Baseline procalcitonin as a predictor of bacterial infection and clinical outcomes in COVID-19: A case-control study.

PURPOSE: Coronavirus disease-2019 (COVID-19) is associated with a wide spectrum of clinical symptoms including acute respiratory failure. Biomarkers that can predict outcomes in patients with COVID-19 can assist with patient management. The aim of this study is to evaluate whether procalcitonin (PCT) can predict clinical outcome and bacterial superinfection in patients infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). METHODS: Adult patients diagnosed with SARS-CoV-2 by nasopharyngeal PCR who were admitted to a tertiary care center in Boston, MA with SARS-CoV-2 infection between March 17 and April 30, 2020 with a baseline PCT value were studied. Patients who were presumed positive for SARS-CoV-2, who lacked PCT levels, or who had a positive urinalysis with negative cultures were excluded. Demographics, clinical and laboratory data were extracted from the electronic medical records. RESULTS: 324 patient charts were reviewed and grouped by clinical and microbiologic outcomes by day 28. Baseline PCT levels were significantly higher for patients who were treated for true bacteremia (p = 0.0005) and bacterial pneumonia (p = 0.00077) compared with the non-bacterial infection group. Baseline PCT positively correlated with the NIAID ordinal scale and survival over time. When compared to other inflammatory biomarkers, PCT showed superiority in predicting bacteremia. CONCLUSIONS: Baseline PCT levels are associated with outcome and bacterial superinfection in patients hospitalized with SARS-CoV-2.

The pulmonary artery catheter: gold standard or redundant relic.

Pulmonary artery catheter (PAC) technology has changed significantly and use has decreased over the last 20 years. Barriers to use include: (a) increased patient risk with placement; (b) ability to measure similar variables via less invasive measures; (c) increased cost; (d) inaccurate measurement leading to misuse of PAC-derived variables; (e) incorrect interpretation and clinical application; and (f) lack of proven benefit for patient management. Advances in technology have allowed for continuous trending of hemodynamic parameters measured via the PAC. Patient risk is similar to that of central line placement; however risks associated with pulmonary artery infarction and rupture are inherent to the PAC. Less invasive assessment of cardiac output equals that of the PAC, whereas pulmonary capillary wedge pressure and mixed venous oxygen saturation monitoring are unique features of the PAC. Effective use of PAC data will require ongoing standardized education. More studies are needed on the cost-effectiveness of PAC monitoring as well as outcome benefits. Much of the data available from the PAC can be obtained via less invasive methods. However, the PAC continues to be useful in specific situations and remains the gold standard for comparison of new technologies. This paper discusses use of the PAC during the past 2 decades and reviews studies affecting its use in clinical practice.