1
|
Jeyapalina S, Wei G, Stoddard GJ, Sudduth JD, Lundquist M, Huntsman M, Marquez JL, Agarwal JP. Serum procalcitonin level is independently associated with mechanical ventilation and case-fatality in hospitalized COVID-19-positive US veterans-A potential marker for disease severity. PLoS One 2023; 18:e0284520. [PMID: 37068086 PMCID: PMC10109491 DOI: 10.1371/journal.pone.0284520] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 04/02/2023] [Indexed: 04/18/2023] Open
Abstract
The Coronavirus-19 disease (COVID-19) has claimed over 6.8 million lives since first being reported in late 2019. The virus that causes COVID-19 disease is highly contagious and spreads rapidly. To date, there are no approved prognostic tools that could predict why some patients develop severe or fatal disease outcomes. Early COVID-19 studies found an association between procalcitonin (PCT) and hospitalization or duration of mechanical ventilation and death but were limited by the cohort sizes. Therefore, this study was designed to confirm the associations of PCT with COVID-19 disease severity outcomes in a large cohort. For this retrospective data analysis study, 27,154 COVID-19-positive US veterans with post-infection PCT laboratory test data and their disease severity outcomes were accessed using the VA electronic healthcare data. Cox regression models were used to test the association between serum PCT levels and disease outcomes while controlling for demographics and relevant confounding variables. The models demonstrated increasing disease severity (ventilation and death) with increasing PCT levels. For PCT serum levels above 0.20 ng/ml, the unadjusted risk increased nearly 2.3-fold for mechanical ventilation (hazard ratio, HR, 2.26, 95%CI: 2.11-2.42) and in-hospital death (HR, 2.28, 95%CI: 2.16-2.41). Even when adjusted for demographics, diabetes, pneumonia, antibiotic use, white blood cell count, and serum C-reactive protein levels, the risks remained relatively high for mechanical ventilation (HR, 1.80, 95%CI: 1.67-1.94) and death (HR, 1.76, 95%CI: 1.66-1.87). These data suggest that higher PCT levels have independent associations with ventilation and in-hospital death in veterans with COVID-19 disease, validating previous findings. The data suggested that serum PCT level may be a promising prognostic tool for COVID-19 severity assessment and should be further evaluated in a prospective clinical trial.
Collapse
Affiliation(s)
- Sujee Jeyapalina
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, United States of America
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States of America
| | - Guo Wei
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States of America
| | - Gregory J Stoddard
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States of America
| | - Jack D Sudduth
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, United States of America
| | - Margaret Lundquist
- Research, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, United States of America
| | - Merodean Huntsman
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, United States of America
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States of America
| | - Jessica L Marquez
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, United States of America
| | - Jayant P Agarwal
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, United States of America
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States of America
| |
Collapse
|
2
|
Atallah NJ, Warren HM, Roberts MB, Elshaboury RH, Bidell MR, Gandhi RG, Adamsick M, Ibrahim MK, Sood R, Bou Zein Eddine S, Cobler-Lichter MJ, Alexander NJ, Timmer KD, Atallah CJ, Viens AL, Panossian VS, Scherer AK, Proctor T, Smartt S, Letourneau AR, Paras ML, Johannes S, Wiemer J, Mansour MK. Baseline procalcitonin as a predictor of bacterial infection and clinical outcomes in COVID-19: A case-control study. PLoS One 2022; 17:e0262342. [PMID: 35025929 PMCID: PMC8758006 DOI: 10.1371/journal.pone.0262342] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 12/22/2021] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Coronavirus disease-2019 (COVID-19) is associated with a wide spectrum of clinical symptoms including acute respiratory failure. Biomarkers that can predict outcomes in patients with COVID-19 can assist with patient management. The aim of this study is to evaluate whether procalcitonin (PCT) can predict clinical outcome and bacterial superinfection in patients infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). METHODS Adult patients diagnosed with SARS-CoV-2 by nasopharyngeal PCR who were admitted to a tertiary care center in Boston, MA with SARS-CoV-2 infection between March 17 and April 30, 2020 with a baseline PCT value were studied. Patients who were presumed positive for SARS-CoV-2, who lacked PCT levels, or who had a positive urinalysis with negative cultures were excluded. Demographics, clinical and laboratory data were extracted from the electronic medical records. RESULTS 324 patient charts were reviewed and grouped by clinical and microbiologic outcomes by day 28. Baseline PCT levels were significantly higher for patients who were treated for true bacteremia (p = 0.0005) and bacterial pneumonia (p = 0.00077) compared with the non-bacterial infection group. Baseline PCT positively correlated with the NIAID ordinal scale and survival over time. When compared to other inflammatory biomarkers, PCT showed superiority in predicting bacteremia. CONCLUSIONS Baseline PCT levels are associated with outcome and bacterial superinfection in patients hospitalized with SARS-CoV-2.
