Abstract
We examined the characteristics of pro-calcitonin (PCT) in hospitalized COVID-19 patients (cohort 1) and clinical outcomes of antibiotic use stratified by PCT in non-critically ill patients without bacterial co-infection (cohort 2). Retrospective reviews were performed in adult, hospitalized COVID-19 patients during March-May 2020. For cohort 1, we excluded hospital transfers, renal disease and extra-pulmonary infection without isolated pathogen(s). For cohort 2, we further excluded microbiologically confirmed infection, ‘do not resuscitate ± do not intubate’ status, and intensive care unit (ICU). For cohort 1, PCT was compared between absent/low-suspicion and proven bacterial co-infections. Factors associated with elevated PCT and sensitivity/specificity/PPV/NPV of PCT cutoffs for identifying bacterial co-infections were explored. For cohort 2, clinical outcomes including mechanical ventilation within 5 days (MV5) were compared between the antibiotic and non-antibiotic groups stratified by PCT ≥ 0.25 µg/L. Nine hundred and twenty four non-ICU and 103 ICU patients were included (cohort 1). The median PCT was higher in proven vs. absent/low-suspicion of bacterial co-infection. Elevated PCT was significantly associated with proven bacterial co-infection, ICU status and oxygen requirement. For PCT ≥ 0.25 µg/L, sensitivity/specificity/PPV/NPV were 69/65/6.5/98% (non-ICU) and 75/33/8.6/94% (ICU). For cohort 2, 756/1305 (58%) patients were included. Baseline characteristics were balanced between the antibiotic and non-antibiotic groups except PCT ≥ 0.25 µg/L (antibiotic:non-antibiotic = 59%:24%) and tocilizumab use (antibiotic:non-antibiotic = 5%:2%). 23% (PCT < 0.25 µg/L) and 58% (PCT ≥ 0.25 µg/L) received antibiotics. Antibiotic group had significantly higher rates of MV5. COVID-19 severity inferred from ICU status and oxygen requirement as well as the presence of bacterial co-infections were associated with elevated PCT. PCT showed poor PPV and high NPV for proven bacterial co-infections. The use of antibiotics did not show improved clinical outcomes in COVID-19 patients with PCT ≥ 0.25 µg/L outside of ICU when bacterial co-infections are of low suspicion.
Keywords: Antibiotics; COVID-19; Characteristics; Clinical outcomes; Procalcitonin; Utility.
【저자키워드】 COVID-19, procalcitonin, Antibiotics, clinical outcomes, Characteristics, Utility., 【초록키워드】 intensive care, mechanical ventilation, Tocilizumab, hospital, Infection, COVID-19 severity, procalcitonin, oxygen, Antibiotics, clinical outcomes, ICU, Clinical outcome, Cohort, Critically ill, clinical, Patient, group, renal disease, disease, bacterial co-infection, antibiotic use, Bacterial, hospitalized COVID-19 patient, antibiotic, COVID-19 patient, retrospective review, do not resuscitate, do not intubate, Factor, hospitalized COVID-19 patients, baseline characteristics, status, non-ICU, Cutoff, renal, Oxygen requirement, non-critically ill patients, PCT, ICU patient, pro-calcitonin, performed, examined, significantly, elevated, median, significantly higher, excluded, stratified, microbiologically, non-critically ill patient, NPV, PPV, use of antibiotics, 【제목키워드】 Clinical outcome, hospitalized COVID-19 patient, procalcitonin level, stratified,