Informing antimicrobial management in the context of COVID-19: understanding the longitudinal dynamics of C-reactive protein and procalcitonin
Abstract Background To characterise the longitudinal dynamics of C-reactive protein (CRP) and Procalcitonin (PCT) in a cohort of hospitalised patients with COVID-19 and support antimicrobial decision-making. Methods Longitudinal CRP and PCT concentrations and trajectories of 237 hospitalised patien...
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| Format: | Article |
| Language: | English |
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BMC
2021-09-01
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| Series: | BMC Infectious Diseases |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12879-021-06621-7 |
| _version_ | 1818582660110352384 |
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| author | Damien K. Ming Ashleigh C. Myall Bernarnd Hernandez Andrea Y. Weiße Robert L. Peach Mauricio Barahona Timothy M. Rawson Alison H. Holmes |
| author_facet | Damien K. Ming Ashleigh C. Myall Bernarnd Hernandez Andrea Y. Weiße Robert L. Peach Mauricio Barahona Timothy M. Rawson Alison H. Holmes |
| author_sort | Damien K. Ming |
| collection | DOAJ |
| description | Abstract Background To characterise the longitudinal dynamics of C-reactive protein (CRP) and Procalcitonin (PCT) in a cohort of hospitalised patients with COVID-19 and support antimicrobial decision-making. Methods Longitudinal CRP and PCT concentrations and trajectories of 237 hospitalised patients with COVID-19 were modelled. The dataset comprised of 2,021 data points for CRP and 284 points for PCT. Pairwise comparisons were performed between: (i) those with or without significant bacterial growth from cultures, and (ii) those who survived or died in hospital. Results CRP concentrations were higher over time in COVID-19 patients with positive microbiology (day 9: 236 vs 123 mg/L, p < 0.0001) and in those who died (day 8: 226 vs 152 mg/L, p < 0.0001) but only after day 7 of COVID-related symptom onset. Failure for CRP to reduce in the first week of hospital admission was associated with significantly higher odds of death. PCT concentrations were higher in patients with COVID-19 and positive microbiology or in those who died, although these differences were not statistically significant. Conclusions Both the absolute CRP concentration and the trajectory during the first week of hospital admission are important factors predicting microbiology culture positivity and outcome in patients hospitalised with COVID-19. Further work is needed to describe the role of PCT for co-infection. Understanding relationships of these biomarkers can support development of risk models and inform optimal antimicrobial strategies. |
| first_indexed | 2024-12-16T07:52:55Z |
| format | Article |
| id | doaj.art-8cc97ea33545413e98a599626bbe4f0d |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-12-16T07:52:55Z |
| publishDate | 2021-09-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-8cc97ea33545413e98a599626bbe4f0d2022-12-21T22:38:48ZengBMCBMC Infectious Diseases1471-23342021-09-012111710.1186/s12879-021-06621-7Informing antimicrobial management in the context of COVID-19: understanding the longitudinal dynamics of C-reactive protein and procalcitoninDamien K. Ming0Ashleigh C. Myall1Bernarnd Hernandez2Andrea Y. Weiße3Robert L. Peach4Mauricio Barahona5Timothy M. Rawson6Alison H. Holmes7Centre for Antimicrobial Optimisation, Hammersmith Hospital, Imperial College LondonNational Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College LondonNational Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College LondonSchool of Informatics, University of EdinburghDepartment of Neurology, University Hospital of WürzburgDepartment of Mathematics, Imperial College LondonCentre for Antimicrobial Optimisation, Hammersmith Hospital, Imperial College LondonCentre for Antimicrobial Optimisation, Hammersmith Hospital, Imperial College LondonAbstract Background To characterise the longitudinal dynamics of C-reactive protein (CRP) and Procalcitonin (PCT) in a cohort of hospitalised patients with COVID-19 and support antimicrobial decision-making. Methods Longitudinal CRP and PCT concentrations and trajectories of 237 hospitalised patients with COVID-19 were modelled. The dataset comprised of 2,021 data points for CRP and 284 points for PCT. Pairwise comparisons were performed between: (i) those with or without significant bacterial growth from cultures, and (ii) those who survived or died in hospital. Results CRP concentrations were higher over time in COVID-19 patients with positive microbiology (day 9: 236 vs 123 mg/L, p < 0.0001) and in those who died (day 8: 226 vs 152 mg/L, p < 0.0001) but only after day 7 of COVID-related symptom onset. Failure for CRP to reduce in the first week of hospital admission was associated with significantly higher odds of death. PCT concentrations were higher in patients with COVID-19 and positive microbiology or in those who died, although these differences were not statistically significant. Conclusions Both the absolute CRP concentration and the trajectory during the first week of hospital admission are important factors predicting microbiology culture positivity and outcome in patients hospitalised with COVID-19. Further work is needed to describe the role of PCT for co-infection. Understanding relationships of these biomarkers can support development of risk models and inform optimal antimicrobial strategies.https://doi.org/10.1186/s12879-021-06621-7Bacterial co-infectionCOVID-19BiomarkersAntimicrobial stewardshipRisk stratificationClinical decision-support |
| spellingShingle | Damien K. Ming Ashleigh C. Myall Bernarnd Hernandez Andrea Y. Weiße Robert L. Peach Mauricio Barahona Timothy M. Rawson Alison H. Holmes Informing antimicrobial management in the context of COVID-19: understanding the longitudinal dynamics of C-reactive protein and procalcitonin BMC Infectious Diseases Bacterial co-infection COVID-19 Biomarkers Antimicrobial stewardship Risk stratification Clinical decision-support |
| title | Informing antimicrobial management in the context of COVID-19: understanding the longitudinal dynamics of C-reactive protein and procalcitonin |
| title_full | Informing antimicrobial management in the context of COVID-19: understanding the longitudinal dynamics of C-reactive protein and procalcitonin |
| title_fullStr | Informing antimicrobial management in the context of COVID-19: understanding the longitudinal dynamics of C-reactive protein and procalcitonin |
| title_full_unstemmed | Informing antimicrobial management in the context of COVID-19: understanding the longitudinal dynamics of C-reactive protein and procalcitonin |
| title_short | Informing antimicrobial management in the context of COVID-19: understanding the longitudinal dynamics of C-reactive protein and procalcitonin |
| title_sort | informing antimicrobial management in the context of covid 19 understanding the longitudinal dynamics of c reactive protein and procalcitonin |
| topic | Bacterial co-infection COVID-19 Biomarkers Antimicrobial stewardship Risk stratification Clinical decision-support |
| url | https://doi.org/10.1186/s12879-021-06621-7 |
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