Collapse
Affiliation(s)
- Natalie J. Atallah
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
- Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
- * E-mail: (MM); (NA)
| | - Hailey M. Warren
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
| | - Matthew B. Roberts
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
- Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Ramy H. Elshaboury
- Department of Pharmacy, Massachusetts General Hospital, Boston, MA, United States of America
| | - Monique R. Bidell
- Department of Pharmacy, Massachusetts General Hospital, Boston, MA, United States of America
| | - Ronak G. Gandhi
- Department of Pharmacy, Massachusetts General Hospital, Boston, MA, United States of America
| | - Meagan Adamsick
- Department of Pharmacy, Massachusetts General Hospital, Boston, MA, United States of America
| | - Maryam K. Ibrahim
- Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Rupali Sood
- Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Savo Bou Zein Eddine
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
- Department of Surgery, Massachusetts General Hospital, Boston, MA, United States of America
| | | | - Natalie J. Alexander
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
| | - Kyle D. Timmer
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
| | | | - Adam L. Viens
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
| | - Vahe S. Panossian
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Allison K. Scherer
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
- Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Teddie Proctor
- Fisher Diagnostics, Part of Thermo Fisher Scientific, Middletown, VA, United States of America
| | - Sherrie Smartt
- Fisher Diagnostics, Part of Thermo Fisher Scientific, Middletown, VA, United States of America
| | - Alyssa R. Letourneau
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
- Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Molly L. Paras
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
- Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Sascha Johannes
- B·R·A·H·M·S GmbH, Part of Thermo Fisher Scientific, Hennigsdorf, Germany
| | - Jan Wiemer
- B·R·A·H·M·S GmbH, Part of Thermo Fisher Scientific, Hennigsdorf, Germany
| | - Michael K. Mansour
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
- Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
- * E-mail: (MM); (NA)
| |
Collapse
|
3
|
Jiang Z, Liu N, Wang L, Wu J, Guan X. Mining of a Clinical Database: The Interpretation of Intense Serial Procalcitonin in the Prediction for Bloodstream Infection. Front Med (Lausanne) 2021; 8:691793. [PMID: 34692716 PMCID: PMC8526537 DOI: 10.3389/fmed.2021.691793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 09/02/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Procalcitonin (PCT) is a promising biomarker for predicting infection. Bloodstream infection (BSI) is usually a deteriorating stage of sepsis. The purpose of this study was to explore the predictive value of intense serial PCT assays for BSI in the intensive care unit (ICU). Methods: This study was a retrospective study based on a clinical database. We analyzed the data of critically ill patients from February 2016 to May 2020. The patients who received PCT assays and blood cultures (BCs) were classified into four groups according to the BCs: (i) BC negative, (ii) bacteria positive, (iii) fungi-positive, and (iv) combined-positive, and the patients with bacteremia were further subdivided into Gram+ and Gram- bacteremia. Results: The database included 11,219 patients. There were 3,593 patients who met the criteria for the analysis. The PCT concentration differed significantly across BC groups (p < 0.0001). The fluctuation of PCT significantly increased in the BC positive groups (p < 0.0001). According to the receiver operating characteristic (ROC), the optimum cutoff of the fluctuation of PCT was around 8 ng/ml for predicting BSI. Conclusion: Our study indicated that the fluctuation of PCT could be an indicator for screening BSI, but less accurate for Gram-positive infections. With a fluctuation of PCT less than 8 ng/ml, BSI should not be a rational cause for sepsis exacerbating.
