scholarly journals Procalcitonin and COVID-19: A Reliable Clinical Tool

2020 ◽  
Author(s):  
Jessica Bass ◽  
Anshika Singh ◽  
Robin Williams ◽  
David H. Lindner

Abstract BACKGROUND: A procalcitonin (PCT) level is commonly ordered to distinguish between bacterial and viral etiologies of lower respiratory tract infections as it is typically negative in the absence of inflammatory conditions and bacterial infections. With COVID-19 causing an influx of patients presenting with respiratory symptoms, clinicians are in need of useful tools to guide management of these patients. Given the inflammation that is caused by COVID-19, it is currently unknown whether PCT continues to be a reliable or useful test in suspected and confirmed cases of COVID-19 pneumonia. OBJECTIVE: To determine whether PCT remains a clinically useful test in patients who present with lower respiratory tract symptoms in the era of COVID-19. DESIGN: Single-center retrospective cohort studyPARTICIPANTS: 243 adults with lower respiratory tract symptoms who presented to the hospital through the emergency department between April 11, 2020 and May 18, 2020 who received both a COVID-19 test as well as a PCT level. MAIN MEASURES: COVID-19 positivity/negative, PCT level KEY RESULTS: It was found that patients with COVID-19 consistently had negative procalcitonin levels (<0.25ng/mL). Based on the odds ratio, a patient with a positive PCT level was 3.4 times more likely to test negative for COVID than a patient with a PCT level <0.25ng/mL. (1)=13.895, p<0.001. CONCLUSIONS: There is a highly significant association between a negative procalcitonin and positive COVID-19 infection, thus supporting the continued use of PCT in the COVID-19 era.

2016 ◽  
Vol 40 (3) ◽  
Author(s):  
Martha Kaeslin ◽  
Saskia Brunner ◽  
Janine Raths ◽  
Andreas Huber

AbstractImmediate treatment of lower respiratory tract infections (LRTI) caused by bacteria is important to reduce pneumonia and other complications such as systemic inflammatory response syndrome and sepsis. Nowadays procalcitonin (PCT) is the gold standard to differentiate between bacterial and non-bacterial infections in LRTI. The aim of this study was to evaluate if the new Intensive Care Infection Score (ICIS) which is a combination of various cellular measurements made on hematology analyzers could be a potential method to differentiate between bacterial and non-bacterial infections in LRTI.The ICIS is composed of five blood-cell derived parameters characterizing the early innate immune response; (1) mean fluorescence intensity of mature (segmented) neutrophils; (2) the difference in hemoglobin concentration between newly formed red blood cells and the mature ones; (3) absolute number of segmented neutrophils; (4) absolute count of antibody secreting lymphocytes and (5) absolute count of number of granulocytes.The discriminative power of ICIS to differentiate between patients with LRTI of bacterial and non-bacterial origin is as good or even better as the commonly used infection biomarkers PCT, CRP and IL-6.Beside PCT, CRP and IL-6, ICIS could be used as infection marker in LRTI.


BMJ Open ◽  
2018 ◽  
Vol 8 (9) ◽  
pp. e023592
Author(s):  
Serges Tchatchouang ◽  
Jean Joel Bigna ◽  
Ariane Nzouankeu ◽  
Marie-Christine Fonkoua ◽  
Jobert Richie Nansseu ◽  
...  

IntroductionThe burden of lower respiratory tract infections (LRTIs) is a substantial public health concern. However, the epidemiology of LRTI and its bacterial aetiologies are poorly characterised, particularly in the African continent. Providing accurate data can help design cost-effective interventions to curb the burden of respiratory infections in Africa. Therefore, the aim of this systematic review and meta-analysis will be to determine the prevalence of respiratory Bacterial Aetiologies in people with low Respiratory tract Infections in Africa (BARIAFRICA) and associated factors.Methods and analysisWe will search PubMed, EMBASE, Web of Science, African Journals Online, Cumulative Index to Nursing and Allied Health Literature, and Global Index Medicus to identify studies that reported the prevalence (of enough data to compute this estimate) of respiratory bacterial infections in people with LRTIs in Africa from 1 January 2000 to 31 March 2018, without any linguistic restrictions. Study selection, data extraction and risk of bias assessment will be conducted independently by two investigators. Heterogeneity will be evaluated using the χ² test on Cochran’s Q statistic and quantified with H and I² statistics. Prevalence will be pooled using a random-effect meta-analysis model. Subgroup and meta-regression analyses will be used to identify sources of heterogeneity of prevalence estimates. This study will be reported according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.Ethics and disseminationSince this study will be based on published data, it does not require ethical approval. This systematic review and meta-analysis is intended to serve as a basis for determining the burden of LRTIs, for identifying data gaps and for guiding future investigations in Africa. The final report will be published in peer-reviewed journals, presented in conferences and submitted to relevant health policy makers.PROSPERO registration numberCRD42018092359.


