Early procalcitonin to predict mortality in critically ill COVID-19 patients: a multicentric cohort study

BACKGROUND: High levels of procalcitonin (Pct) have been associated with a higher risk of mortality in coViD-19 patients. We explored the prognostic role of early Pct assessment in critically ill coViD-19 patients and whether Pct predictive performance would be influenced by immunosuppression. METHODS: retrospective multicentric analysis of prospective collected data in coViD-19 patients consecutively admitted to 36 intensive care units (icUs) in spain and andorra from March to June 2020. adult (>18 years) patients with confirmed COVID-19 and available PCT values (<72 hours from ICU admission) were included. Patients were considered as “no immunosuppression” (Ni), “chronic immunosuppression” (ci) and “acute immunosuppression” (ait if only tocilizumab; ais if only steroids, aits if both). the primary outcome was the ability of Pct to predict icU mortality. RESULTS: of the 1079 eligible patients, 777 patients were included in the analysis. Mortality occurred in 227 (28%) patients. in the Ni group 144 (19%) patients were included, 67 (9%) in the ci group, 66 (8%) in the ait group, 262 (34%) in the AIS group and 238 (31%) in the AITS group; PCT was significantly higher in non-survivors when compared with survivors (0.64 [0.17-1.44] vs. 0.23 [0.11-0.60] ng/mL; P<0.01); however, in the multivariable analysis, PCT values was not independently associated with ICU mortality. PCT values and ICU mortality were significantly higher in patients in the Ni and ci groups. CONCLUSIONS: Pct values are not independent predictors of icU mortality in coViD-19 patients. acute immunosuppression significantly reduced PCT values, although not influencing its predictive value.