Impact of Pneumococcal Urinary Antigen Testing in COVID-19 Patients: Outcomes from the San Matteo COVID-19 Registry (SMACORE)
Abstract
:1. Introduction
2. Methods
2.1. Patients and Study Design
2.2. Microbiological Methods
2.3. Statistical Analysis
3. Results
3.1. Study Population
3.2. Effects of Positive Urinary Antigen on Mortality and ICU Admission
3.3. Effects of Positive Urinary Antigen on Length of Stay
3.4. Effects of Positive Urinary Antigen on Variation of WHO Ordinal Scale and Laboratory Measures
4. Discussion
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variable | Whole Sample (n = 469) | Negative PUA (n = 427) | Positive PUA (n = 42) | p-Value | |
---|---|---|---|---|---|
Sex, n (%) | Male | 320 (68.2) | 295 (69.1) | 25 (59.5) | |
Female | 149 (31.8) | 132 (30.9) | 17 (40.5) | 0.27 | |
Age, n (%) | mean (sd) | 67.6 (14.7) | 67.6 (14.7) | 67.6 (14.5) | 0.98 |
Death, n (%) | yes | 84 (17.9) | 79 (18.5) | 5 (11.9) | |
no | 385 (82.1) | 348 (81.5) | 37 (88.1) | 0.39 | |
ICU admission, n (%) | yes | 43 (9.2) | 40 (9.4) | 3 (7.1) | |
no | 426 (90.8) | 387 (90.6) | 39 (92.9) | 0.84 | |
CCI, M (sd) | 3.5 (2.3) | 3.4 (2.3) | 3.8 (2.3) | 0.27 | |
missing | 43 | 43 | 0 | ||
Severe immunodepression, n (%) | 13 (3.0) | 11 (2.8) | 2 (4.9) | 0.8 | |
missing | 39 | 38 | 1 | ||
Previous lung disease, n (%) | No | 228 (64.0) | 205 (64.3) | 23 (62.2) | |
Yes | 128 (36.0) | 114 (35.7) | 14 (37.8) | 0.94 | |
missing | 113 | 108 | 5 | ||
Days since onset of symptoms, M (sd) | 6.3 (3.8) | 6.2 (3.8) | 6.6 (3.9) | 0.53 | |
missing | 65 | 63 | 2 | ||
Steroid treatment before hospitalization, n (%) | No | 309 (74.5) | 281 (75.1) | 28 (68.3) | |
Yes | 106 (25.5) | 93 (24.9) | 13 (31.7) | 0.44 | |
missing | 54 | 53 | 1 | ||
Antibiotic treatment before hospitalization (n of atb), n (%) | 0 | 281 (67.2) | 250 (66.5) | 31 (73.8) | |
1 | 125 (29.9) | 117 (31.1) | 8 (19.0) | ||
2 | 12 (2.9) | 9 (2.4) | 3 (7.1) | 0.07 | |
missing | 51 | 51 | 0 | ||
Antibiotic treatment during hospitalization (n of atb), n (%) | 0 | 18 (4.7) | 16 (4.7) | 2 (5.1) | |
1 | 254 (66.7) | 227 (66.4) | 27 (69.2) | ||
2 | 103 (27.0) | 94 (27.5) | 9 (23.1) | ||
3 | 6 (1.6) | 5 (1.5) | 1 (2.6) | 0.9 | |
Radiological findings at CT scan | No CT scan | 256 (71.9) | 228 (71.7) | 28 (73.7) | |
GGO | 21 (5.9) | 20 (6.3) | 1 (2.6) | ||
FO | 8 (2.2) | 7 (2.2) | 1 (2.6) | ||
GGO+FO | 69 (19.4) | 61 (19.2) | 8 (21.1) | ||
others | 2 (0.6) | 2 (0.6) | 0 (0.0) | 0.89 | |
missing | 113 | 109 | 4 | ||
Radiological findings at chest X-ray | 0 | 17 (4.8) | 17 (5.3) | 0 (0.0) | |
GGO | 126 (35.3) | 120 (37.6) | 6 (15.8) | ||
