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Minerva Anestesiologica 2022 April;88(4):259-71

DOI: 10.23736/S0375-9393.22.15942-0


language: English

Early procalcitonin to predict mortality in critically ill COVID-19 patients: a multicentric cohort study

Luigi ZATTERA 1, 2 , Ioannis VELIZIOTIS 2, Adela BENITEZ-CANO 1, Isabel RAMOS 1, Leire LARRAÑAGA 1, Maria NUÑEZ 1, Lorena ROMÁN 1, Irina ADALID 1, Carlos FERRANDO 3, 4, Guido MUÑOZ 3, Egoitz ARRUTI 5, Andrea MININI 2, Eva BASSAS 6, Maria HERNÁNDEZ 7, Fabio S. TACCONE 2, Lorenzo PELUSO 2, Ramon ADALIA 1 on behalf of the Spanish ICU NETWORK 

1 Department of Anesthesiology and Critical Care, Hospital del Mar, Pompeu Fabra University, Barcelona, Spain; 2 Department of Intensive Care, Erasme Hospital, Free University of Brussels, Brussels, Belgium; 3 Department of Anesthesiology and Critical Care, Hospital Clinic, Barcelona, Spain; 4 August Pi i Sunyer Research Institute, Barcelona, Spain; 5 Ubikare Technology, Vizcaya, Spain; 6 Department of Anesthesiology and Critical Care, Hospital Moisès Broggi, Sant Joan Despí, Barcelona, Spain; 7 Department of Anesthesiology and Critical Care, Hospital Universitario Cruces, Barakaldo, Spain

BACKGROUND: High levels of procalcitonin (PCT) have been associated with a higher risk of mortality in COVID-19 patients. We explored the prognostic role of early PCT assessment in critically ill COVID-19 patients and whether PCT predictive performance would be influenced by immunosuppression.
METHODS: Retrospective multicentric analysis of prospective collected data in COVID-19 patients consecutively admitted to 36 intensive care units (ICUs) in Spain and Andorra from March to June 2020. Adult (>18 years) patients with confirmed COVID-19 and available PCT values (<72 hours from ICU admission) were included. Patients were considered as “no immunosuppression” (NI), “chronic immunosuppression” (CI) and “acute immunosuppression” (AIT if only tocilizumab; AIS if only steroids, AITS if both). The primary outcome was the ability of PCT to predict ICU mortality.
RESULTS: Of the 1079 eligible patients, 777 patients were included in the analysis. Mortality occurred in 227 (28%) patients. In the NI group 144 (19%) patients were included, 67 (9%) in the CI group, 66 (8%) in the AIT group, 262 (34%) in the AIS group and 238 (31%) in the AITS group; PCT was significantly higher in non-survivors when compared with survivors (0.64 [0.17-1.44] vs. 0.23 [0.11-0.60] ng/mL; P<0.01); however, in the multivariable analysis, PCT values was not independently associated with ICU mortality. PCT values and ICU mortality were significantly higher in patients in the NI and CI groups.
CONCLUSIONS: PCT values are not independent predictors of ICU mortality in COVID-19 patients. Acute immunosuppression significantly reduced PCT values, although not influencing its predictive value.

KEY WORDS: Procalcitonin; Intensive Care Unit; Adrenal cortex hormones; Tocilizumab; COVID-19

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