10.3823/837 ◽  
2019 ◽  
Vol 9 (3) ◽  
Author(s):  
Nathir Obeidat ◽  
Isam Bsisu ◽  
Faruque Parvez ◽  
Zafrin Islam ◽  
Zaina Obeidat ◽  
...  

Background: Lower respiratory tract infections (LRTI) are a major cause of morbidity and mortality globally. The World Health Organization (WHO) estimates that LRTI are the most common global cause of death from infectious diseases.  However, the specific etiologic agent associated with LRTI is often unknown. Aims: We determined the bacterial infections and seasonal patterns associated with LRTI among hospitalized cases at Jordan University Hospital (JUH) for a period of five years. Methods: We conducted a multi-year study among hospitalized patients in Jordan on LRTI-associated bacterial etiology. Results: We found bacterial infections among 105 (21.1%) out of 495 LRTI patients. The most frequently identified bacteria in the LRTI patients were Staphylococcus aureus (7.7%) followed by Pseudomonas aeruginosa (5.1%). Most of the LRTI patients (95.2%) had at least one chronic disease and many were admitted to the Intensive Care Unit (16.8%). Of the 18 (3.64%) patients with LRTI who died at the hospital, 2 had a bacterial infection. We noticed a seasonal pattern of bacterial infections, with the highest prevalence during the winter months. Conclusions: Our findings suggest that early identification of bacterial agents and control of chronic disease may improve clinical management and reduce morbidity and mortality from LRTI.


2019 ◽  
Vol 57 (5) ◽  
pp. 679-689
Author(s):  
Thomas Baumgartner ◽  
Giedre Zurauskaite ◽  
Christian Steuer ◽  
Luca Bernasconi ◽  
Andreas Huber ◽  
...  

Abstract Background Sphingolipids – the structural cell membrane components – and their metabolites are involved in signal transduction and participate in the regulation of immunity. We investigated the prognostic implications of sphingolipid metabolic profiling on mortality in a large cohort of patients with lower respiratory tract infections (LRTIs). Methods We measured 15 different sphingomyelin (SM) types in patients with LRTIs from a previous Swiss multicenter trial that examined the impact of procalcitonin-guided antibiotic therapy on total antibiotic use and rates and duration of hospitalization. Primary and secondary end points were adverse outcomes – defined as death or intensive care unit admission within 30 days – and 6-year mortality. Results Of 360 patients, 8.9% experienced an adverse outcome within 30 days and 46% died within 6 years. Levels of all SM types were significantly lower in pneumonia patients vs. those with chronic obstructive pulmonary disease (COPD) exacerbation (p<0.0001 for all comparisons). Sphingomyelin subspecies SM (OH) C22:1 and SM (OH) C22:2 were associated with lower risk for short-term adverse outcomes (sex-, gender- and comorbidity-adjusted odds ratios [OR]: 0.036; 95% confidence interval [CI], 0.002–0.600; p=0.021 and 0.037; 95% CI, 0.001–0.848; p=0.039, respectively). We found no significant associations with 6-year mortality for any SM. Conclusions Circulating sphingolipid levels are lower in inflammatory conditions such as pneumonia and correlate with adverse short-term outcomes. Further characterization of the physiological, pathophysiological and metabolic roles of sphingolipids under inflammatory conditions may facilitate understanding of their roles in infectious disease.


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