FO | 55 (15.4) | 45 (14.1) | 10 (26.3) | ||
GGO+FO | 151 (42.3) | 130 (40.8) | 21 (55.3) | ||
others | 8 (2.2) | 7 (2.2) | 1 (2.6) | 0.02 | |
missing | 112 | 108 | 4 | ||
WHO ordinal scale at admission | mean (sd) | 4.5 (1.1) | 4.5 (1) | 4.9 (1.2) | 0.01 |
missing | 46 | 46 | 0 | ||
WHO ordinal scale at day 7 | mean (sd) | 4.4 (1.9) | 4.3 (1.9) | 5 (1.9) | 0.02 |
missing | 70 | 69 | 1 | ||
WHO ordinal scale at day 14 | mean (sd) | 3.1 (2.7) | 3.1 (2.7) | 3.2 (2.7) | 0.91 |
missing | 144 | 140 | 4 | ||
C-reactive protein at admission (mg/mL), M (sd) | 11 (8.6) | 10.9 (8.6) | 12.5 (9) | 0.28 | |
missing | 42 | 38 | 4 | ||
Procalcitonin at admission (ng/mL), M (sd) | 1.1 (5.8) | 1.1 (6) | 1.4 (3.7) | 0.76 | |
missing | 169 | 160 | 9 | ||
Neutrophil count at admission (103/mm3), M (sd) | 36.9 (440.8) | 39.8 (461.6) | 6.7 (3.6) | 0.66 | |
missing | 49 | 44 | 5 | ||
Lymphocyte count at admission (103/mm3), M (sd) | 9.9 (101.7) | 10.6 (106.5) | 1.7 (5.2) | 0.6 | |
missing | 47 | 42 | 5 | ||
C-reactive protein at day 7 (mg/mL), M (sd) | 5 (6.3) | 5 (6.2) | 5.5 (7.6) | 0.69 | |
missing | 211 | 196 | 15 | ||
Neutrophil count at day 7 (103/mm3) | 10.4 (52) | 10.6 (54.8) | 7.8 (3.8) | 0.79 | |
missing | 208 | 192 | 16 | ||
Lymphocyte count at day 7 (103/mm3), M (sd) | 1.2 (1.6) | 1.3 (1.7) | 1.1 (0.5) | 0.52 | |
missing | 208 | 192 | 16 |
Variable | HR | 95% CI | p-Value |
---|---|---|---|
30 days mortality | |||
Age | 1.09 | [1.06–1.12] | <0.001 |
CCI | 0.98 | [0.84–1.14] | 0.78 |
Severe immunosuppression | 5.87 | [0.87–1.03] | 0.01 |
Days since onset of symptoms | 0.95 | [0.87–1.03] | 0.20 |
WHO ordinal scale at admission | 1.21 | [1.02–1.43] | 0.04 |
CRP levels (mg/mL) | 1.02 | [1–1.04] | 0.03 |
Positive PUA | 0.53 | [0.22–1.28] | 0.16 |
ICU admission | |||
CCI | 0.85 | [0.73–0.99] | 0.05 |
Antibiotic treatment before hospitalization (atb = 1) | 2.2 | [1.12–4.35] | 0.03 |
Antibiotic treatment before hospitalization (atb = 2) | 3.67 | [1.06–12.75] | 0.05 |
PCTI levels (ng/mL) | 1.04 | [1.01–1.07] | 0.01 |
Positive PUA | 0.8 | [0.25–2.54] | 0.70 |
Variable | Estimate | SE | p-Value |
---|---|---|---|
Intercept | −3.64 | 5.26 | 0.49 |
Antibiotic treatment before hospitalization (atb = 1) | 0.29 | 1.56 | 0.85 |
Antibiotic treatment before hospitalization (atb = 2) | 7.24 | 4.07 | 0.08 |
Antibiotic treatment during hospitalization (atb = 1) | −2.13 | 3.57 | 0.55 |
Antibiotic treatment during hospitalization (atb = 2) | −2.31 | 3.67 | 0.53 |
Antibiotic treatment during hospitalization (atb = 3) | 19.02 | 6.62 | <0.001 |
WHO ordinal scale at admission | 3.51 | 0.81 | <0.001 |
