• Flavia Galli, Francesco Bindo, Anna Motos, Laia Fernández-Barat, Enric Barbeta, Albert Gabarrús, Adrián Ceccato, Jesús F Bermejo-Martin, Ricard Ferrer, Jordi Riera, Oscar Peñuelas, José Ángel Lorente, David de Gonzalo-Calvo, Rosario Menéndez, Jessica Gonzalez, Sofia Misuraca, Andrea Palomeque, Rosario Amaya-Villar, José Manuel Añón, Ana Balan Mariño, Carme Barberà, José Barberán, Aaron Blandino Ortiz, Elena Bustamante-Munguira, Jesús Caballero, María Luisa Cantón-Bulnes, Cristina Carbajales Pérez, Nieves Carbonell, Mercedes Catalán-González, Raul de Frutos, Nieves Franco, Cristóbal Galbán, Ana Lopez Lago, Víctor D Gumucio-Sanguino, Maria Del Carmen de la Torre, Emilio Díaz, Ángel Estella, Elena Gallego Curto, José Luis García-Garmendia, José Manuel Gómez, Arturo Huerta, Ruth Noemí Jorge García, Ana Loza-Vázquez, Judith Marin-Corral, María Cruz Martin Delgado, Amalia Martínez de la Gándara, Ignacio Martínez Varela, Juan Lopez Messa, M AlbaicetaGuillermoGCIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.Departamento de Biología Funcional, Instituto Universitario de Oncología del Principado de Asturias, Instituto de Investigación Sanitaria del , María Teresa Nieto, Mariana Andrea Novo, Yhivian Peñasco, Felipe Pérez-García, Juan Carlos Pozo-Laderas, Pilar Ricart, Victor Sagredo, Angel Sánchez-Miralles, Susana Sancho Chinesta, Ferran Roche-Campo, Lorenzo Socias, Jordi Solé-Violan, Fernando Suarez-Sipmann, Luis Tamayo Lomas, José Trenado, Alejandro Úbeda, Luis Jorge Valdivia, Pablo Vidal, Maria Victoria Boado, Alejandro Rodríguez, Massimo Antonelli, Francesco Blasi, Ferran Barbé, Antoni Torres, and CIBERESUCICOVID Project investigators (COV20/00110, ISCIII).
• Department of Intensive Care, Emergency Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
• Intensive Care Med. 2023 Aug 1; 49 (8): 934945934-945.

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.© 2023. The Author(s).

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