The Importance of Procalcitonin Levels in COVID-19 Pneumonia

Abstract

Objective: Our aim in this study is to determine how procalcitonin levels are affected in RT-PCR (Real-Time Polymerase Chain Reaction) positive COVID-19 pneumonia. To investigate the value of this parameter in terms of biochemical parameters in RT-PCR positive patients and to propose new opinions on the subject. Methods: One hundred COVID-19 patients admitted to the hospital with positive RT-PCR test and above the age of 18 were included in our study. The data of the patients were collected retrospectively from the hospital system. RT-PCR positive patients were divided into two groups as thoracic CT (computed tomography) positive and CT negative, and procalcitonin values were investigated between these two groups. The obtained results were evaluated in the SPSS 25 program. Results: Of the 100 patients with positive RT-PCR tests, 39 patients were CT negative and 61 patients were CT positive. Although the procalcitonin levels measured in the CT positive patient group were higher than the CT negative group, it was not statistically significant (0.113 ± 0.154 ng / mL, 0.064 ± 0.058 ng / mL, p = 0.510). Conclusion: Our results show that the procalcitonin level cannot distinguish the presence of COVID-19 pneumonia in RT-PCR positive patients. High procalcitonin levels may predict that the disease becomes more complicated.

Keywords

• COVID-19
• Pneumonia
• Procalcitonin

COVİD-19 Pnömonisinde Prokalsitonin Düzeylerinin Önemi

Abstract

Amaç: Bu çalışmadaki amacımız, RT-PCR (Real-Time Polymerase Chain Reaction) pozitif COVID-19 pömonisinde prokalsitonin seviyelerinin nasıl etkilendiğini tespit etmek. Bu parametrenin RT-PCR pozitif hastalarda biyokimyasal parametre açısından değerini araştırmak, konuyla ilgili yeni görüşler ileri sürebilmektir. Gereç ve Yöntem: Çalışmamıza hastaneye başvuran 18 yaş üstü RT-PCR testi pozitif olup servise yatışı olan 100 COVİD-19 hasta dahil edildi. Hastaların verileri hastanenin sisteminden geriye dönük olarak toplandı. RT-PCR pozitif hastalar toraks BT (bilgisayarlı tomografi) pozitif ve BT negatif diye iki gruba ayrıldı ve bu iki grup arasında prokalsitonin değerleri araştırıldı. Elde elden sonuçlar SPSS 25 programında değerlendirildi. Bulgular: RT-PCR testi pozitif olan 100 hastanın 39'unda BT negatif, 61'inde BT pozitifti. BT pozitif hasta grubunda ölçülen prokalsitonin düzeyleri, BT negatif hasta grubuna göre yüksek olmasına rağmen istatiksel olarak anlamlı bulunmadı (0.113±0.154 ng/mL, 0.064±0.058 ng/mL, p=0.510). Sonuç: Elde ettiğimiz sonuçlar prokalsitonin düzeyinin RT-PCR pozitif hastalarda COVID-19 pnömonisinin varlığını ayırt edemeyeceğini göstermektedir. Prokalsitonin düzeyindeki yükseklik hastalığın daha komplike bir hale geldiğini öngörebilir.

Keywords

• COVID-19
• Pnömoni
• Prokalsitonin

References

1. Metintas S. Epidemiology of COVID-19. Eurasian J Pulmonol 2020;22, Suppl S1:2-7.
2. T.C. Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü: COVID-19 (SARS-CoV-2 Enfeksiyonu) Rehberi. Bilim Kurulu Çalışması, T.C. Sağlık Bakanlığı 12 Nisan 2020, Ankara.
3. Nishiura, H.; Linton, N.M.; Akhmetzhanov, A.R. Initial Cluster of Novel Coronavirus (2019-nCoV) Infections in Wuhan, China Is Consistent with Substantial Human-to-Human Transmission. J. Clin. Med. 2020, 9, 488. https://doi.org/10.3390/jcm9020488.
4. McIntosh K. Coronavirus disease 2019 (COVID-19): Epidemiology, virology, clinical features, diagnosis, and prevention. UpToDate. (https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-epidemiology-virology-clinical-features-diagnosis-and-prevention).
5. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020;NEJMoa2002032. https://doi.org/10.1101/2020.02.06.20020974.
6. Wang Z, Yang B, Li Q, Wen L, Zhang R. Clinical Features of 69 Cases with Coronavirus Disease 2019 in Wuhan, China. Clin Infect Dis 2020;ciaa272. https://doi.org/10.1093/cid/ciaa272.
7. Wang C, Horby P, Hayden FG, Gao GF. A novel coronavirus outbreak of global health concern. Lancet 2020;395:470-473. https://doi.org/10.1016/S0140-6736(20)30185-9.
8. Li Z, Yi Y, Luo X, Xiong N, Liu Y, Li S, et al. Development and clinical application of a rapid IgM-IgG combined antibody test for SARS-CoV-2 infection diagnosis. J Med Virol. 2020. 27:25727. https://doi.org/10.1002/jmv.25727.

