Elevated Procalcitonin Is Positively Associated with the Severity of COVID-19: A Meta-Analysis Based on 10 Cohort Studies.

Yue Shen,Cheng Cheng,Guangcai Duan,Xue Zheng,Shuaiyin Chen,Yuefei Jin,Mengshi Chen

doi:10.3390/medicina57060594

Yue Shen, Cheng Cheng + Show 5 more

Open Access

https://doi.org/10.3390/medicina57060594

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Abstract

Background and Objectives: Procalcitonin (PCT) is positively associated with the severity of COVID-19 (including severe, critical, or fatal outcomes), but some of the confounding factors are not considered. The aim of this meta-analysis was to estimate the adjusted relationship between elevated procalcitonin on admission and the severity of COVID-19. Materials and Methods: We searched 1805 articles from PubMed, Web of Science, and Embase databases up to 2 April 2021. The articles were selected which reported the adjusted relationship applying multivariate analysis between PCT and the severity of COVID-19. The pooled effect estimate was calculated by the random-effects model. Results: The meta-analysis included 10 cohort studies with a total of 7716 patients. Patients with elevated procalcitonin on admission were at a higher risk of severe and critical COVID-19 (pooled effect estimate: 1.77, 95% confidence interval (CI): 1.38–2.29; I2 = 85.6%, p < 0.001). Similar results were also observed in dead patients (pooled effect estimate: 1.77, 95% CI: 1.36–2.30). After adjusting for diabetes, the positive association between PCT and the severity of COVID-19 decreased. Subgroup analysis revealed heterogeneity between studies and sensitivity analysis showed that the results were robust. There was no evidence of publication bias by Egger’s test (p = 0.106). Conclusions: Higher procalcitonin is positively associated with the severity of COVID-19, which is a potential biomarker to evaluate the severity of COVID-19 and predict the prognosis.

Highlights

The Coronavirus Disease 2019 (COVID-19) pandemic has spread rapidly around the world in a short time, resulting in more than 116 million cases worldwide and 2.62 million deaths [1]
After controlling the potential confounders, our meta-analysis revealed that elevated PCT on admission was positively associated with the severity of COVID-19, and the relationship existed between elevated PCT on admission and dead patients
We found that the high heterogeneity may be partly explained by the confounding factor of diabetes, and heterogeneity lowered in studies that adjusted for diabetes compared to those that did not adjust for diabetes

Summary

Introduction

The Coronavirus Disease 2019 (COVID-19) pandemic has spread rapidly around the world in a short time, resulting in more than 116 million cases worldwide and 2.62 million deaths [1]. Mortality was 4–5% higher in patients who received tocilizumab monotherapy compared with those who did not receive tocilizumab or steroids [5] Inflammatory biomarkers, such as PCT, C-reactive protein, and interleukin (IL)-6, may be potential targets for the treatment or prediction of COVID-19 [6]. Procalcitonin (PCT) is positively associated with the severity of COVID-19 (including severe, critical, or fatal outcomes), but some of the confounding factors are not considered The aim of this meta-analysis was to estimate the adjusted relationship between elevated procalcitonin on admission and the severity of COVID-19. Patients with elevated procalcitonin on admission were at a higher risk of severe and critical COVID-19 (pooled effect estimate: 1.77, 95% confidence interval (CI): 1.38–2.29; I2 = 85.6%, p < 0.001). Conclusions: Higher procalcitonin is positively associated with the severity of COVID-19, which is a potential biomarker to evaluate the severity of COVID-19 and predict the prognosis

Methods

Results

Conclusion