Procalcitonin for antimicrobial stewardship among cancer patients admitted with COVID-19
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, United States
- Pharmacy Clinical Programs, The University of Texas MD Anderson Cancer Center, United States
Tables
Table 1
Baseline patient characteristics of hospitalized cancer patients with coronavirus disease 2019 (COVID-19) with different procalcitonin (PCT) levels*.
| Characteristic | PCT <0.25 ng/ml | PCT ≥0.25 ng/ml | p-Value |
|---|---|---|---|
| (n=358) | (n=172) | ||
| Age, median (range), years | 61 (13–91) | 64 (14–86) | 0.11 |
| Sex, male | 178 (50) | 95 (55) | 0.23 |
| Type of cancer | 0.79 | ||
| Hematological malignancy only | 142 (40) | 63 (37) | |
| Solid tumor only | 195 (54) | 99 (58) | |
| Both of above | 21 (6) | 10 (6) | |
| Status of cancer | 0.90 | ||
| Active | 315 (88) | 152 (88) | |
| No evidence of disease | 43 (12) | 20 (12) | |
| Active cancer therapy within 30 days | 118 (33) | 58 (34) | 0.86 |
| Chemotherapy received | 272 (76) | 121 (70) | 0.16 |
| Chronic kidney disease | 114/327 (35) | 89/168 (53) | <0.001 |
| Asthma | 44/327 (13) | 23/168 (14) | 0.94 |
| Chronic obstructive pulmonary disease | 59/327 (18) | 34/168 (20) | 0.55 |
| Congestive heart failure | 46/327 (14) | 33/168 (20) | 0.11 |
| Diabetes mellitus | 164/327 (50) | 83/168 (49) | 0.87 |
| Coronary artery disease | 12/327 (4) | 3/168 (2) | 0.25 |
| Hypertension | 251/327 (77) | 137/168 (82) | 0.22 |
| Venous thromboembolic event | 42/327 (13) | 19/168 (11) | 0.62 |
| Obesity | 37/327 (11) | 20/168 (12) | 0.85 |
| Obstructive sleep apnea | 55/327 (17) | 18/168 (11) | 0.07 |
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*
Values in table are number of patients (percentage) unless otherwise indicated.
Table 2
Characteristics of COVID hospital admission in cancer patients with coronavirus disease 2019 (COVID-19) with different procalcitonin (PCT) levels*.
| PCT <0.25 ng/ml | PCT ≥0.25 ng/ml | p-Value | |
|---|---|---|---|
| (n=358) | (n=172) | ||
| ANC <1000/µl at admission | 33/352 (9) | 16 (9) | 0.98 |
| ALC <1000/µl at admission | 219/348 (63) | 126/169 (75) | 0.009 |
| Pneumonia | 270/357 (76) | 141 (82) | 0.10 |
| Oxygen supplementation within 72 hr | 191/356 (54) | 118 (69) | 0.001 |
| Positive bacterial culture | 20 (6) | 30 (17) | <0.0001 |
| Site of positive culture | |||
| Blood | 2/20 (10) | 10/30 (33) | 0.09 |
| Lower respiratory tract | 5/20 (25) | 10/30 (33) | 0.53 |
| Wound | 6/20 (30) | 5/30 (17) | 0.31 |
| Urine | 10/20 (50) | 8/30 (27) | 0.09 |
| Transfusion reaction culture | 0/20 (0) | 1/30 (3) | >0.99 |
| Cerebrospinal fluid | 0/20 (0) | 1/30 (3) | >0.99 |
| Positive fungal culture | 3 (1) | 8 (5) | 0.007 |
| Viral co-infection | 2 (1) | 0 (0) | >0.99 |
| Duration of hospital stay, median (IQR), days | 6 (4–10) | 10 (6–18) | <0.0001 |
| IV antibiotic treatment | 271 (76) | 154 (90) | <0.001 |
| Duration of IV antibiotic treatment, | 4 (2–6) | 6 (3–7) | <0.0001 |
| median (IQR), days | |||
| Duration of IV antibiotic therapy ≥72 hr | 162 (45) | 119 (69) | <0.0001 |
| Duration of IV antibiotic therapy ≥7 days | 54 (15) | 54 (31) | <0.0001 |
| ICU admission | 51 (14) | 50 (29) | <0.0001 |
| Duration of ICU stay, median (IQR), days | 1 (1–4) | 3 (1–3) | 0.13 |
| Mortality within 30 days of COVID-19 diagnosis | 20 (6) | 33 (19) | <0.0001 |
-
*
Values in table are number of patients (percentage) unless otherwise indicated.
-
ALC, absolute lymphocyte count; ANC, absolute neutrophil count; IQR, interquartile range.
Table 3
Treatment and outcomes of hospitalized cancer patients with coronavirus disease 2019 (COVID-19) with procalcitonin (PCT) <0.25 ng/ml and negative bacterial cultures.
| Duration of antibiotic treatment | |||
|---|---|---|---|
| Outcomes | <72 hr | ≥72 hr | p-Value |
| (n=176) | (n=111) | ||
| N (%) | N (%) | ||
| Duration of hospital stay (days), median (IQR) | 5 (3–7) | 7 (5–11) | <0.0001 |
| Mortality within 30 days of COVID-19 diagnosis | 5 (3) | 2 (2) | 0.71 |
| Note: Patients with intensive care unit (ICU) admission during hospitalization and patients who died within 3 days after hospital admission were excluded from analysis. | |||
Table 4
NPV of PCT <0.25 ng/ml and relative risk (RR) associated with PCT ≥0.25 ng/ml for selected outcomes in hospitalized cancer patients with coronavirus disease 2019 (COVID-19).
| Outcome | NPV of PCT <0.25 ng/ml | 95% CI | RR of PCT ≥0.25 ng/ml | 95% CI |
|---|---|---|---|---|
| Positive bacterial culture | 0.94 | 0.92–0.97 | 3.12 | 1.83–5.34 |
| Use of IV antibiotics | 0.24 | 0.20–0.29 | 1.18 | 1.09–1.28 |
| Use of IV antibiotics ≥72 hr | 0.55 | 0.49–0.60 | 1.53 | 1.31–1.78 |
| Use of IV antibiotics ≥7 days | 0.85 | 0.81–0.88 | 2.08 | 1.50–2.90 |
| ICU admission | 0.86 | 0.82–0.89 | 2.04 | 1.45–2.88 |
| Death within 30 days after COVID-19 diagnosis | 0.94 | 0.92–0.97 | 3.43 | 2.03–5.80 |
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NPV = negative predictive value; RR = relative risk; 95% CI = 95% confidence interval.
Additional files
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MDAR checklist
- https://cdn.elifesciences.org/articles/81151/elife-81151-mdarchecklist1-v2.docx
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Supplementary file 1
Independent impact of PCT on outcomes by multivariable logistic regression analysis.
- https://cdn.elifesciences.org/articles/81151/elife-81151-supp1-v2.docx
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Supplementary file 2
Comparing outcomes between hospitalized COVID-19 patients with different PCT values under active cancer treatment.
- https://cdn.elifesciences.org/articles/81151/elife-81151-supp2-v2.docx
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Procalcitonin for antimicrobial stewardship among cancer patients admitted with COVID-19
eLife 11:e81151.
https://doi.org/10.7554/eLife.81151