Collapse
Affiliation(s)
- Zhiyi Jiang
- Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ning Liu
- Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Luhao Wang
- Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jianfeng Wu
- Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiangdong Guan
- Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
4
|
Gharamti AA, Mei F, Jankousky KC, Huang J, Hyson P, Chastain DB, Fan J, Osae S, Zhang WW, Montoya JG, Erlandson KM, Scherger SJ, Franco-Paredes C, Henao-Martínez AF, Shapiro L. Diagnostic Utility of a Ferritin-to-Procalcitonin Ratio to Differentiate Patients With COVID-19 From Those With Bacterial Pneumonia: A Multicenter Study. Open Forum Infect Dis 2021; 8:ofab124. [PMID: 34183978 PMCID: PMC7989180 DOI: 10.1093/ofid/ofab124] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 03/10/2021] [Indexed: 12/28/2022] Open
Abstract
Background There is an urgent need for accurate, rapid, inexpensive biomarkers that can differentiate coronavirus disease 2019 (COVID-19) from bacterial pneumonia. We assess the role of the ferritin-to-procalcitonin (F/P) ratio to classify pneumonia cases into those due to COVID-19 vs those due to bacterial pathogens. Methods This multicenter case–control study compared patients with COVID-19 with those with bacterial pneumonia, admitted between March 1 and May 31, 2020. Patients with COVID-19 and bacterial pneumonia co-infection were excluded. The F/P in patients with COVID-19 vs with bacterial pneumonia were compared. Receiver operating characteristic curve analysis determined the sensitivity and specificity of various cutoff F/P values for COVID-19 vs bacterial pneumonia. Results A total of 242 COVID-19 pneumonia cases and 34 bacterial pneumonia controls were included. Patients with COVID-19 pneumonia had a lower mean age (57.1 vs 64.4 years; P = .02) and a higher body mass index (30.74 vs 27.15 kg/m2; P = .02) compared with patients with bacterial pneumonia. Cases and controls had a similar proportion of women (47% vs 53%; P = .5), and COVID-19 patients had a higher prevalence of diabetes mellitus (32.6% vs 12%; P = .01). The median F/P was significantly higher in patients with COVID-19 (4037.5) compared with the F/P in bacterial pneumonia (802; P < .001). An F/P ≥877, used to diagnose COVID-19, resulted in a sensitivity of 85% and a specificity of 56%, with a positive predictive value of 93.2% and a likelihood ratio of 1.92. In multivariable analyses, an F/P ≥877 was associated with greater odds of identifying a COVID-19 case (odds ratio, 11.27; 95% CI, 4–31.2; P < .001). Conclusions An F/P ≥877 increases the likelihood of COVID-19 pneumonia compared with bacterial pneumonia.
