Ming Damien K, Myall Ashleigh C, Hernandez Bernard, Weiße Andrea Y, Peach Robert L, Barahona Mauricio, Rawson Timothy M, Holmes Alison H
Centre for Antimicrobial Optimisation, Hammersmith Hospital, Imperial College London, Du Cane Road, London, W12 0NN, UK.
National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK.
BMC Infect Dis. 2021 Sep 8;21(1):932. doi: 10.1186/s12879-021-06621-7.
To characterise the longitudinal dynamics of C-reactive protein (CRP) and Procalcitonin (PCT) in a cohort of hospitalised patients with COVID-19 and support antimicrobial decision-making.
Longitudinal CRP and PCT concentrations and trajectories of 237 hospitalised patients with COVID-19 were modelled. The dataset comprised of 2,021 data points for CRP and 284 points for PCT. Pairwise comparisons were performed between: (i) those with or without significant bacterial growth from cultures, and (ii) those who survived or died in hospital.
CRP concentrations were higher over time in COVID-19 patients with positive microbiology (day 9: 236 vs 123 mg/L, p < 0.0001) and in those who died (day 8: 226 vs 152 mg/L, p < 0.0001) but only after day 7 of COVID-related symptom onset. Failure for CRP to reduce in the first week of hospital admission was associated with significantly higher odds of death. PCT concentrations were higher in patients with COVID-19 and positive microbiology or in those who died, although these differences were not statistically significant.
Both the absolute CRP concentration and the trajectory during the first week of hospital admission are important factors predicting microbiology culture positivity and outcome in patients hospitalised with COVID-19. Further work is needed to describe the role of PCT for co-infection. Understanding relationships of these biomarkers can support development of risk models and inform optimal antimicrobial strategies.
描述新冠病毒病（COVID-19）住院患者队列中C反应蛋白（CRP）和降钙素原（PCT）的纵向动态变化，并为抗菌决策提供支持。
对237例COVID-19住院患者的CRP和PCT浓度及变化轨迹进行建模。数据集包括2021个CRP数据点和284个PCT数据点。在以下两组之间进行成对比较：（i）培养物中有或无显著细菌生长的患者；（ii）住院存活或死亡的患者。
微生物学检查呈阳性的COVID-19患者（第9天：236 vs 123mg/L，p<0.0001）以及死亡患者（第8天：226 vs 152mg/L，p<0.0001）的CRP浓度随时间升高，但仅在COVID-19相关症状出现7天后。入院第一周CRP未降低与死亡几率显著升高相关。COVID-19患者中微生物学检查呈阳性或死亡患者的PCT浓度较高，尽管这些差异无统计学意义。
入院第一周的绝对CRP浓度和变化轨迹都是预测COVID-19住院患者微生物培养阳性和预后的重要因素。需要进一步开展工作来描述PCT在合并感染中的作用。了解这些生物标志物之间的关系有助于开发风险模型并为优化抗菌策略提供依据。
