support. Procalcitonin is an indicator of disease severity, which can facilitate timely clinical decision-making, and determination of procalcitonin levels during COVID-19 patients’ follow-up, as well as being used in assessing risk, predicting prognosis, and improving patient survival. The assessment of hematological laboratory parameters upon admission, which help in differentiating between severe and non-severe cases, high-risk and low-risk cases of mortality, allows raising awareness, monitoring and timely treatment of patients with COVID-19, as well as their early improvement of clinical condition. Inflammatory biochemical and hemocytometric measures are feasible, easily interpretable, and widely available biomarkers in most healthcare settings, favorable for being used in treatment and severity determination, in predicting clinical outcomes, and in the prognosis of patients with COVID-19. However, the assessment of the accuracy of these biomarkers needs to be determined in further more relevant worldwide studies, showing a more precise design, more accurate performance, and having larger sample sizes.
... Conventional blood tests included blood cell counts (especially neutrophils and lymphocytes) and size distribution [5][6][7][8]. Common laboratory tests included procalcitonin (PCT) [9], C-reactive protein (CRP) [10], D-dimer [11], interleukin-6 (IL-6) [12], and others [13]. In addition, parameters reflecting organ dysfunction have been extensively studied [14][15][16][17]. ...
For coronavirus disease 2019 (COVID-19), a pandemic disease characterized by strong immune dysregulation in severe patients, convenient and efficient monitoring of the host immune response is critical. Human hosts respond to viral and bacterial infections in different ways, the former is characterized by the activation of interferon stimulated genes (ISGs) such as IFI27, while the latter is characterized by the activation of anti-bacterial associated genes (ABGs) such as S100A12. This two-tiered innate immune response has not been examined in COVID-19. In this study, the activation patterns of this two-tiered innate immune response represented by IFI27 and S100A12 were explored based on 1421 samples from 17 transcriptome datasets derived from the blood of COVID-19 patients and relevant controls. It was found that IFI27 activation occurred in most of the symptomatic patients and displayed no correlation with disease severity, while S100A12 activation was more restricted to patients under severe and critical conditions with a stepwise activation pattern. In addition, most of the S100A12 activation was accompanied by IFI27 activation. Furthermore, the activation of IFI27 was most pronounced within the first week of symptom onset, but generally waned after 2-3 weeks. On the other hand, the activation of S100A12 displayed no apparent correlation with disease duration and could last for several months in certain patients. These features of the two-tiered innate immune response can further our understanding on the disease mechanism of COVID-19 and may have implications to the clinical triage. Development of a convenient two-gene protocol for the routine serial monitoring of this two-tiered immune response will be a valuable addition to the existing laboratory tests.
... Studies found that CRP levels correlate with PCT levels among COVID-19 patients [24]. Furthermore, some studies found that an elevated PCT level was associated with worsening renal functions and the development of disseminated intravascular coagulation in COVID-19 patients [25][26][27]. ...
Background and Objectives: An elevated procalcitonin level has classically been linked to bacterial infections. Data on the association between elevated procalcitonin and the outcome of coronavirus disease 2019 (COVID-19) are conflicting. Some linked it to associated bacterial co-infections, while others correlated the elevation with disease severity without coexisting bacterial infections. We aimed to investigate the association between high procalcitonin and the severity of COVID-19. Materials and Methods: Hospitalized patients with confirmed COVID-19 pneumonia were divided into two groups: the normal-procalcitonin group and the high-procalcitonin group (>0.05 ng/mL). Patients with concomitant bacterial infections on admission were excluded. The primary outcomes were the need for intensive care unit (ICU) admission, progression to invasive mechanical ventilation (IMV), and in-hospital 28-day mortality. Results: We included 260 patients in the normal procalcitonin group and 397 patients in the high procalcitonin group. The mean age was 55 years and 49% were females. A higher number of patients in the elevated procalcitonin group required ICU admission (32.7% vs. 16.2%, p < 0.001) and IMV (27.2% vs. 13.5%, p < 0.001). In-hospital mortality was significantly higher in the elevated procalcitonin group (18.9% vs. 8.5%, p < 0.001). After adjusting for other covariates, procalcitonin > 0.05 ng/mL was an independent predictor of progression to IMV (OR, 1.71; 95% CI, 1.08–2.71; p = 0.022), ICU admission (OR, 1.73; 95% CI, 1.13–2.66; p = 0.011), and in-hospital mortality (OR, 1.99; 95% CI, 1.14–3.47; p = 0.015). An elevated procalcitonin level was the strongest predictor of in-hospital mortality. Conclusions: Measurement of procalcitonin can have a prognostic role among COVID-19 patients. The admission procalcitonin level can identify patients at risk of ICU admission, progression to IMV, and in-hospital mortality.
