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Procalcitonin concentration in the emergency department predicts 30-day mortality in COVID-19 better than the lymphocyte count, the neutrophil-tolymphocyte ratio, or the C-reactive protein level

L√≥pez-Ayala P, Alcaraz-Serna A, Valls Carb√≥ A, Cuadrado Cenzual MA, Torrej√≥n Mart√≠nez MJ, L√≥pez Picado A, Mart√≠nez Valero C, Miranda JD, D√≠az del Arco C, Cozar L√≥pez G, Su√°rez-Cadenas MM, Jerez Fern√°ndez P, Ang√≥s B, Rodr√≠guez Adrada E, Cardassay E, Del Toro E, Chaparro D, Montalvo Moraleda MT, Espejo Paeres C, Garc√≠a Bri√Ī√≥n MA, Hern√°ndez Mart√≠n-Romo V, Ortega L, Fern√°ndez P√©rez C, Mart√≠nez-Novillo M, Gonz√°lez Armengol JJ, Gonz√°lez Del Castillo J, Mueller CE, Mart√≠n-S√°nchez FJ

Instituto de Investigación Cardiovascular de Basel (CRIB), Servicio de Cardiología, Hospital Universitario de Basel, Universidad de Basel, Basel, Switzerland. Hospital Universitario de Lausanne (CHUV), Departamento de Medicine, Servicio de Inmunología y Alergología, Lausanne, Switzerland. Servicio de Neurología, Hospital Clínico San Carlos, Madrid, Spain. Servicio de Laboratorio de Análisis Biomédicos, Hospital Clínico San Carlos, Madrid, Spain. Facultad de Medicina, Universidad Complutense de Madrid, Spain. Instituto de Investigación de la Salud, Hospital San Carlos, Madrid, Spain. División de Modelos de Riesgo de Repsol, Madrid, Spain. Servicio de Anatomía Patológica, Hospital Clínico San Carlos, Madrid, Spain. Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, Spain. Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain. Departamento de Sistemas de la Información y Tecnologías, Hospital Clínico San Carlos, Madrid, Spain. Servicio de Medicina Preventiva, Hospital Clínico San Carlos, Madrid, Spain.

Background. Although many demographic and clinical predictors of mortality have been studied in relation to COVID-19, little has been reported about the prognostic utility of inflammatory biomarkers.
Methods. Retrospective cohort study. All patients with laboratory-confirmed COVID-19 treated in a hospital emergency department were included consecutively if baseline measurements of the following biomarkers were on record: lymphocyte counts, neutrophil-to-lymphocyte ratio NRL, and C-reactive protein (CRP) and procalcitonin (PCT) levels. We analyzed associations between the biomarkers and all-cause 30-day mortality using Cox regression models and dose‚Äďresponse curves.
Results. We included 896 patients, 151 (17%) of whom died within 30 days. The median (interquartile range) age was 63 (51-78) years, and 494 (55%) were men. NLR, CRP and PCT levels at ED presentation were higher, while lymphocyte counts were lower, in patients who died compared to those who survived (P < .001). The areas under the
receiver operating characteristic curves revealed the PCT concentration (0.79; 95% CI, 0.75-0.83) to be a better predictor of 30-day mortality than the lymphocyte count (0.70; 95% CI, 0.65-0.74; P < .001), the NLR (0.74; 95% CI, 0.69-0.78; P = .03), or the CRP level (0.72; 95% CI, 0.68-0.76; P < .001). The proposed PCT concentration decision
points for use in emergency department case management were 0.06 ng/L (negative) and 0.72 ng/L (positive). These cutoffs helped classify risk in 357 patients (40%). Multivariable analysis demonstrated that the PCT concentration had the strongest association with mortality.
Conclusion. PCT concentration in the emergency department predicts all-cause 30-day mortality in patients with COVID-19 better than other inflammatory biomarkers.

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