Observational studyIntensive care medicine2023
Procalcitonin and C-reactive protein to rule out early bacterial coinfection in COVID-19 critically ill patients.
Open access · hybridAbstract readObservational Study
In one paragraph
Observational study in Intensive care medicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers.
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25citing papers in PubMed
7.1field-weighted citation impact, top 2% of its field
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Who cites it
25 citing papers in PubMed, 33 citations in OpenAlex.
- A clinical scoring system for the early identification of superinfections in patients with severe fever with thrombocytopenia syndrome: An ambispective multicentre cohort study.PLoS neglected tropical diseases · 2026Article
- Age-Structured Clinical Background Is More Strongly Associated with C-Reactive Protein Levels than Individual Respiratory Viruses During Respiratory Virus Testing.Pathogens (Basel, Switzerland) · 2026Article
- Procalcitonin Levels in ICU Patients with SARS-CoV-2-Associated Viral Sepsis.Journal of clinical medicine · 2026Article
- The Resistance Paradox in COVID-19 Ventilator-Associated Pneumonia: A Retrospective Study on Rapid Molecular Stewardship.Antibiotics (Basel, Switzerland) · 2026Article
- Comparing routine hematological parameters on COVID-19, bacterial infections, and coinfection in elderly severe community-acquired pneumonia, a retrospective study in primary hospitals.Journal of family medicine and primary care · 2026Article
- Combined predictive accuracy of inflammatory and hematologic indicators for urinary tract-related bloodstream infection.American journal of translational research · 2026Article
- Development and validation of a predictive model for ventilator-associated pneumonia in patients with cardiogenic shock: based on the MIMIC-IV database.Journal of thoracic disease · 2025Article
- Predictive Performance of SAPS-3, SOFA Score, and Procalcitonin for Hospital Mortality in COVID-19 Viral Sepsis: A Cohort Study.Life (Basel, Switzerland) · 2025Article
- A novel nomogram for the early identification of coinfections in elderly patients with coronavirus disease 2019.Virology journal · 2025Observational
- Does Empirical Antibiotic Use Improve Outcomes in Ventilated Patients with Pandemic Viral Infection? A Multicentre Retrospective Study.Antibiotics (Basel, Switzerland) · 2025Article
- Development of a risk prediction model for secondary infection in severe/critical COVID-19 patients.BMC infectious diseases · 2025Article
- Early Predictive Value of Infectious Markers for Ventilator-associated Pneumonia after Stanford Type A Aortic Dissection Surgery.Reviews in cardiovascular medicine · 2025Article
- Role of Artificial Intelligence in Identifying Vital Biomarkers with Greater Precision in Emergency Departments During Emerging Pandemics.International journal of molecular sciences · 2025Article
- Presepsin is a biomarker that can predict mortality in sepsis patients.Revista da Associacao Medica Brasileira (1992) · 2025Article
- Clinical characteristics and predictive models for hospitalized patients with COVID-19 combined with bacterial pneumonia.PloS one · 2025Article
- Dual threat: Susceptibility mechanisms and treatment strategies for COVID-19 and bacterial co-infections.Computational and structural biotechnology journal · 2025Review
- The Influence of COVID-19 on Antimicrobial Resistance Trends at a Secondary Care Hospital in Slovenia: An Interrupted Time Series Analysis.Antibiotics (Basel, Switzerland) · 2024Article
- Enhancing sepsis biomarker development: key considerations from public and private perspectives.Critical care (London, England) · 2024Review
- The long Pentraxin PTX3 serves as an early predictive biomarker of co-infections in COVID-19.EBioMedicine · 2024Article
- Comparative Impact of an Optimized PK/PD Target Attainment of Piperacillin-Tazobactam vs. Meropenem on the Trend over Time of SOFA Score and Inflammatory Biomarkers in Critically Ill Patients Receiving Continuous Infusion Monotherapy for Treating Documented Gram-Negative BSIs and/or VAP.Antibiotics (Basel, Switzerland) · 2024Article
Corrections and comments
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Authors and funding
74 authors at 20 institutions in 2 countries.
Flavia Galli *Department of Intensive Care, Emergency Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Francesco Bindo *Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Anna MotosCIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
Laia Fernández-BaratCIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain. lfernan1@recerca.clinic.cat.
Enric BarbetaCIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
Albert GabarrúsCIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
Adrián CeccatoCIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
Jesús F Bermejo-MartinCIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
Ricard FerrerIntensive Care Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Barcelona, Spain.
Jordi RieraIntensive Care Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Barcelona, Spain.
Oscar PeñuelasCIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
José Ángel LorenteCIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
David de Gonzalo-CalvoCIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
Rosario MenéndezCIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
Jessica GonzalezCIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
Sofia MisuracaRespiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Andrea PalomequeCIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
Rosario Amaya-VillarIntensive Care Clinical Unit, Hospital Universitario Virgen de Rocío, Seville, Spain.