Collapse
Affiliation(s)
- Amal A Gharamti
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Fei Mei
- Department of Vascular Surgery, Yichang Central People's Hospital, The First College of Clinical Medical Science, China Three Gorges University, Yichang, Hubei, China
| | - Katherine C Jankousky
- Department of Medicine, University of Colorado, Anschutz Medical Center Aurora, Aurora, Colorado, USA
| | - Jin Huang
- School of Medicine, University of Colorado, Anschutz Medical Center Aurora, Aurora, Colorado, USA
| | - Peter Hyson
- Department of Medicine, University of Colorado, Anschutz Medical Center Aurora, Aurora, Colorado, USA
| | - Daniel B Chastain
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Albany, Georgia, USA
| | - Jiawei Fan
- Department of Vascular Surgery, Yichang Central People's Hospital, The First College of Clinical Medical Science, China Three Gorges University, Yichang, Hubei, China
| | - Sharmon Osae
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Albany, Georgia, USA
| | - Wayne W Zhang
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Washington and Puget Sound VA Health Care System, Seattle, Washington, USA
| | - José G Montoya
- Dr Jack S. Remington Laboratory for Specialty Diagnostics, Palo Alto, California, USA
| | - Kristine M Erlandson
- Division of Infectious Diseases, University of Colorado, Anschutz Medical Center Aurora, Aurora, Colorado, USA
| | - Sias J Scherger
- Division of Infectious Diseases, University of Colorado, Anschutz Medical Center Aurora, Aurora, Colorado, USA
| | - Carlos Franco-Paredes
- Division of Infectious Diseases, University of Colorado, Anschutz Medical Center Aurora, Aurora, Colorado, USA.,Hospital Infantil de México, Federico Gómez, México City, México
| | - Andrés F Henao-Martínez
- Division of Infectious Diseases, University of Colorado, Anschutz Medical Center Aurora, Aurora, Colorado, USA
| | - Leland Shapiro
- Division of Infectious Diseases, University of Colorado, Anschutz Medical Center Aurora, Aurora, Colorado, USA.,Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado, USA
| |
Collapse
|
5
|
Gilbert DN, Leggett JE, Wang L, Ferdosian S, Gelfer GD, Johnston ML, Footer BW, Hendrickson KW, Park HS, White EE, Heffner J. Enhanced Detection of Community-Acquired Pneumonia Pathogens With the BioFire® Pneumonia FilmArray® Panel. Diagn Microbiol Infect Dis 2021; 99:115246. [PMID: 33253962 PMCID: PMC7566680 DOI: 10.1016/j.diagmicrobio.2020.115246] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/28/2020] [Accepted: 10/11/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Although most observational studies identify viral or bacterial pathogens in 50% or less of patients hospitalized with community-acquired pneumonia (CAP), we previously demonstrated that a multi-test bundle (MTB) detected a potential pathogen in 73% of patients. This study compares detection rates for potential pathogens with the MTB versus the Biofire® Pneumonia FilmArray® panel (BPFA) multiplex PCR platform and presents an approach for integrating BPFA results as a foundation for subsequent antibiotic stewardship (AS) activities. METHODS Between January 2017 to March 2018, all patients admitted for CAP were enrolled. Patients were considered evaluable if all elements of the MTB and the BPFA were completed, and they met other a priori inclusion criteria. The primary endpoint was the percentage of potential pathogens detected using the MTB (8 viral and 6 bacterial targets) versus the BPFA (8 viral and 18 bacterial targets). Blood and sputum cultures were performed on all patients. Two or more procalcitonin (PCT) levels assisted clinical assessments as to whether detected bacteria were invading or colonizing. RESULTS Of 585 enrolled patients, 274 were evaluable. A potential viral pathogen was detected in 40.5% with MTB versus 60.9% of patients with BPFA with an odds ratio (95% CI) of 9.00 (4.12 to 23.30) p<0.01. A potential bacterial pathogen was identified in 66.4% with the MTB vs 75.5% with the BPFA odds ratio (95% CI) of 2.09 (1.24 to 3.59), p 0.003). Low PCT levels helped identify detected bacteria as colonizers.
Collapse
Affiliation(s)
- David N Gilbert
- Department of Medical Education, Providence Portland Medical Center, Portland, Oregon.
