C-reactive protein-guided use of procalcitonin in COVID-19
C-reactive protein-guided use of procalcitonin in COVID-19
Background: a low procalcitonin (PCT) concentration facilitates exclusion of bacterial co-infections in COVID-19, but high costs associated with PCT measurements preclude universal adoption. Changes in inflammatory markers, including C-reactive protein (CRP), can be concordant, and predicting low PCT concentrations may avoid costs of redundant tests and support more cost-effective deployment of this diagnostic biomarker.
Objectives: to explore whether, in COVID-19, low PCT values could be predicted by the presence of low CRP concentrations.
Methods: unselected cohort of 224 COVID-19 patients admitted to hospital that underwent daily PCT and CRP measurements as standard care. Both 0.25 ng/mL and 0.5 ng/mL were used as cut-offs for positive PCT test results. Geometric mean was used to define high and low CRP values at each timepoint assessed.
Results: admission PCT was <0.25 ng/mL in 160/224 (71.4%), 0.25-0.5 ng/mL in 27 (12.0%) and >0.5 ng/mL in 37 (16.5%). Elevated PCT was associated with increased risk of death (P = 0.0004) and was more commonly associated with microbiological evidence of bacterial co-infection (P < 0.0001). For high CRP values, significant heterogeneity in PCT measurements was observed, with maximal positive predictive value of 50% even for a PCT cut-off of 0.25 ng/mL. In contrast, low CRP was strongly predictive of low PCT concentrations, particularly <0.5 ng/mL, with a negative predictive value of 97.6% at time of hospital admission and 100% 48 hours into hospital stay.
Conclusions: CRP-guided PCT testing algorithms can reduce unnecessary PCT measurement and costs, supporting antimicrobial stewardship strategies in COVID-19.
dlab180
Houghton, Rebecca
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Moore, Nathan
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Williams, Rebecca
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El-Bakri, Fatima
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Peters, Jonathan
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Mori, Matilde
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Vernet, Gabrielle
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Lynch, Jessica
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Lewis, Henry
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Tavener, Maryanna
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Durham, Tom
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Bowyer, Jack
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Saeed, Kordo
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Pollara, Gabriele
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December 2021
Houghton, Rebecca
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Moore, Nathan
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Williams, Rebecca
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El-Bakri, Fatima
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Peters, Jonathan
3c661fd3-23a3-4bd9-9379-b98b0a84d28f
Mori, Matilde
18cda4a0-217e-4911-95b6-71f8a7a7dc32
Vernet, Gabrielle
015cbc5a-ff6d-48cf-b352-1b520bd505f8
Lynch, Jessica
814a50ff-5fdb-49af-986d-b61b23324b3c
Lewis, Henry
e6b6a91b-e87f-437b-baca-e30c14874312
Tavener, Maryanna
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Durham, Tom
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Bowyer, Jack
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Saeed, Kordo
87cb67e5-71e8-4759-bf23-2ea00ebd8b39
Pollara, Gabriele
e1c9f947-db4f-41c3-9b81-5bd4531cf007
Houghton, Rebecca, Moore, Nathan, Williams, Rebecca, El-Bakri, Fatima, Peters, Jonathan, Mori, Matilde, Vernet, Gabrielle, Lynch, Jessica, Lewis, Henry, Tavener, Maryanna, Durham, Tom, Bowyer, Jack, Saeed, Kordo and Pollara, Gabriele
(2021)
C-reactive protein-guided use of procalcitonin in COVID-19.
JAC-Antimicrobial Resistance, 3 (4), .
(doi:10.1093/jacamr/dlab180).
Abstract
Background: a low procalcitonin (PCT) concentration facilitates exclusion of bacterial co-infections in COVID-19, but high costs associated with PCT measurements preclude universal adoption. Changes in inflammatory markers, including C-reactive protein (CRP), can be concordant, and predicting low PCT concentrations may avoid costs of redundant tests and support more cost-effective deployment of this diagnostic biomarker.
Objectives: to explore whether, in COVID-19, low PCT values could be predicted by the presence of low CRP concentrations.
Methods: unselected cohort of 224 COVID-19 patients admitted to hospital that underwent daily PCT and CRP measurements as standard care. Both 0.25 ng/mL and 0.5 ng/mL were used as cut-offs for positive PCT test results. Geometric mean was used to define high and low CRP values at each timepoint assessed.
Results: admission PCT was <0.25 ng/mL in 160/224 (71.4%), 0.25-0.5 ng/mL in 27 (12.0%) and >0.5 ng/mL in 37 (16.5%). Elevated PCT was associated with increased risk of death (P = 0.0004) and was more commonly associated with microbiological evidence of bacterial co-infection (P < 0.0001). For high CRP values, significant heterogeneity in PCT measurements was observed, with maximal positive predictive value of 50% even for a PCT cut-off of 0.25 ng/mL. In contrast, low CRP was strongly predictive of low PCT concentrations, particularly <0.5 ng/mL, with a negative predictive value of 97.6% at time of hospital admission and 100% 48 hours into hospital stay.
Conclusions: CRP-guided PCT testing algorithms can reduce unnecessary PCT measurement and costs, supporting antimicrobial stewardship strategies in COVID-19.
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dlab180
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Accepted/In Press date: 3 November 2021
e-pub ahead of print date: 28 November 2021
Published date: December 2021
Identifiers
Local EPrints ID: 453319
URI: http://eprints.soton.ac.uk/id/eprint/453319
PURE UUID: 23f6d8cc-d0e3-4730-954c-eb1496d6e37b
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Date deposited: 12 Jan 2022 17:42
Last modified: 17 Mar 2024 03:56
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Contributors
Author:
Rebecca Houghton
Author:
Nathan Moore
Author:
Rebecca Williams
Author:
Fatima El-Bakri
Author:
Jonathan Peters
Author:
Matilde Mori
Author:
Gabrielle Vernet
Author:
Jessica Lynch
Author:
Henry Lewis
Author:
Maryanna Tavener
Author:
Tom Durham
Author:
Jack Bowyer
Author:
Kordo Saeed
Author:
Gabriele Pollara
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