• Emergencias · Apr 2022

    Procalcitonin concentration in the emergency department predicts 30-day mortality in COVID-19 better than the lymphocyte count, the neutrophil-tolymphocyte ratio, or the C-reactive protein level.

    • Pedro López-Ayala, Ana Alcaraz-Serna, Adrián Valls Carbó, Mª Ángeles Cuadrado Cenzual, María José Torrejón Martínez, Amanda López Picado, Carmen Martínez Valero, MirandaJuande DJDDivisión de Modelos de Riesgo de Repsol, Madrid, España., Cristina Díaz Del Arco, Gabriel Cozar López, Suárez-CadenasMaría Del MarMDMInstituto de Investigación de la Salud, Hospital San Carlos, Madrid, España. Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, España., Jerez FernándezPabloPServicio de Urgencias, Hospital Clínico San Carlos, Madrid, España., Beatriz Angós, Esther Rodríguez Adrada, Eduardo Cardassay, Enrique Del Toro, David Chaparro, María Teresa Montalvo Moraleda, Carolina Espejo Paeres, Miguel Ángel García Briñón, Víctor Hernández Martín-Romo, Luis Ortega, Cristina Fernández Pérez, Mercedes Martínez-Novillo, Juan Jorge González Armengol, Juan González Del Castillo, Christian E Mueller, Martín-SánchezF JavierFJFacultad de Medicina, Universidad Complutense de Madrid, España. Instituto de Investigación de la Salud, Hospital San Carlos, Madrid, España. Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, España., and IdISSC-COVID-TASKFORCE and COVID-19_URG-HCSC Register investigators.
    • Instituto de Investigación Cardiovascular de Basel (CRIB), Servicio de Cardiología, Hospital Universitario de Basel, Universidad de Basel, Basel, Suiza.
    • Emergencias. 2022 Apr 1; 34 (2): 119-127.

    ObjectivesAlthough many demographic and clinical predictors of mortality have been studied in relation to COVID-19, little has been reported about the prognostic utility of inflammatory biomarkers.Material And MethodsRetrospective cohort study. All patients with laboratory-confirmed COVID-19 treated in a hospital emergency department were included consecutively if baseline measurements of the following biomarkers were on record: lymphocyte counts, neutrophil-to-lymphocyte ratio NRL, and C-reactive protein (CRP) and procalcitonin (PCT) levels. We analyzed associations between the biomarkers and all-cause 30-day mortality using Cox regression models and dose-response curves.ResultsWe included 896 patients, 151 (17%) of whom died within 30 days. The median (interquartile range) age was 63 (51-78) years, and 494 (55%) were men. NLR, CRP and PCT levels at ED presentation were higher, while lymphocyte counts were lower, in patients who died compared to those who survived (P .001). The areas under the receiver operating characteristic curves revealed the PCT concentration (0.79; 95% CI, 0.75-0.83) to be a better predictor of 30-day mortality than the lymphocyte count (0.70; 95% CI, 0.65-0.74; P .001), the NLR (0.74; 95% CI, 0.69-0.78; P = .03), or the CRP level (0.72; 95% CI, 0.68-0.76; P .001). The proposed PCT concentration decision points for use in emergency department case management were 0.06 ng/L (negative) and 0.72 ng/L (positive). These cutoffs helped classify risk in 357 patients (40%). Multivariable analysis demonstrated that the PCT concentration had the strongest association with mortality.ConclusionPCT concentration in the emergency department predicts all-cause 30-day mortality in patients with COVID-19 better than other inflammatory biomarkers.

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