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. 2021 Mar 14;8(6):ofab124.
doi: 10.1093/ofid/ofab124. eCollection 2021 Jun.

Diagnostic Utility of a Ferritin-to-Procalcitonin Ratio to Differentiate Patients With COVID-19 From Those With Bacterial Pneumonia: A Multicenter Study

Amal A Gharamti  1 , Fei Mei  2 , Katherine C Jankousky  3 , Jin Huang  4 , Peter Hyson  3 , Daniel B Chastain  5 , Jiawei Fan  2 , Sharmon Osae  5 , Wayne W Zhang  6 , José G Montoya  7 , Kristine M Erlandson  8 , Sias J Scherger  8 , Carlos Franco-Paredes  8   9 , Andrés F Henao-Martínez  8 , Leland Shapiro  8   10
Affiliations

Diagnostic Utility of a Ferritin-to-Procalcitonin Ratio to Differentiate Patients With COVID-19 From Those With Bacterial Pneumonia: A Multicenter Study

Amal A Gharamti et al. Open Forum Infect Dis. .

Abstract

Background: There is an urgent need for accurate, rapid, inexpensive biomarkers that can differentiate coronavirus disease 2019 (COVID-19) from bacterial pneumonia. We assess the role of the ferritin-to-procalcitonin (F/P) ratio to classify pneumonia cases into those due to COVID-19 vs those due to bacterial pathogens.

Methods: This multicenter case-control study compared patients with COVID-19 with those with bacterial pneumonia, admitted between March 1 and May 31, 2020. Patients with COVID-19 and bacterial pneumonia co-infection were excluded. The F/P in patients with COVID-19 vs with bacterial pneumonia were compared. Receiver operating characteristic curve analysis determined the sensitivity and specificity of various cutoff F/P values for COVID-19 vs bacterial pneumonia.

Results: A total of 242 COVID-19 pneumonia cases and 34 bacterial pneumonia controls were included. Patients with COVID-19 pneumonia had a lower mean age (57.1 vs 64.4 years; P = .02) and a higher body mass index (30.74 vs 27.15 kg/m2; P = .02) compared with patients with bacterial pneumonia. Cases and controls had a similar proportion of women (47% vs 53%; P = .5), and COVID-19 patients had a higher prevalence of diabetes mellitus (32.6% vs 12%; P = .01). The median F/P was significantly higher in patients with COVID-19 (4037.5) compared with the F/P in bacterial pneumonia (802; P < .001). An F/P ≥877, used to diagnose COVID-19, resulted in a sensitivity of 85% and a specificity of 56%, with a positive predictive value of 93.2% and a likelihood ratio of 1.92. In multivariable analyses, an F/P ≥877 was associated with greater odds of identifying a COVID-19 case (odds ratio, 11.27; 95% CI, 4-31.2; P < .001).

Conclusions: An F/P ≥877 increases the likelihood of COVID-19 pneumonia compared with bacterial pneumonia.

Keywords: COVID-19; SARS-CoV-2; ferritin; pneumonia; procalcitonin.

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Figures

Figure 1.
Figure 1.
A, Ferritin to procalcitonin ratios of patients with COVID-19 pneumonia and patients with bacterial pneumonia (controls) at UC Health. B, Ferritin to procalcitonin ratios in patients with COVID-19 pneumonia and patients with bacterial pneumonia (controls) in the 3 cohorts combined. Abbreviation: COVID-19, coronavirus disease 2019.
Figure 2.
Figure 2.
A, Receiver operating characteristic analysis of ferritin-to-procalcitonin ratio cutoff values predicting COVID-19 diagnosis for UCHealth. B, Receiver operating characteristic analysis of ferritin-to-procalcitonin ratio cutoff values predicting COVID-19 diagnosis in the Putney Memorial and Yichang Central People’s Hospital Cohorts. Abbreviations: COVID-19, coronavirus disease 2019; ROC, receiver operating characteristics.
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