Cidade José Pedro, Coelho Luís, Póvoa Pedro
Intensive Care Unit 4, Department of Intensive Care, São Francisco Xavier Hospital, Centro Hospitalar Lisboa Ocidental, 1449-005 Lisbon, Portugal.
Nova Medical School, Clinical Medicine, CHRC, NOVA University of Lisbon, 1169-056 Lisbon, Portugal.
J Clin Med. 2023 Sep 22;12(19):6110. doi: 10.3390/jcm12196110.
The SARS-CoV-2 infection is a cause of hypoxemic acute respiratory failure, leading to frequent intensive care unit (ICU) admission. Due to invasive organ support and immunosuppressive therapies, these patients are prone to nosocomial infections. Our aim was to assess the value of daily measurements of C-reactive protein (CRP) and Procalcitonin (PCT) in the early identification of ICU-acquired infections in COVID-19 patients.
We undertook a prospective observational cohort study (12 months). All adult mechanically ventilated patients admitted for ≥72 h to ICU with COVID-19 pneumonia were divided into an infected group ( = 35) and a non-infected group ( = 83). Day 0 was considered as the day of the diagnosis of infection (infected group) and Day 10 was that of ICU stay (non-infected group). The kinetics of CRP and PCT were assessed from Day -10 to Day 10 and evaluated using a general linear model, univariate, repeated-measures analysis.
118 patients (mean age 63 years, 74% males) were eligible for the analysis. The groups did not differ in patient age, gender, CRP and PCT serum levels at ICU admission. However, the infected group encompassed patients with a higher severity (SOFA score at ICU admission, = 0.009) and a higher 28-day mortality ( < 0.001). Before D0, CRP kinetics showed a significant increase in infected patients, whereas in noninfected it remained almost unchanged ( < 0.001), while PCT kinetics did not appear to retain diagnostic value to predict superinfection in COVID-19 patients ( = 0.593).
COVID-19 patients who developed ICU-acquired infections exhibited different biomarker kinetics before the diagnosis of those infections. Daily CRP monitoring and the recognition of the CRP kinetics could be useful in the prediction of ICU-acquired infections.
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染是低氧性急性呼吸衰竭的一个病因，导致频繁入住重症监护病房（ICU）。由于有创器官支持和免疫抑制治疗，这些患者易发生医院感染。我们的目的是评估每日测量C反应蛋白（CRP）和降钙素原（PCT）在早期识别新型冠状病毒肺炎（COVID-19）患者ICU获得性感染中的价值。
我们进行了一项前瞻性观察队列研究（12个月）。所有因COVID-19肺炎入住ICU且机械通气≥72小时的成年患者被分为感染组（n = 35）和非感染组（n = 83）。感染组将确诊感染日视为第0天，非感染组将入住ICU第10天视为第0天。从第-10天到第10天评估CRP和PCT的动力学，并使用一般线性模型、单变量重复测量分析进行评估。
118例患者（平均年龄63岁，74%为男性）符合分析条件。两组在患者年龄、性别、入住ICU时的CRP和PCT血清水平方面无差异。然而，感染组患者的病情更严重（入住ICU时的序贯器官衰竭评估（SOFA）评分，P = 0.009）且28天死亡率更高（P < 0.001）。在第0天之前，感染患者的CRP动力学显示显著升高，而非感染患者的CRP几乎保持不变（P < 0.001），而PCT动力学似乎对预测COVID-19患者的继发感染没有诊断价值（P = 0.593）。
发生ICU获得性感染的COVID-19患者在这些感染诊断之前表现出不同的生物标志物动力学。每日监测CRP以及识别CRP动力学可能有助于预测ICU获得性感染。
