Skip to main content

Main menu

  • Home
  • Our journals
    • Clinical Medicine
    • Future Healthcare Journal
  • Subject collections
  • About the RCP
  • Contact us

Clinical Medicine Journal

  • ClinMed Home
  • Content
    • Current
    • Ahead of print
    • Archive
  • Author guidance
    • Instructions for authors
    • Submit online
  • About ClinMed
    • Scope
    • Editorial board
    • Policies
    • Information for reviewers
    • Advertising

User menu

  • Log in

Search

  • Advanced search
RCP Journals
Home
  • Log in
  • Home
  • Our journals
    • Clinical Medicine
    • Future Healthcare Journal
  • Subject collections
  • About the RCP
  • Contact us
Advanced

Clinical Medicine Journal

clinmedicine Logo
  • ClinMed Home
  • Content
    • Current
    • Ahead of print
    • Archive
  • Author guidance
    • Instructions for authors
    • Submit online
  • About ClinMed
    • Scope
    • Editorial board
    • Policies
    • Information for reviewers
    • Advertising

Procalcitonin for patient stratification and identification of bacterial co-infection in COVID-19

Jennie Han, Timothy Gatheral and Craig Williams
Download PDF
DOI: https://doi.org/10.7861/clinmed.Let.20.3.3
Clin Med May 2020
Jennie Han
Royal Lancaster Infirmary, Ashton Road, Lancaster, UK
Roles: Foundation doctor
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Timothy Gatheral
Royal Lancaster Infirmary, Ashton Road, Lancaster, UK
Roles: Consultant in respiratory medicine
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Craig Williams
Royal Lancaster Infirmary, Ashton Road, Lancaster, UK
Roles: Consultant and professor in microbiology
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Info & Metrics
Loading

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

  1. ↵
    1. Chen N
    , Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020;395:507–13.
    OpenUrlCrossRefPubMed
  2. ↵
    1. Guan WJ
    , Ni ZY, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020 [Epub ahead of print].
  3. ↵
    1. Chen G
    , Wu D, Guo W, et al. Clinical and immunologic features in severe and moderate Coronavirus Disease 2019. J Clin Invest 2020 [Epub ahead of print].
  4. ↵
    1. Chen T
    , Wu D, Chen H, et al. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study. BMJ 2020;368:m1295.
    OpenUrlFREE Full Text
  5. ↵
    1. Müller B
    , Becker K, Schächinger H, et al. Calcitonin precursors are reliable markers of sepsis in a medical intensive care unit. Crit Care Med 2000;28:977–83.
    OpenUrlCrossRefPubMed
  6. ↵
    1. Müller B
    , Harbarth S, Stolz D, et al. Diagnostic and prognostic accuracy of clinical and laboratory parameters in community-acquired pneumonia. BMC Infect Dis 2007;7:10.
    OpenUrlCrossRefPubMed
  7. ↵
    1. Rodríguez AH
    , Avilés-Jurado FX, Díaz E, et al. Procalcitonin (PCT) levels for ruling-out bacterial coinfection in ICU patients with influenza: A CHAID decision-tree analysis. J Infect 2016;72:143–51.
    OpenUrl
Back to top
Previous articleNext article

Article Tools

Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Citation Tools
Procalcitonin for patient stratification and identification of bacterial co-infection in COVID-19
Jennie Han, Timothy Gatheral, Craig Williams
Clinical Medicine May 2020, 20 (3) e47; DOI: 10.7861/clinmed.Let.20.3.3

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Procalcitonin for patient stratification and identification of bacterial co-infection in COVID-19
Jennie Han, Timothy Gatheral, Craig Williams
Clinical Medicine May 2020, 20 (3) e47; DOI: 10.7861/clinmed.Let.20.3.3
del.icio.us logo Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • References
  • Info & Metrics

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • Extended laboratory panel testing in the Emergency Department for risk-stratification of patients with COVID-19: a single centre retrospective service evaluation
  • Google Scholar

More in this TOC Section

  • Hyperbaric oxygen therapy for the treatment of long COVID
  • Fibromyalgia and attention deficit hyperactivity disorder
  • Same-day emergency care
Show more Letters to the Editor

Similar Articles

FAQs

  • Difficulty logging in.

There is currently no login required to access the journals. Please go to the home page and simply click on the edition that you wish to read. If you are still unable to access the content you require, please let us know through the 'Contact us' page.

  • Can't find the CME questionnaire.

The read-only self-assessment questionnaire (SAQ) can be found after the CME section in each edition of Clinical Medicine. RCP members and fellows (using their login details for the main RCP website) are able to access the full SAQ with answers and are awarded 2 CPD points upon successful (8/10) completion from:  https://cme.rcplondon.ac.uk

Navigate this Journal

  • Journal Home
  • Current Issue
  • Ahead of Print
  • Archive

Related Links

  • ClinMed - Home
  • FHJ - Home
clinmedicine Footer Logo
  • Home
  • Journals
  • Contact us
  • Advertise
HighWire Press, Inc.

Follow Us:

  • Follow HighWire Origins on Twitter
  • Visit HighWire Origins on Facebook

Copyright © 2021 by the Royal College of Physicians