... Conflicting evidence exists regarding the utility of procalcitonin in diagnosing bacterial coinfections. [10][11][12][13][14] PCT has been investigated as a tool to diagnose ventilator-associated pneumonia (VAP) 15 and secondary pulmonary infections, including both viral and bacterial infections, in patients with COVID-19. 16,17 Although early literature suggests that elevated PCT is associated with COVID-19 disease severity and increased mortality, there is a paucity of data specific to critically ill COVID-19 patients with concomitant bacterial pneumonia. ...
... 16,17 Although early literature suggests that elevated PCT is associated with COVID-19 disease severity and increased mortality, there is a paucity of data specific to critically ill COVID-19 patients with concomitant bacterial pneumonia. 10,11,[18][19][20] The role of PCT in distinguishing between viral and bacterial pneumonia in COVID-19 patients remains unclear. The purpose of this study was to determine the utility of PCT in predicting secondary bacterial pneumonia coinfection in critically ill patients with COVID-19. ...
... Patients with a baseline serum creatinine of 1.5 mg/dL or greater were excluded as prior literature identified PCT was inversely related to glomerular filtration rate and therefore PCT's value cannot be assured in patients with poor renal function. 10 The electronic medical record system, Allscripts Sunrise Clinical Manager (Chicago, IL) was used to abstract data. Collected variables were defined, a standardized data abstract form was utilized, and abstractors were trained on the utilization of the form prior to assembling data. ...
Background: Historically, procalcitonin(PCT) has been used as a predictor of bacterial infection and to guide antibiotic therapy in hospitalized patients. The purpose of this study was to determine PCT's diagnostic utility in predicting secondary bacterial pneumonia in critically ill patients with severe COVID-19 pneumonia. Methods: A retrospective cohort study was conducted in COVID-19 adults admitted to the ICU between March 2020, and March 2021. All included patients had a PCT level within 72 h of presentation and serum creatinine of <1.5mg/dL. A PCT threshold of 0.5ng/mL was used to compare patients with high( ≥ 0.5ng/mL) versus low(< 0.5ng/mL) PCT. Bacterial pneumonia was defined by positive respiratory culture. A receiver operating characteristics (ROC) curve was utilized to evaluate PCT as a diagnostic test for bacterial pneumonia, with an area under the curve(AUC) threshold of 0.7 to signify an accurate diagnostic test. A multivariable model was constructed to identify variables associated with in-hospital mortality. Results: There were 165 patients included: 127 low PCT versus 38 high PCT. There was no significant difference in baseline characteristics, vital signs, severity of disease, or outcomes among low versus high PCT groups (all p > 0.05). While there was no difference in bacterial pneumonia in low versus high groups (34(26.8%) versus 12(31.6%), p = 0.562), more patients in the high PCT group had bacteremia (19(15%) versus 11(28.9%), p = 0.050). Sensitivity was 26.1% and specificity was 78.2% for PCT to predict bacterial pneumonia coinfection in ICU patients with COVID-19 pneumonia. ROC yielded an AUC 0.54 (p = 0.415). After adjusting for LDH>350U/L and creatinine in multivariable regression, PCT did not enhance performance of the regression model. Conclusions: PCT offers little to no predictive utility in diagnosing concomitant bacterial pneumonia in critically ill patients with COVID-19 nor in predicting increased severity of disease or worse outcomes including mortality.
... Prior to COVID-19, procalcitonin (PCT) was used to differentiate bacterial from viral origins of systemic inflammation with respect to lower respiratory tract infections and sepsis [6−9]. However, procalcitonin elevations have been observed in hospitalized COVID-19 patients leading to difficulties distinguishing viral and bacterial processes [10,13]. One study found that elevated procalcitonin occurred in COVID-19 patients without bacterial pneumonia, and erroneously guided clinicians to prescribe unnecessary antibiotics [11]. ...
Our objectives were to evaluate the role of procalcitonin (PCT) in identifying bacterial co-infections in hospitalized COVID-19 patients and quantify antibiotic prescribing during the 2020 pandemic surge. Hospitalized COVID-19 patients with both a test and blood or respiratory culture sent on admission were included in this retrospective study. Confirmed co-infection was determined by an infectious diseases specialist.
In total, 819 patients were included; 335 (41%) had an elevated procalcitonin (>0.5 ng/mL) and of these, 42 (13%) had an initial bacterial co-infection. Positive predictive value of elevated procalcitonin for co-infection was 13% while the negative predictive value was 94%. Ninety-six percent of patients with an elevated procalcitonin received antibiotics (median 6 days of therapy), compared to 82% with low procalcitonin (median 4 days of therapy) (adjusted OR:3.3, p<0.001).
We observed elevated initial procalcitonin in many COVID patients without concurrent bacterial co-infections which potentially contributed to antibiotic over-prescribing.