| | - James E Leggett
- Department of Medical Education, Providence Portland Medical Center, Portland, Oregon
| | - Lian Wang
- Department of Medical Education, Providence Portland Medical Center, Portland, Oregon
| | - Shirin Ferdosian
- Department of Medical Education, Providence Portland Medical Center, Portland, Oregon
| | - Gita D Gelfer
- Department of Medical Education, Providence Portland Medical Center, Portland, Oregon
| | - Michael L Johnston
- Department of Medical Education, Providence Portland Medical Center, Portland, Oregon
| | - Brent W Footer
- Department of Medical Education, Providence Portland Medical Center, Portland, Oregon
| | - Kathryn W Hendrickson
- Department of Medical Education, Providence Portland Medical Center, Portland, Oregon
| | - Hiromichi S Park
- Department of Medical Education, Providence Portland Medical Center, Portland, Oregon
| | - Emma E White
- Department of Medical Education, Providence Portland Medical Center, Portland, Oregon
| | - John Heffner
- Department of Medical Education, Providence Portland Medical Center, Portland, Oregon
| |
Collapse
|
6
|
Ginsburg AS, Klugman KP. COVID-19 pneumonia and the appropriate use of antibiotics. LANCET GLOBAL HEALTH 2020; 8:e1453-e1454. [PMID: 33188730 PMCID: PMC7833845 DOI: 10.1016/s2214-109x(20)30444-7] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 09/29/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Amy Sarah Ginsburg
- Clinical Trials Center, University of Washington, Seattle, WA 98115, USA.
| | | |
Collapse
|
7
|
Wen H, Lv M. Correlation analysis between serum procalcitonin and infarct volume in young patients with acute cerebral infarction. Neurol Sci 2020; 42:3189-3196. [PMID: 33108576 DOI: 10.1007/s10072-020-04856-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 10/22/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To detect the serum procalcitonin (PCT) level and determine its relationship with the infarct volume in young patients with acute cerebral infarction. METHODS According to the infarct volume, young patients with acute cerebral infarction were divided into large group, intermediate group, and small group. The severity of clinical symptoms was determined according to the National Institute of Health Stroke Scale (NIHSS) score. Healthy young people were selected as the control group. Serum PCT levels were measured. The relationship among PCT, volume, and NIHSS score was analyzed. RESULTS PCT in observation group was significantly higher than that in control group (t = 6.879, P = 0.011), and PCT in severe group was significantly higher than in mild group (t = 6.978, P = 0.016). PCT in large cerebral infarction group was higher than that in intermediate and small-size infarct group (P = 0.0036 and P < 0.0001, respectively), and PCT in intermediate cerebral infarction group was higher than that in small-size infarct group (P = 0.0024). In observation group, the PCT level was positively correlated with both NIHSS (r = 0.793, P = 0.022) and infarction volume (r = 0.649, P = 0.007). CONCLUSION The level of PCT in young patients with acute cerebral infarction may be related to the inflammatory reaction of the cerebral artery and positively related to the volume of cerebral infarction and NIHSS score. To some extent, PCT concentration can predict the disease severity of acute cerebral infarction.
Collapse
Affiliation(s)
- Huijun Wen
- Department of Neurology, Baoji Municipal Central Hospital, 8 Jiangtan Road, Baoji, 721008, Shaanxi, People's Republic of China
| | - Maikou Lv
- Department of Neurology, Baoji Municipal Central Hospital, 8 Jiangtan Road, Baoji, 721008, Shaanxi, People's Republic of China.
