Association of procalcitonin, C-reaction protein and other risk factors with mortality among COVID-19 patients in Erbil city

Tara Srood Suad
Department of Basics Science, College of Medicine, Hawler Medical University, Erbil, Iraq.
Chato Ali Taher
Department of Basics Science, College of Medicine, Hawler Medical University, Erbil, Iraq.
Share:

Abstract

Background and objective: The coronavirus disease pandemic, was a serious threat to global health, which attacked the community in December 2019 without warning and had disastrous effects. Inflammatory factors are important for COVID-19 mortality. We aimed to identify potential demographic risk factors as well as the potential role of procalcitonin and other inflammatory biomarkers as indicators of severity and outcome in patients with COVID-19.

Methods: A cross-sectional prospective study that was conducted in Lalav Hospital, West Emergency Hospital and a Private clinical center in Erbil city, Iraq. The cases (106) were collected from August 2021 to November 2021. All included patients were diagnosed with COVID-19 through laboratory confirmation using real-time reverse transcriptase–polymerase chain reaction (RT-PCR).

Results: Our results showed that serum procalcitonin levels were significantly higher and positively correlated with mortality in COVID-19 patients (P = 0.005). The severity of COVID-19 and abnormal serial measurements of plasma D-dimer and serum C- reactive protein levels were found to be significantly correlated (P = 0.028 and P = 0.041, respectively). Diabetes, hypertension, and advanced age were noted as risk factors.

Conclusion: Procalcitonin may be an indicator of disease severity. Serial procalcitonin measurements and the recognition of potential risk factors are crucial for predicting the prognosis among COVID-19 patients.

Metrics

Metrics Loading ...

