Serum Procalcitonin as a Predictive Biomarker in COVID-19: A Retrospective Cohort Analysis

Abstract

INTRODUCTION:  Since the onset of COVID-19, physicians and scientists have been working to further understand biomarkers associated with the infection, so that patients who have contracted the virus can be treated. Although COVID-19 is a complex virus that affects patients differently, current research suggests that COVID-19 infections have been associated with increased procalcitonin, a biomarker traditionally indicative of bacterial infections. This paper aims to investigate the relationship between COVID-19 infection severity and procalcitonin levels in the hopes to aid the management of patients with COVID-19 infections. METHODS:  Patient data were obtained from the Renaissance School of Medicine at Stony Brook University. The data of the patients who had tested positive for COVID-19 and had an associated procalcitonin value (n=1046) was divided into age splits of 18-59, 59-74, and 74-90. Multiple factors were analyzed to determine the severity of each patient's infection. Patients were divided into low, medium, and high severity dependent on the patient's COVID-19 severity. A one-way analysis of variance (ANOVA) was done for each age split to compare procalcitonin values of the severity groups within the respective age split. Next, post hoc analysis was done for the severity groups in each age split to further compare the groups against each other.  Results: One-way ANOVA testing of the three age splits all had a resulting p<0.0001, displaying that the null hypothesis was rejected. In the post hoc analysis, however, the test failed to reject the null hypothesis when comparing the medium and high severity groups against each other in the 59-74 and 74-90 age splits. The null hypothesis was rejected in all pairwise comparisons in the 18-59 age split. We determined that a procalcitonin value of greater than 0.24 ng/mL would be characterized as a more severe COVID-19 infection when considering patient factors and comorbidities. Conclusion: The analysis of the data concluded that elevated procalcitonin levels correlated with the severity of COVID-19 infections. This finding can be used to assist medical providers in the management of COVID-19 patients.