9. Hao W, Li M. Clinical diagnostic value of CT imaging in COVID-19 with multiple negative RT-PCR testing. Travel Med Infect Dis. 2020; 34: 101627. https://doi.org/10.1016/j.tmaid.2020.101627.
10. Wang S, Kang B, Ma, J, Zeng X, Xiao, M, Guo J, et al. A deep learning algorithm using CT images to screen for corona virus disease (COVID-19). medRxiv 2020.02.14.20023028. https://doi.org/10.1101/2020.02.14.20023028.
11. Zhai P, Ding Y, Wu X, Long J, Zhong Y, Li Y. The epidemiology, diagnosis and treatment of COVID-19. Int J Antimicrob Agents. 2020; 55(5): 105955. https://doi.org/10.1016/j.ijantimicag.2020.105955.
12. Creamer AW, Kent AE, Albur M. Procalcitonin in respiratory disease: use as a biomarker for diagnosis and guiding antibiotic therapy. Breathe 2019; 15: 296-304. https://doi.org/10.1183/20734735.0258-2019.
13. Carrol ED, Thomson APJ, Hart CA. Procalcitonin as a marker of sepsis. International Journal of Antimicrobial Agents 2002; 20: 1-9.
14. Kamat IS, Ramachandran V, Eswaran H, Guffey D, Musher D. Procalcitonin to distinguish viral from bacterial pneumonia: a systematic review and meta-analysis. Clin Infect Dis 2020; 70: 538-542. https://doi.org/10.1093/cid/ciz545.
15. Schuetz P, Wirz Y, Sager R, Christ-Crain M, Stolz D, Tamm M, et al. Effect of procalcitonin-guided antibiotic treatment on mortality in acute respiratory infections: a patient level meta-analysis. Lancet Infect Dis 2018; 18: 95-107. https://doi.org/10.1016/S1473-3099(17)30592-3.
16. Fang Y, Zhang H, Xie J, Lin M, Ying L, Pang P, et al. Sensitivity of chest CT for COVID-19: comparison to RTPCR. Radiology 2020 https://doi.org/10.1148/radiol.2020200432.
17. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, 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. https://doi.org/10.1016/S0140-6736(20)30211-7.
18. Guan WJ, Ni ZY, Hu Y, Liang WH, Qu CQ, He JX, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020.
19. Liu F, Li L, Xu M, Wu J, Luo D, Zhu Y, et al. Prognostic value of interleukin-6, C-reactive protein, and procalcitonin in patients with COVID-19 J Clin Virol. 2020 Jun; 127: 104370. https://doi.org/10.1016/j.jcv.2020.104370.
20. Hu R, Han C, Pei S, Yin M, Chen X. Procalcitonin levels in COVID-19 patients Int J Antimicrob Agents. 2020 Aug; 56(2): 106051. https://doi.org/10.1016/j.ijantimicag.2020.106051.
21. Lippi G, Plebani M. Procalcitonin in patients with severe coronavirus disease 2019 (COVID-19): A meta-analysis. Clin Chim Acta. 2020 Jun;505:190-191. Epub 2020 Mar 4. PMID: 32145275; https://doi.org/10.1016/j.cca.2020.03.004.
22. Vazzana N, Dipaola F, Ognibene S. Procalcitonin and secondary bacterial infections in COVID-19: association with disease severity and outcomes Acta Clin Belg. 2020 Sep;23. 10.1080/17843286.2020.1824749. 23. Xu JB, Xu C, Zhang RB, Wu M, Pan CK, Li XJ, et al. Associations of procalcitonin, C reaction protein and neutrophil to lymphocyte ratio with mortality in hospitalized COVID 19 patients in China. Scientific Reports. 2020;10:150-158.
23. Heesom L, Rehnberg L, Nasim-Mohi M, Jackson AIR, Celinski M, Dushianthan A, et al. Procalcitonin as an antibiotic stewardship tool in COVID-19 patients in the intensive care. Journal of Global Antimicrobial Resistance. 2020;22:782–784.
24. Elshazli RM, Toraih EA, Elgaml A, El-Mowafy M, El-Mesery M, Amin MN, et al. Diagnostic and prognostic value of hematological and immunological markers in COVID-19 infection: A meta-analysis of 6320 patients. PLoS One. 2020;15(8):e0238160.
25. Li J, He X, Yuanyuan Y, Zhang W, Li X, Zhang Y, et al. Meta-analysis investigating the rela- tionship between clinical features, outcomes, and severity of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) pneumonia. Am J Infect Control. 2021 Jan; 49(1): 82–89.
26. Müller B, Becker KL, Schächinger H, Rickenbacher PR, Huber PR, Zimmerli W, et al. Calcitonin precursors are reliable markers of sepsis in a medical intensive care unit. Crit Care Med 2000;28:977-83. https://doi.org/10.1097/00003246-200004000-00011.
27. Müller B, Harbarth S, Stolz D, Bingisser R, Mueller C, Leuppi J, et al. Diagnostic and prognostic accuracy of clinical and laboratory parameters in community-acquired pneumonia. BMC Infect Dis 2007;7:10. https://doi.org/10.1186/1471-2334-7-10.
28. Kotula JJ, Moore WS, Chopra A, Cies JJ. Association of procalcitonin value and bacterial coinfections in pediatric patients with viral lower respiratory tract infections admitted to the pediatric intensive care unit. J. Pediatr. Pharmacol. Ther. 2018;23:466-472. https://doi.org/10.5863/1551-6776-23.6.466.