Prognostic Value of Procalcitonin and C-Reactive Protein in 1608 Critically Ill Patients with Severe Influenza Pneumonia
Raquel Carbonell,
Gerard Moreno,
Ignacio Martín-Loeches,
Frederic Gomez-Bertomeu,
Carolina Sarvisé,
Josep Gómez,
María Bodí,
Emili Díaz,
Elisabeth Papiol,
Sandra Trefler,
Mercedes Nieto,
Angel Estella,
María Jiménez Herrera,
Pablo Vidal Cortés,
Juan José Guardiola,
Jordi Solé-Violán,
Alejandro Rodríguez
Affiliations
Raquel Carbonell
Critical Care Department, Hospital Universitari Joan XXIII, 43005 Tarragona, Spain
Gerard Moreno
Critical Care Department, Hospital Universitari Joan XXIII, 43005 Tarragona, Spain
Ignacio Martín-Loeches
Department of Anaesthesia and Critical Care, St James’s University Hospital, Trinity Centre for Health Sciences, Multidisciplinary Intensive Care Research Organization (MICRO), Dublin 8, Ireland
Frederic Gomez-Bertomeu
Microbiology, Hospital Universitari Joan XXIII, 43005 Tarragona, Spain
Carolina Sarvisé
Microbiology, Hospital Universitari Joan XXIII, 43005 Tarragona, Spain
Josep Gómez
Tarragona Health Data Research Working Group (THeDaR)-ICU Hospital Joan XXIII, 43005 Tarragona, Spain
María Bodí
Critical Care Department URV/IISPV/CIBERES, Hospital Universitari Joan XXIII, 43005 Tarragona, Spain
Emili Díaz
Critical Care Department/CIBERES, Hospital Parc Taulí, 08208 Sabadell, Spain
Elisabeth Papiol
Critical Care Department, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain
Sandra Trefler
Critical Care Department, Hospital Universitari Joan XXIII, 43005 Tarragona, Spain
Mercedes Nieto
Critical Care Department, Hospital Clínico San Carlos, 28040 Madrid, Spain
Angel Estella
Critical Care Department, Hospital de Jerez, 11407 Jerez de la Frontera, Spain
María Jiménez Herrera
Dean Nursing Faculty, Universitat Rovira i Virgili, 43003 Tarragona, Spain
Pablo Vidal Cortés
Critical Care Department, Complejo Hospitalario Universitario Ourense, 32005 Ourense, Spain
Juan José Guardiola
Department of Pulmonary, Critical Care and Sleep Medicine, University of Louisville, Louisville, KY 40202, USA
Jordi Solé-Violán
Critical Care Department Hospital Universitario Dr. Negrín, 35010 Las Palmas de Gran Canaria, Spain
Alejandro Rodríguez
Critical Care Department URV/IISPV/CIBERES, Hospital Universitari Joan XXIII, 43005 Tarragona, Spain
Background: Procalcitonin (PCT) and C-Reactive protein (CRP) are well-established sepsis biomarkers. The association of baseline PCT levels and mortality in pneumonia remains unclear, and we still do not know whether biomarkers levels could be related to the causative microorganism (GPC, GNB). The objective of this study is to address these issues. Methods: a retrospective observational cohort study was conducted in 184 Spanish ICUs (2009–2018). Results: 1608 patients with severe influenza pneumonia with PCT and CRP available levels on admission were included, 1186 with primary viral pneumonia (PVP) and 422 with bacterial Co-infection (BC). Those with BC presented higher PCT levels (4.25 [0.6–19.5] versus 0.6 [0.2–2.3]ng/mL) and CRP (36.7 [20.23–118] versus 28.05 [13.3–109]mg/dL) as compared to PVP (p versus 0.53 [0.19–2.1], p = 0.001) and BC (6.9 [0.93–28.5] versus 3.8 [0.5–17.37], p = 0.039). However, no significant association with mortality was observed in the multivariate analysis. The PCT levels (ng/mL) were significantly higher in polymicrobial infection (8.4) and GPC (6.9) when compared with GNB (1.2) and Aspergillus (1.7). The AUC-ROC of PCT for GPC was 0.67 and 0.32 for GNB. The AUROC of CRP was 0.56 for GPC and 0.39 for GNB. Conclusions: a single PCT/CRP value at ICU admission was not associated with mortality in severe influenza pneumonia. None of the biomarkers have enough discriminatory power to be used for predicting the causative microorganism of the co-infection.
