Owen Richards, Medical student
Mr
Cardiff University, United Kingdom
Disclosure information not submitted.
Charlotte Killick, Medical student
Miss
Cardiff University, United Kingdom
Disclosure information not submitted.
Yusuf Cheema, Medical student
Mr
Cardiff University, United States
Disclosure information not submitted.
Charles King, Medical student
Mr
Cardiff University, United Kingdom
Disclosure information not submitted.
Tamas Szakmany, MD, PhD, FCCM
Consultant in Intensive Care
Aneurin Bevan University Health Board
Cwmbran, United Kingdom
Disclosure information not submitted.
Title: Procalcitonin kinetics may indicate presence of secondary bacterial infections in COVID19 ARDS
Introduction: Secondary bacterial infection in Covid-19 is associated with increased mortality and disproportionately affects critically ill patients. Consistent monitoring of PCT levels in critical care may provide crucial insight in detecting or predicting co-infection and guiding treatment. Our study aims to investigate the comparative efficacy of change in PCT and other commonly available biomarkers in revealing or predicting microbiologically proven secondary bacterial infection in the ICU Covid-19 patient.
Methods: Single centre retrospective observational study conducted in Aneurin Bevan University Health Board in Wales, UK. Patients admitted to ICU between 9th March 2020 to 5th June 2020 were screened daily and recruited to the study providing they fulfilled the inclusion criteria: age ≥ 18-years old; SARS-CoV-2 infection confirmed by positive RT-PCR. Daily biomarker and secondary infection: bloodstream infection (BSI) and ventilator associated pneumonia (VAP) data was collected. For the primary comparison of patients with vs. without PCT rise, a logistic regression model was fitted with occurrence of at least one BSI or VAP event.
RESULTS&CONCLUSIONS: 65 patients with a positive SARS-CoV-2 PCR test were admitted to ICU between the specified observation dates and included in the analysis. PCT rise was observed in 35 (53.8%) of patients, CRP rise in 42 (67.4%) and WCC rise in 52 (80%) of the patients. Secondary infection was confirmed in 33 (50.8%) patients. VAP was the most common ICU-acquired infection, occurring in 28/65 (43.1%) patients, of whom 8/65 (12.3%) suffered both VAP and BSI during their ICU stay. 5/65 (7.7%) patients were observed to have BSI in isolation. A PCT rise was present in 69.7% of the patients with at least one confirmed VAP and/or BSI event. CRP and WCC rises occurred in 69.7% and 93.9% of patients with confirmed VAP and/or BSI, respectively. Logistic regression analysis found a significant association between PCT rise and occurrence of BSI or VAP (OR= 9.83, 95%CI: 1.67, 77.69; p=0.02). Conversely, no statistically significant relationship was found between either a CRP rise (p=0.87) or a WCC rise (p=0.48) and the occurrence of VAP and/or BSI. Our finding that confirmed VAP and BSI was associated with a rise in PCT provides a promising insight into the usefulness of this biomarker.