Bacterial co-infection raises in-hospital mortality of COVID-19 patients: a retrospective study
Kaican Zong1, Wen Li1, Yingya Fu1
1Department of Respiratory Medicine, The Seventh People's Hospital of Chongqing, Affiliated Central Hospital of Chongqing University of Technology, Chongqing, China.
Insights
Bacterial co-infection in COVID-19 patients significantly increases in-hospital mortality. Early detection using neutrophil count, procalcitonin (PCT), and pneumonia inflammation index (PII) is crucial for better outcomes.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Pulmonology
Background:
- COVID-19 patients are susceptible to secondary bacterial infections.
- Bacterial co-infection can complicate COVID-19 clinical course and outcomes.
- Understanding the impact of bacterial co-infection on mortality is critical for patient management.
Purpose of the Study:
- To investigate the association between bacterial co-infection and in-hospital mortality in COVID-19 patients.
- To evaluate the utility of neutrophil count and procalcitonin (PCT) in identifying bacterial co-infection.
- To assess the role of pneumonia inflammation index (PII) in predicting mortality in co-infected patients.
Main Methods:
- Retrospective analysis of COVID-19 patient data.
- Utilized neutrophil count and PCT to identify suspected bacterial co-infection (SBI).
- Employed logistic regression models and subgroup analysis based on PII and clinical classification.
Main Results:
- Bacterial co-infection was present in 51% of COVID-19 patients.
- Patients with suspected bacterial infection (SBI) had significantly higher in-hospital mortality (26% vs. 9%, P < 0.001).
- Bacterial co-infection was independently associated with increased mortality (OR 1.694) and was more prevalent in critical and severe cases.
Conclusions:
- Bacterial co-infection significantly elevates in-hospital mortality in COVID-19 patients.
- Neutrophil count, PCT, and PII are valuable tools for differentiating bacterial co-infection.
- Prompt identification and management of bacterial co-infection are essential for improving COVID-19 patient survival.
Background:
We aim to explore whether the bacterial co-infection with COVID-19 will raise the in-hospital mortality.
Methods:
COVID-19 patients' information were collected for analysis in our retrospective study. Neutrophil count and procalcitonin (PCT) were used to estimate whether there was a suspected bacterial co-infection.
Results:
The main baselines between the suspected bacterial infection (SBI) and no evidence of bacterial infection (NBI) groups were no significant differences. In SBI group, patients required more therapies than NBI group. There was significantly higher in-hospital mortality (26% vs.9%, P < 0.001) between SBI and NBI groups in overall population. And in each subgroup based on pneumonia inflammation index (PII), it also showed higher in-hospital mortality of COVID-19 patients with bacterial co-infection. With logistic regression models, it showed that bacterial co-infection was associated with significantly higher in-hospital mortality in overall population (OR 1.694, 95% CI 1.179-2.434, p = 0.004) and mild subgroup (OR 2.374, 95% CI 1.249-4.514, p = 0.008). The rate of bacterial co-infection in overall population was 51%. At the same time, it showed a significantly higher rate of bacterial co-infection in critical subgroup than severe subgroup (63% vs. 49%, p = 0.003), and than that in moderate subgroup (63% vs. 48%, p = 0.002) based on clinical classification. It showed a significantly higher rates of bacterial co-infection in severe subgroup than moderate subgroup (66% vs. 49%, p = 0.001) based on PII. The result showed that the risk factor associated with significantly higher in-hospital mortality was PII (OR 1.018, 95%CI 1.012 to 1.024, P < 0.001) with logistic regression models.
Interpretation:
Bacterial co-infection estimated by Neutrophil count and procalcitonin significantly raises in-hospital mortality of COVID-19 patients in overall population in our study. Its impact is more significant in mild and moderate PII subgroups. PII based on CT imaging combined with neutrophil count and PCT is beneficial for accurate differentiation of bacterial co-infection of COVID-19.
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