José Manuel AñónCIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
Ana Balan MariñoHospital Universitario San Agustín, Asturias, Spain.
Carme BarberàHospital Santa Maria, IRBLleida, Lleida, Spain.
José BarberánHospital Universitario HM Montepríncipe, Facultad HM Hospitales de Ciencias de la Salud, Universidad Camilo Jose Cela, Madrid, Spain.
Aaron Blandino OrtizServicio de Medicina Intensiva, Hospital Universitario Ramón y Cajal, Madrid, Spain.
Elena Bustamante-MunguiraCIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
Jesús CaballeroCritical Intensive Medicine Department, Hospital Universitari Arnau de Vilanova de Lleida, IRBLleida, Lleida, Spain.
María Luisa Cantón-BulnesIntensive Care Clinical Unit, Hospital Universitario Virgen Macarena, Seville, Spain.
Cristina Carbajales PérezIntensive Care Unit, Hospital Álvaro Cunqueiro, Vigo, Spain.
Nieves CarbonellIntensive Care Unit, Hospital Clínico Universitario, Valencia, Spain.
Mercedes Catalán-GonzálezDepartment of Intensive Care Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain.
Raul de FrutosServicio de Anestesiología y Reanimación, Hospital Universitario Basurto, Bilbao, Spain.
Nieves FrancoHospital Universitario de Móstoles, Madrid, Spain.
Cristóbal GalbánDepartment of Critical Care Medicine, CHUS, Complejo Hospitalario Universitario de Santiago, Santiago, Spain.
Ana Lopez LagoDepartment of Critical Care Medicine, CHUS, Complejo Hospitalario Universitario de Santiago, Santiago, Spain.
Víctor D Gumucio-SanguinoDepartment of Intensive Care, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.
Maria Del Carmen de la TorreHospital de Mataró de Barcelona, Barcelona, Spain.
Emilio DíazDepartment of Medicine, Critical Care Department, Corporació Sanitària Parc Taulí, Universitat Autònoma de Barcelona (UAB), Sabadell, Barcelona, Spain.
Ángel EstellaDepartment of Medicine, Intensive Care Unit University Hospital of Jerez, University of Cádiz, INIBiCA, Cádiz, Spain.
Elena Gallego CurtoCIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
José Luis García-GarmendiaIntensive Care Unit, Hospital San Juan de Dios del Aljarafe, Bormujos, Seville, Spain.
José Manuel GómezHospital General Universitario Gregorio Marañón, Madrid, Spain.
Arturo HuertaPulmonary and Critical Care Division, Emergency Department, Clínica Sagrada Família, Barcelona, Spain.
Ruth Noemí Jorge GarcíaIntensive Care Department, Hospital Nuestra Señora de Gracia, Saragossa, Spain.
Ana Loza-VázquezUnidad de Medicina Intensiva, Hospital Universitario Virgen de Valme, Seville, Spain.
Judith Marin-CorralCritical Care Department, Hospital del Mar-IMIM, Barcelona, Spain.
María Cruz Martin DelgadoHospital Universitario Torrejón-Universidad Francisco de Vitoria, Madrid, Spain.
Amalia Martínez de la GándaraDepartment of Intensive Medicine, Hospital Universitario Infanta Leonor, Madrid, Spain.
Ignacio Martínez VarelaCritical Care Department, Hospital Universitario Lucus Augusti, Lugo, Spain.
Juan Lopez MessaComplejo Asistencial Universitario de Palencia, Palencia, Spain.
Guillermo M AlbaicetaCIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
María Teresa NietoHospital General de Segovia, Segovia, Spain.
Mariana Andrea NovoServei de Medicina Intensiva, Hospital Universitari Son Espases, Illes Balears, Palma, Spain.
Yhivian PeñascoServicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
Felipe Pérez-GarcíaServicio de Microbiología Clínica, Facultad de Medicina, Departamento de Biomedicina y Biotecnología, Hospital Universitario Príncipe de Asturias - Universidad de Alcalá, Alcalá de Henares, Madrid, Spain.
Juan Carlos Pozo-LaderasUGC-Medicina Intensiva, Hospital Universitario Reina Sofia, Instituto Maimonides IMIBIC, Córdoba, Spain.
Pilar RicartServei de Medicina Intensiva, Hospital Universitari Germans Trias, Badalona, Spain.
Victor SagredoHospital Universitario de Salamanca, Salamanca, Spain.
Angel Sánchez-MirallesIntensive Care Unit, Hospital Universitario Sant Joan d'Alacant, Sant Joan d'Alacant, Alicante, Spain.
