Procalcitonin for patient stratification and identification of bacterial co-infection in COVID-19
Editor – an abundance of biomarkers has been measured in hospitalised patients with COVID-19. Initial reports from China have shown that most patients with COVID-19 did not have elevated procalcitonin (>0.5 μg/L).1,2 However, elevated levels were found more frequently in severe cases and in patients who died.2–4
Variance in procalcitonin levels have previously been proposed to differentiate systemic inflammation of bacterial origin from viral origin in community acquired pneumonia and sepsis, with a significant rise indicating bacterial infection.5,6 The lack of a procalcitonin rise in viral infections may be due to virus-stimulated production of interferon-γ by macrophages, which inhibits TNF-α in the immune response.5 The presence of lower procalcitonin levels has been shown to have a 94% negative predictive value for bacterial co-infection in intensive care unit patients with confirmed influenza A(H1N1)pdm09.7 Therefore, we suggest that raised procalcitonin observed in COVID-19 could be due either to bacterial co-infection, which is itself causing increased severity and driving systemic sepsis, or as a direct marker of a more severe or widespread viral infection.
As such, procalcitonin measurement on admission may be a useful marker to firstly predict patient deterioration in hospital and secondly, non-elevated procalcitonin on admission may be a good predictor of the absence of bacterial co-infection and allow the more targeted use of antimicrobials thus promoting antibiotic stewardship. Further work is needed to correlate the presence of raised procalcitonin and the presence of bacterial co-infection in COVID-19 patients.
- © Royal College of Physicians 2020. All rights reserved.
References
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- Guan WJ
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- Chen G
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- Chen T
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- Rodríguez AH
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