Abstract
BackgroundPatients diagnosed with COVID-19 frequently require mechanical ventilation. Knowledge of laboratory tests associated with the prolonged need for mechanical ventilation may guide resource allocation. We hypothesized that an elevated plasma procalcitonin level (>0.1 ng/ml) would be associated with the duration of invasive mechanical ventilation.MethodsPatients diagnosed with COVID-19, who were admitted to any of our health system’s hospitals between March 9th-April 20th, 2020 and required invasive mechanical ventilation, were eligible for this observational cohort study. Demographics, comorbidities, components of the Sequential Organ Failure Assessment score, and procalcitonin levels on admission were obtained from the electronic health record. The primary outcome was the duration of mechanical ventilation; secondary outcomes included 28-day mortality and time to intubation. Outcomes were assessed within the first 28 days of admission. Baseline demographics and comorbidities were summarized by descriptive statistics. Univariate comparisons were made using Pearson’s chi-square test for binary outcomes and Mann-Whitney U test for continuous outcomes. A multiple linear regression was fitted to assess the association between procalcitonin levels and the duration of mechanical ventilation.ResultsPatients with an initial procalcitonin level >0.1 ng/ml required a significantly longer duration of mechanical ventilation than patients with a level of ≤0.1 ng/ml (p = 0.021) in the univariate analysis. There was no significant difference in 28-day mortality or time to intubation between the two groups. After adjusted analysis using multivariable linear regression, the duration of mechanical ventilation was, on average, 5.6 (p = 0.016) days longer in patients with an initial procalcitonin level >0.1 ng/ml.ConclusionIn this cohort of 93 mechanically ventilated COVID-19 patients, we found an association between an initial plasma procalcitonin level >0.1 ng/ml and the duration of mechanical ventilation. These findings may help to identify patients at risk for prolonged mechanical ventilation upon admission.
Highlights
Since the initial outbreak in the Hubei Province of China in November 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread around the world and was declared a pandemic by the World Health Organization [1, 2]
The National Institutes of Health (NIH) had no involvement in Patients diagnosed with COVID-19 frequently require mechanical ventilation
Procalcitonin and duration of mechanically ventilated COVID-19 patients study design, collection, analysis, interpretation of data, writing of the report, or the decision to submit the article for publication
Summary
Since the initial outbreak in the Hubei Province of China in November 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread around the world and was declared a pandemic by the World Health Organization [1, 2]. Based on observational studies from the epicenters of the pandemic in Wuhan, China, the Lombardy region in Italy, and the New York City area in the United States, a significant portion of patients diagnosed with coronavirus disease 2019 (COVID-19) were admitted to the intensive care unit (ICU) for ventilatory support: Between 17%-24% of hospitalized patients and up to 72% of patients admitted to the ICU have required invasive mechanical ventilation [2,3,4,5]. Knowledge of laboratory tests associated with prolonged mechanical ventilation and mortality in a health care environment constrained by high demand and limited resources, especially regarding ventilatory support, is critical. In a critically ill COVID-19 cohort from a large United States healthcare system, we hypothesized that elevated plasma procalcitonin levels would be associated with a longer duration of mechanical ventilation. We hypothesized that an elevated plasma procalcitonin level (>0.1 ng/ml) would be associated with the duration of invasive mechanical ventilation
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