Susana Sancho ChinestaServicio de Medicina Intensiva, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
Ferran Roche-CampoHospital Verge de la Cinta, Institut d'Investigació Sanitària Pere Virgili (IISPV), Tortosa, Tarragona, Spain.
Lorenzo SociasIntensive Care Unit, Hospital Son Llàtzer, Illes Balears, Palma, Spain.
Jordi Solé-ViolanCIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
Fernando Suarez-SipmannIntensive Care Unit, Hospital Universitario La Princesa, Madrid, Spain.
Luis Tamayo LomasCIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
José TrenadoServicio de Medicina Intensiva, Hospital Universitario Mútua de Terrassa, Terrassa, Barcelona, Spain.
Alejandro ÚbedaServicio de Medicina Intensiva, Hospital Punta de Europa, Algeciras, Spain.
Luis Jorge ValdiviaHospital Universitario de León, León, Spain.
Pablo VidalComplexo Hospitalario Universitario de Ourense, Orense, Spain.
Maria Victoria BoadoHospital Universitario de Cruces, Barakaldo, Spain.
Alejandro RodríguezCritical Care Department, Hospital Universitario Joan XXIII, CIBERES, Rovira & Virgili University, IISPV, Tarragona, Spain.
Massimo AntonelliDepartment of Intensive Care, Emergency Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Francesco BlasiRespiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Ferran BarbéCIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
Antoni TorresCIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain. atorres@clinic.cat.ORCID http://orcid.org/0000-0002-8643-2167
CIBERESUCICOVID Project investigators (COV20/00110, ISCIII)
Instituto de Salud Carlos III · ESHospital de Cruces · ESHospital General De Segovia · ESHospital de León · ESHospital Universitari i Politècnic La Fe · ESHospital Universitari Sant Joan D'Alacant · ESInstituto Maimónides de Investigación Biomédica de Córdoba · ESUniversidad de Alcalá · ESComplejo Hospitalario Universitario de Santiago · ESHospital General Universitario Gregorio Marañón · ESHospital Universitario Virgen Macarena · ESInstitut de Recerca Biomèdica Catalunya Sud · ESUniversitat Autònoma de Barcelona · ESComplexo Hospitalario Universitario A Coruña · ESHospital Del Mar · ESHospital Universitario Son Espases · ESUniversity Hospital Complex Of Vigo · ESUniversity of Milan · ITHospital de Basurto · ESHospital de Mataró · ES
Funding
Instituto de Salud Carlos III COV20/00110Instituto de Salud Carlos III ISCIIIInstituto de Salud Carlos III Miguel Servet 2020: CP20/00041Instituto de Salud Carlos III Sara Borrell 2021: CD21/00087
Abstract
purposeAlthough the prevalence of community-acquired respiratory bacterial coinfection upon hospital admission in patients with coronavirus disease 2019 (COVID-19) has been reported to be < 5%, almost three-quarters of patients received antibiotics. We aim to investigate whether procalcitonin (PCT) or C-reactive protein (CRP) upon admission could be helpful biomarkers to identify bacterial coinfection among patients with COVID-19 pneumonia.
methodsWe carried out a multicentre, observational cohort study including consecutive COVID-19 patients admitted to 55 Spanish intensive care units (ICUs). The primary outcome was to explore whether PCT or CRP serum levels upon hospital admission could predict bacterial coinfection among patients with COVID-19 pneumonia. The secondary outcome was the evaluation of their association with mortality. We also conducted subgroups analyses in higher risk profile populations.
resultsBetween 5 February 2020 and 21 December 2021, 4076 patients were included, 133 (3%) of whom presented bacterial coinfection. PCT and CRP had low area under curve (AUC) scores at the receiver operating characteristic (ROC) curve analysis [0.57 (95% confidence interval (CI) 0.51-0.61) and 0.6 (95% CI, 0.55-0.64), respectively], but high negative predictive values (NPV) [97.5% (95% CI 96.5-98.5) and 98.2% (95% CI 97.5-98.9) for PCT and CRP, respectively]. CRP alone was associated with bacterial coinfection (OR 2, 95% CI 1.25-3.19; p = 0.004). The overall 15, 30 and 90 days mortality had a higher trend in the bacterial coinfection group, but without significant difference. PCT ≥ 0.12 ng/mL was associated with higher 90 days mortality.
conclusionOur study suggests that measurements of PCT and CRP, alone and at a single time point, are not useful for ruling in or out bacterial coinfection in viral pneumonia by COVID-19.
Indexed as
CoinfectionCOVID-19BiomarkersCalcitoninC-Reactive ProteinCritical IllnessHumansProcalcitoninRetrospective StudiesROC CurveBiomarkersCalcitoninC-Reactive ProteinProcalcitoninBacterial coinfectionCOVID-19C-reactive proteinCritically illIntensive careProcalcitonin
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