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      Serum Procalcitonin Levels on Admission Predict Death in Severe and Critical COVID-19 Patients in Wuhan, China

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          Background: We evaluated whether the serum procalcitonin (PCT) level could predict death in severe and critical coronavirus disease 2019 (COVID-19) patients.

          Methods: This study included 129 COVID-19 patients. PCT levels on admission, treatment, and death were collected. The outcomes were compared.

          Results: The optimum cutoff value of the PCT level determined by receiver operator characteristic curve analysis to predict all-cause death was 0.085 ng/mL, with sensitivity of 95.7% and specificity of 72.6%. Overall, 78 patients had a PCT level below 0.085 ng/mL and 51 patients had a PCT level of 0.085 ng/mL or greater. High-PCT-level patients had lower levels of lymphocytes (P=0.001) and albumin (P=0.002) and higher levels of creatinine (P=0.024), D-dimer (P=0.002), and white blood cells, neutrocytes (P<0.001), high-sensitivity C-reactive protein (P<0.001), interleukin-6 (P<0.001), interleukin-8 (P=0.001), interleukin-10 (P=0.001), tumor necrosis factor (P<0.001), erythrocyte sedimentation rate (P=0.001), and ferritin (P=0.001). During the 30-day observation period, 23 patients died. Mortality was significantly higher in high-PCT-level patients than in patients with low PCT levels (43.1% vs. 1.3%; P<0.001). The risks of death (P<0.0001) and ventilator use (P<0.0001) were increased in patients with PCT levels of 0.085 ng/mL or greater.

          Conclusions: A PCT level of 0.085 ng/mL or greater on admission could effectively predict death and ventilator use in severe and critical COVID-19 patients.

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          Utility of serum procalcitonin values in patients with acute exacerbations of chronic obstructive pulmonary disease: a cautionary note

          Background Serum procalcitonin levels have been used as a biomarker of invasive bacterial infection and recently have been advocated to guide antibiotic therapy in patients with chronic obstructive pulmonary disease (COPD). However, rigorous studies correlating procalcitonin levels with microbiologic data are lacking. Acute exacerbations of COPD (AECOPD) have been linked to viral and bacterial infection as well as noninfectious causes. Therefore, we evaluated procalcitonin as a predictor of viral versus bacterial infection in patients hospitalized with AECOPD with and without evidence of pneumonia. Methods Adults hospitalized during the winter with symptoms consistent with AECOPD underwent extensive testing for viral, bacterial, and atypical pathogens. Serum procalcitonin levels were measured on day 1 (admission), day 2, and at one month. Clinical and laboratory features of subjects with viral and bacterial diagnoses were compared. Results In total, 224 subjects with COPD were admitted for 240 respiratory illnesses. Of these, 56 had pneumonia and 184 had AECOPD alone. A microbiologic diagnosis was made in 76 (56%) of 134 illnesses with reliable bacteriology (26 viral infection, 29 bacterial infection, and 21 mixed viral bacterial infection). Mean procalcitonin levels were significantly higher in patients with pneumonia compared with AECOPD. However, discrimination between viral and bacterial infection using a 0.25 ng/mL threshold for bacterial infection in patients with AECOPD was poor. Conclusion Procalcitonin is useful in COPD patients for alerting clinicians to invasive bacterial infections such as pneumonia but it does not distinguish bacterial from viral and noninfectious causes of AECOPD.
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            Novel applications for serum procalcitonin testing in clinical practice.

            Procalcitonin has emerged as a reliable marker of acute bacterial infection in hospitalized patients and the assay has recently been incorporated into several clinical algorithms to reduce antimicrobial overuse, but its use in patients with end-organ dysfunction is controversial. Areas covered: In this review, the authors examine what is known about procalcitonin testing in patients with organ dysfunction, including those with end-stage renal disease, congestive heart failure, chronic obstructive pulmonary disease, and cirrhosis, and explore how the assay is now being used in the management of non-infectious diseases. Expert commentary: Procalcitonin holds tremendous promise to identify a diverse set of medical conditions beyond those associated with acute bacterial infection, including post-surgical anastomotic leaks, acute kidney injury, and complications after intracerebral hemorrhage. The authors review recent studies examining procalcitonin in these areas and explore how the assay might be used to guide diagnosis and prognosis of non-infectious diseases in the near future.

              Author and article information

              Cardiovascular Innovations and Applications
              Compuscript (Ireland )
              September 2020
              September 2020
              : 5
              : 1
              : 37-44
              1Department of Cardiology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, 100034 Beijing, China
              2The Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi road, Xicheng District, 100037 Beijing, China
              Author notes
              Correspondence: Jianping Li and Jing Zhou, Department of Cardiology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, 100034 Beijing, China, Tel.: +86 13521531013, E-mail: lijianping03455@ ; and Department of Cardiology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, 100034 Beijing, China, Tel: +86 13651185517; E-mail: zhoujing1232004@

              aThese three authors contributed equally to this work.

              Copyright © 2020 Cardiovascular Innovations and Applications

              This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 Unported License (CC BY-NC 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See

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