References

  1. She J, Jiang J, Ye L, Hu L, Bai CH, Song Y. 2019 novel coronavirus of pneumonia in Wuhan, China: emerging attack and management strategies. Clin Transl Med. 2020; 9(19). doi: 10.1186/s40169-020-00271-z
  2. WHO Coronavirus (COVID-19) Dashboard. Accessed August 28, 2022. https://covid19.who.int
  3. Pal M, Berhanu G, Desalegn C, Kandi V. Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2): An Update. Cureus. 2020; 12(3). doi:10.7759/cureus.7423
  4. Zhu ZH, Lian X, Su X, Wu W, Marraro G, Zeng Y. From SARS and MERS to COVID-19: a summary and comparison of severe acute respiratory infections caused by three highly pathogenic human coronaviruses. Respir Res. 2020; 21(1):224. doi:10.1186/s12931-020-01479-w
  5. Pan F, Yang L, Li Y, Liang B, Li L, Ye T, et al. Factors associated with death outcome in patients with severe coronavirus disease-19 (COVID-19): a case-control study. Int J Med Sci. 2020; 17(9):1281-92. doi:10.7150/ijms.46614
  6. Zhao W, Li H, Li J, Xu B, Xu J. The mechanism of multiple organ dysfunction syndrome in patients with COVID‐19. J Med Virol. 2022; 94(5):1886-92. doi:10.1002/jmv.27627
  7. Wang Y, Tian H, Zhang L, Man ZH, Dandan G, Wenting W, et al. Reduction of secondary transmission of SARS-CoV-2 in households by face mask use, disinfection, and social distancing: a cohort study in Beijing, China. BMJ Glob Health. 2020; 5(5):e002794. doi:10.1136/bmjgh-2020-002794
  8. Samadizadeh S, Masoudi M, Rastegar M, Salimi V, Shahbaz MB, Tahamtan A. COVID-19: Why does disease severity vary among individuals? Respir Med. 2021; 180:106356. doi:10.1016/j.rmed.2021.106356
  9. Zhao Y, Cui C, Zhang K, Jialin L, Jinfu X, Eric N, et al. COVID19: A Systematic Approach to Early Identification and Healthcare Worker Protection. Front Public Health. 2020; 8:205. doi:10.3389/fpubh.2020.00205
  10. Milenkovic M, Hadzibegovic A, Kovac M, Jovanovic B, Stanisavljevic J, Djikic M, et al. D-dimer, CRP, PCT, and IL-6 Levels at Admission to ICU Can Predict In-Hospital Mortality in Patients with COVID-19 Pneumonia. Longevity OMAC. 2022; 2022:9. doi:10.1155/2022/8997709
  11. Ryoo SM, Han KS, Ahn S, Tae Gun SH, Sung Yeon H, Sung Phil CH, et al. The usefulness of C-reactive protein and procalcitonin to predict prognosis in septic shock patients: A multicenter prospective registry-based observational study. Sci Rep. 2019; 9(29):6579. doi:10.1038/s41598-019-42972-7
  12. Rowland T, Hilliard H, Barlow G. Procalcitonin: Potential Role in Diagnosis and Management. Adv Clin Chem. 2015; 68:71-86. doi:10.1016/bs.acc.2014.11.005
  13. Vijayan AL, Vanimaya, Ravindran S, Saikant R, Lakshmi S, Kartik R, et al. Procalcitonin: a promising diagnostic marker for sepsis and antibiotic therapy. J Intensive Care. 2017; 5:51. doi:10.1186/s40560-017-0246-8
  14. Peters C, Williams K, Un EA, Little L, Saad A, Lendrum K, et al. Use of procalcitonin for antibiotic stewardship in patients with COVID-19: A quality improvement project in a district general hospital. Clin Med (Lond). 2021; 21(1):71-76. doi:10.7861/clinmed.2020-0614
  15. Adebisi Y, Dasola N, Olushola I, Uwizeyimana TH, Olayemi A, Ukor N. The use of antibiotics in COVID-19 management: a rapid review of national treatment guidelines in 10 African countries. Trop Med Health. 2021; 49(51). doi:10.1186/s41182-021-00344-w
  16. National Institute of Health. COVID-19 Treatment Guidelines. Accessed February 14, 2023. https://www.covid19treatmentguidelines.nih.gov/overview/clinical-spectrum/
  17. Achangwa C, Park H, Ryu S. Incubation period of wild type of SARS-CoV-2 infections by age, gender, and epidemic periods. Front Public Health. 2022; 10:905020. doi:10.3389/fpubh.2022.905020
  18. Rashedi J, Poor BM, Asgharzadeh V, Pourostadi M, Kafil H, Vegari A, et al. Risk Factors for COVID-19. Infez Med. 2020; 28(4):469-74. PMID: 33257620
  19. Docherty AB, Harrison EM, Green C, Hardwick H, Pius R, Norman L, et al. Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study. Br Med J. 2020; 369(m1985). doi:10.1136/bmj.m1985
  20. Jordan R, Adab P, Cheng K. Covid-19: risk factors for severe disease and death. Br Med J 2020; 368. doi:10.1136/bmj.m1198
  21. Zewotir T, Dessie Z. Mortality-related risk factors of COVID-19: a systematic review and meta-analysis of 42 studies and 423,117 patients. BMC Infect Dis. 2021; 21. doi:10.1186/s12879-021-06536-3.
  22. Wang D, Hu B, Hu C, Xing L, Zhang J, Wang B, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China. JAMA. 2020; 323. doi:10.1001/jama.2020.1585
  23. Shepherd R, Cheung AS, Pang K, Saffery R, Novakovic B. Sexual Dimorphism in Innate Immunity: The Role of Sex Hormones and Epigenetics. Front Immunol. 2020; 11:604000. doi:10.3389/fimmu.2020.604000