| |
Collapse
|
8
|
Gharamti AA, Mei F, Jankousky KC, Huang J, Hyson P, Chastain DB, Fan J, Osae S, Zhang WW, Montoya JG, Erlandson KM, Scherger SJ, Franco-Paredes C, Henao-Martínez AF, Shapiro L. Diagnostic utility of a Ferritin-to-Procalcitonin Ratio to differentiate patients with COVID-19 from those with Bacterial Pneumonia: A multicenter study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.10.20.20216309. [PMID: 33106821 PMCID: PMC7587841 DOI: 10.1101/2020.10.20.20216309] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
IMPORTANCE There is a need to develop tools to differentiate COVID-19 from bacterial pneumonia at the time of clinical presentation before diagnostic testing is available. OBJECTIVE To determine if the Ferritin-to-Procalcitonin ratio (F/P) can be used to differentiate COVID-19 from bacterial pneumonia. DESIGN This case-control study compared patients with either COVID-19 or bacterial pneumonia, admitted between March 1 and May 31, 2020. Patients with COVID-19 and bacterial pneumonia co-infection were excluded. SETTING A multicenter study conducted at three hospitals that included UCHealth and Phoebe Putney Memorial Hospital in the United States, and Yichang Central People's Hospital in China. PARTICIPANTS A total of 242 cases with COVID-19 infection and 34 controls with bacterial pneumonia. MAIN OUTCOMES AND MEASURES The F/P in patients with COVID-19 or with bacterial pneumonia were compared. Receiver operating characteristic analysis determined the sensitivity and specificity of various cut-off F/P values for the diagnosis of COVID-19 versus bacterial pneumonia. RESULTS Patients with COVID-19 pneumonia had a lower mean age (57.11 vs 64.4 years, p=0.02) and a higher BMI (30.74 vs 27.15 kg/m 2 , p=0.02) compared to patients with bacterial pneumonia. Cases and controls had a similar proportion of women (47% vs 53%, p=0.5) and COVID-19 patients had a higher prevalence of diabetes mellitus (32.6% vs 12%, p=0.01). The median F/P was significantly higher in patients with COVID-19 (4037.5) compared to the F/P in bacterial pneumonia (802, p<0.001). An F/P ≥ 877 used to diagnose COVID-19 resulted in a sensitivity of 85% and a specificity of 56%, with a positive predictive value of 93.2%, and a likelihood ratio of 1.92. In multivariable analyses, an F/P ≥ 877 was associated with greater odds of identifying a COVID-19 case (OR: 11.27, CI: 4-31.2, p<0.001). CONCLUSIONS AND RELEVANCE An F/P ≥ 877 increases the likelihood of COVID-19 pneumonia compared to bacterial pneumonia. Further research is needed to determine if obtaining ferritin and procalcitonin simultaneously at the time of clinical presentation has improved diagnostic value. Additional questions include whether an increased F/P and/or serial F/P associates with COVID-19 disease severity or outcomes.
Collapse
Affiliation(s)
- Amal A. Gharamti
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Fei Mei
- Department of Vascular Surgery, Yichang Central People’s Hospital, The first College of Clinical Medical Science, China Three Gorges University, Yichang, Hubei, China
| | - Katherine C. Jankousky
- Department of Medicine, School of Medicine, University of Colorado, Anschutz Medical Center Aurora, CO, USA
| | - Jin Huang
- School of Medicine, University of Colorado, Anschutz Medical Center Aurora, CO, USA
| | - Peter Hyson
- Department of Medicine, School of Medicine, University of Colorado, Anschutz Medical Center Aurora, CO, USA
| | - Daniel B. Chastain
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Albany, GA, USA
| | - Jiawei Fan
- Department of Vascular Surgery, Yichang Central People’s Hospital, The first College of Clinical Medical Science, China Three Gorges University, Yichang, Hubei, China
| | - Sharmon Osae
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Albany, GA, USA
| | - Wayne W. Zhang
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Washington and Puget Sound VA Health Care System, Seattle, WA, USA
| | - José G. Montoya
- Co-director, Dr. Jack S. Remington Laboratory for Specialty Diagnostics, Palo Alto, California
| | - Kristine M. Erlandson
- Division of Infectious Diseases, University of Colorado, Anschutz Medical Center Aurora, CO, USA
| | - Sias J. Scherger
- Division of Infectious Diseases, University of Colorado, Anschutz Medical Center Aurora, CO, USA
| | - Carlos Franco-Paredes
- Division of Infectious Diseases, University of Colorado, Anschutz Medical Center Aurora, CO, USA
- Hospital Infantil de México, Federico Gómez, México City, México
| | - Andrés F. Henao-Martínez
- Division of Infectious Diseases, University of Colorado, Anschutz Medical Center Aurora, CO, USA
| | - Leland Shapiro
- Division of Infectious Diseases, University of Colorado, Anschutz Medical Center Aurora, CO, USA
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora CO, USA
| |
Collapse
|