Dexamethasone and tocilizumab treatment considerably reduces the value of C-reactive protein and procalcitonin to detect secondary bacterial infections in COVID-19 patients

Autor: Celine R. M. van Latum, Jeroen Schouten, Matthijs Kox, Noortje F. van Kempen, Tim Frenzel, Peter Pickkers, Emma J. Kooistra, Maarten van den Berg, Niklas Bruse, Miranda van Berkel
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Male
medicine.medical_specialty
Secondary infection
Critical Illness
lnfectious Diseases and Global Health Radboud Institute for Molecular Life Sciences [Radboudumc 4]
Critical Care and Intensive Care Medicine
Antibodies
Monoclonal
Humanized
Gastroenterology
Procalcitonin
Dexamethasone
Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18]
chemistry.chemical_compound
All institutes and research themes of the Radboud University Medical Center
Tocilizumab
Internal medicine
medicine
Humans
Prospective Studies
Prospective cohort study
Aged
Netherlands
biology
Receiver operating characteristic
business.industry
RC86-88.9
Coinfection
Research
Other Research Radboud Institute for Health Sciences [Radboudumc 0]
C-reactive protein
COVID-19
Medical emergencies. Critical care. Intensive care. First aid
Bacterial Infections
Middle Aged
medicine.disease
Women's cancers Radboud Institute for Health Sciences [Radboudumc 17]
COVID-19 Drug Treatment
lnfectious Diseases and Global Health Radboud Institute for Health Sciences [Radboudumc 4]
C-Reactive Protein
chemistry
biology.protein
Female
business
Prediction
medicine.drug
Zdroj: Critical Care
Critical Care, 25
Critical Care, Vol 25, Iss 1, Pp 1-12 (2021)
Critical Care, 25, 1
ISSN: 1466-609X
1364-8535
Popis: BackgroundProcalcitonin (PCT) and C-reactive protein (CRP) were previously shown to have value for the detection of secondary infections in critically ill COVID-19 patients. However, since the introduction of immunomodulatory therapy, the value of these biomarkers is unclear. We investigated PCT and CRP kinetics in critically ill COVID-19 patients treated with dexamethasone with or without tocilizumab, and assessed the value of these biomarkers to detect secondary bacterial infections.MethodsIn this prospective study, 190 critically ill COVID-19 patients were divided into three treatment groups:no dexamethasone, no tocilizumab (D−T−),dexamethasone, no tocilizumab (D+T−), anddexamethasone and tocilizumab (D+T+). Serial data of PCT and CRP were aligned on the last day of dexamethasone treatment, and kinetics of these biomarkers were analyzed between 6 days prior to cessation of dexamethasone and 10 days afterwards. Furthermore, the D+T− and D+T+ groups were subdivided into secondary infection and no-secondary infection groups to analyze differences in PCT and CRP kinetics and calculate detection accuracy of these biomarkers for the occurrence of a secondary infection.ResultsFollowing cessation of dexamethasone, there was a rebound in PCT and CRP levels, most pronounced in the D+T− group. Upon occurrence of a secondary infection, no significant increase in PCT and CRP levels was observed in the D+T− group (p = 0.052 andp = 0.08, respectively). Although PCT levels increased significantly in patients of the D+T+ group who developed a secondary infection (p = 0.0003), this rise was only apparent from day 2 post-infection onwards. CRP levels remained suppressed in the D+T+ group. Receiver operating curve analysis of PCT and CRP levels yielded area under the curves of 0.52 and 0.55, respectively, which are both markedly lower than those found in the group of COVID-19 patients not treated with immunomodulatory drugs (0.80 and 0.76, respectively, withpvalues for differences between groups of 0.001 and 0.02, respectively).ConclusionsCessation of dexamethasone in critically ill COVID-19 patients results in a rebound increase in PCT and CRP levels unrelated to the occurrence of secondary bacterial infections. Furthermore, immunomodulatory treatment with dexamethasone and tocilizumabconsiderably reducesthe value of PCT and CRP for detection of secondary infections in COVID-19 patients.
Databáze: OpenAIRE
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