  24. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu U, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020; 395(10223):497-506. doi:10.1016/S0140-6736(20)30183-5
  25. Sun S, Martinez L, Ge Y. COVID-19 Transmission Dynamics Among Close Contacts of Index Patients With COVID-19: A Population-Based Cohort Study in Zhejiang Province, China. JAMA Intern Med. 2021; 181(10):1343-50. doi:10.1001/jamainternmed.2021.4686
  26. Heneghan C, Spencer E. Transmission of SARs-COV-2: Updated Protocols for a series of systematic reviews. The Centre for Evidence-Based Medicine; 3. [cited 5 January 2023]; Available from: https://www.cebm.net/study/covid-19-risk-of-transmission-in-covid-19-among-close-contacts/). doi: 10.6084/m9.figshare.19229754.v3
  27. Chen T, Dai Z, Mo P, Li X, Ma ZH, Song SH, et al. Clinical Characteristics and Outcomes of Older Patients with Coronavirus Disease 2019 (COVID-19) in Wuhan, China: A Single-Centered, Retrospective Study. J Gerontol A Biol Sci Med Sci. 2020; 75(9):1788-95. doi: 10.1093/gerona/glaa089.
  28. Jin A, Yan B, Hua W, Feng D, Xu B, Liang L, et al. Clinical characteristics of patients diagnosed with COVID-19 in Beijing. Biosaf Health. 2020; 2(2):104-111. doi:10.1016/j.bsheal.2020.05.003
  29. Shi L, Wang Y, Duan G, Wang Y, Yang H. Dyspnea rather than fever is a risk factor for predicting mortality in patients with COVID-19 - J Infect. 2020; 81(4). doi:10.1016/j.jinf.2020.05.013
  30. Pullen M, Skipper C, Hullsiek K, Okafor E, Pastick K, Bangdiwala A, et al. Symptoms of COVID-19 Outpatients in the United States. Open Forum Infect Dis. 2020; 7(7). doi: 10.1093/ofid/ofaa271
  31. Mohammed Y, Sepandi M, Taghrid M. Determine the most common clinical symptoms in COVID-19 patients: a systematic review and meta-analysis. J Prev Med Hyg. 2020; 61(3):E304-E312. doi:10.15167/2421-4248/jpmh2020.61.3.1530
  32. Utku A, Budak G, Karabay O, Güçlü E, Okan H, Vatan A. Main symptoms in patients presenting in the COVID-19 period. Scott Med J. 2020; 65(4):127-132. doi:10.1177/0036933020949253
  33. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu ZH, et al. Clinical course, and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020; 395(10229):1054-1062. doi:10.1016/S0140-6736(20)30566-3
  34. Savoia C, Volpe M, Kreutz R. Hypertension, a Moving Target in COVID-19. Circ Res. 2021; 128(7):1062-1079. doi:10.1161/CIRCRESAHA.121.318054
  35. Lippi G, Wong J, Henry B. Hypertension and its severity or mortality in Coronavirus Disease 2019 (COVID-19): a pooled analysis. Pol Arch Intern Med. 2020; 130. doi:10.20452/pamw.15272
  36. Fang L, Karakiulakis G, Roth M. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection?Lancet Respir Med. 2020; 8(4):e21. doi:10.1016/S2213-2600(20)30116-8
  37. Rao SH, Lau A, So H. Exploring Diseases/Traits and Blood Proteins Causally Related to Expression of ACE2, the Putative Receptor of SARS-CoV-2: A Mendelian Randomization Analysis Highlights Tentative Relevance of Diabetes-Related Traits. Diabetes Care. 2020; 43(7):1416-1426. doi:10.2337/dc20-0643
  38. Zavareh M, Bayani M, Shokri M, Ebrahimpour S, Babazadeh A, Mehraeen R, et al. C-Reactive Protein as a Prognostic Indicator in COVID-19 Patients. Interdiscip Perspect Infect Dis. 2021;.2021:5557582. doi: 10.1155/2021/5557582.
  39. Liu F, Li L, Xu M, Wu J, Luo D, Zhu Y, et al. Prognostic value of interleukin-6, C-reactive protein, and procalcitonin in patients with COVID-19. J Clin Virol. 2020; 127:104370. doi:10.1016/j.jcv.2020.104370
  40. Lippi G, Plebani M. Laboratory abnormalities in patients with COVID-2019 infection.
  41. Clin Chem Lab Med. 2020; 58(7):1131-1134. doi:10.1515/cclm-2020-0198
  42. Vanhomwegen C, Veliziotis I, Malinverni S, Konopnicki D, Dechamps PH, Claus M, et al. Procalcitonin accurately predicts mortality but not bacterial infection in COVID-19 patients admitted to intensive care unit. Ir J Med Sci. 2021; 190(4): 1649–1652. doi:10.1007/s11845-020-02485-z
  43. Tan L, Kang X, Ji X, Li G, Wang Q, Li Y, et al. Validation of Predictors of Disease Severity and Outcomes in COVID-19 Patients: A Descriptive and Retrospective Study. Med. 2020; 1(1):128-38.e3. doi:10.1016/j.medj.2020.05.002
  44. Zhou Y, Teng X, Han M, Shi J, Li X, Zhang X, et al. The value of PCT, IL-6, and CRP in the early diagnosis and evaluation of COVID-19. Eur Rev Med Pharmacol Sci. 2021; 25(2):1097-100. doi:10.26355/eurrev_202101_24680
How to Cite
Srood Suad , T., & Ali Taher, C. (2025). Association of procalcitonin, C-reaction protein and other risk factors with mortality among COVID-19 patients in Erbil city . Zanco Journal of Medical Sciences (Zanco J Med Sci), 29(1), 99–109. https://doi.org/10.15218/zjms.2025.011

Send mail to Author


Send Cancel