CT scan GGO | 5.64 | 3.23 | 0.08 |
CT scan FO | 0.45 | 5.48 | 0.93 |
CT scan GGO and FO | 10.17 | 1.93 | <0.001 |
CT scan others | 4.11 | 8.49 | 0.63 |
Chest X-ray GGO | 1.83 | 3.52 | 0.60 |
Chest X-ray FO | 4.36 | 3.74 | 0.25 |
Chest X-ray GGO and FO | 2.93 | 3.63 | 0.42 |
Chest X-ray others | 4.29 | 6.53 | 0.51 |
CRP at admission (mg/mL) | 0.14 | 0.09 | 0.13 |
PCTI at admission (ng/mL) | 0.49 | 0.19 | 0.01 |
Positive PUA | 1.71 | 2.37 | 0.47 |
Variable | Estimate | SE | p-Value |
---|---|---|---|
Intercept | 2.30 | 0.38 | <0.001 |
Time (day 7 vs. day 0) | −0.10 | 0.12 | 0.41 |
Time (day 14 vs. day 0) | −1.33 | 0.14 | <0.001 |
PUA | 0.37 | 0.32 | 0.26 |
Age | 0.03 | 0.01 | <0.001 |
Time (day 7 vs. day 0) × PUA | 0.19 | 0.36 | 0.60 |
Time (day 14 vs. day 0) × PUA | −0.38 | 0.39 | 0.34 |
Variable | C-Reactive Protein (mg/mL) | Lymphocyte Count (103/mm3) | Neutrophil Count (103/mm3) | ||||||
---|---|---|---|---|---|---|---|---|---|
est | SE | p-Value | est | SE | p-Value | est | SE | p-Value | |
Intercept | 6.33 | 1.49 | <0.001 | 148.12 | 48.39 | <0.001 | 3652 | 10.80 | <0.001 |
Time (day 7 vs. day 0) | −5.87 | 0.54 | <0.001 | −19.89 | 21.74 | 0.36 | −8.55 | 4.70 | 0.07 |
PUA | 1.01 | 1.27 | 0.43 | −31.22 | 45.30 | 0.49 | −8.61 | 10.25 | 0.40 |
Age | 0.07 | 0.02 | <0.001 | −1.64 | 0.68 | 0.02 | −0.39 | 0.15 | 0.01 |
Time (day 7 vs. day 0) × PUA | −0.59 | 1.52 | 0.70 | 26.36 | 65.15 | 0.69 | 8.16 | 14.46 | 0.57 |
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Valsecchi, P.; Colaneri, M.; Zuccaro, V.; Asperges, E.; Costanzo, F.; Mariani, B.; Roda, S.; Minucci, R.; Bertuccio, F.; Fraolini, E.; et al. Impact of Pneumococcal Urinary Antigen Testing in COVID-19 Patients: Outcomes from the San Matteo COVID-19 Registry (SMACORE). J. Pers. Med. 2021, 11, 762. https://doi.org/10.3390/jpm11080762
Valsecchi P, Colaneri M, Zuccaro V, Asperges E, Costanzo F, Mariani B, Roda S, Minucci R, Bertuccio F, Fraolini E, et al. Impact of Pneumococcal Urinary Antigen Testing in COVID-19 Patients: Outcomes from the San Matteo COVID-19 Registry (SMACORE). Journal of Personalized Medicine. 2021; 11(8):762. https://doi.org/10.3390/jpm11080762
Chicago/Turabian StyleValsecchi, Pietro, Marta Colaneri, Valentina Zuccaro, Erika Asperges, Filippo Costanzo, Bianca Mariani, Silvia Roda, Rita Minucci, Francesco Bertuccio, Elia Fraolini, and et al. 2021. "Impact of Pneumococcal Urinary Antigen Testing in COVID-19 Patients: Outcomes from the San Matteo COVID-19 Registry (SMACORE)" Journal of Personalized Medicine 11, no. 8: 762. https://doi.org/10.3390/jpm11080762