The Clinical Utility of Serial Procalcitonin and Procalcitonin Clearance in Predicting the Outcome of COVID-19 Patients

Abstract

ABSTRACTBackgroundThe pandemic of coronavirus disease 2019 (COVID-19) represents a significant threat to global health. Sensitive tests that effectively predict the disease outcome are essentially required to guide proper intervention.ObjectivesTo evaluate the predictive ability of serial procalcitonin (PCT) measurement to predict the outcome of COVID-19 patients, using PCT clearance (PCT-c) as a tool to reflect its dynamic changes.MethodsA prospective observational study of inpatients diagnosed with COVID-19 at the Quarantine Hospitals of Ain-Shams University, Cairo, Egypt. During the first five days of hospitalization, serial PCT and PCT-c values were obtained and compared between survivors and non-survivors. Patients were followed up to hospital discharge or in-hospital mortality.ResultsCompared to survivors, serial PCT levels of non-survivors were significantly higher (p ≤ 0.001) and progressively increased during follow-up. In contrast, PCT-c values were significantly lower (p < 0.01) and progressively decreased. Receiver operating characteristic (ROC) curve analysis showed that using the initial PCT value alone, at a cut-off value of 0.80 ng/ml, the area under the curve for predicting in-hospital mortality was 0.81 with 61.1% sensitivity and 87.3% accuracy. Serial measurements showed better predictive performance, and the combined prediction value was better than the single prediction by the initial PCT alone.ConclusionsSerial PCT measurement could be a helpful laboratory tool to predict the prognosis and outcome of COVID-19 patients. Moreover, PCT-c could be a reliable tool to assess PCT progressive kinetics.