Procalcitonin, but not D-dimer, is an Inapplicable Biomarker for Severe COVID-19
Pro-calcitonin and D-dimer are among predictive biomarkers for the severity and mortality of COVID-19. The application of these parameters in the clinical setting of Indonesian hospitals is less documented. This study aims to evaluate the association between procalcitonin and D-dimer with COVID-19. This research is part of a retrospective study evaluating 249 hospitalized COVID-19 patients in Bandung, Indonesia. Patients who were positive for procalcitonin or D-dimer were selected. Clinical data of age, sex, comorbid condition, peripheral oxygen saturation (SpO2), and death were assessed. There were 39 and 28 patients tested for procalcitonin and D-dimer respectively. The level of procalcitonin was not associate with the severity of COVID-19 (p=0.442), death (p=0.506), comorbid condition (p=0.601) or the use of the antibiotics. However, the level of D-dimer in patients with severe COVID-19 was significantly higher than those with non-severe COVID-19 (p=0.0468). Our study shows that procalcitonin levels are not associated with COVID-19. However, D-dimer is associated with the severity of COVID-19.
Keywords: COVID-19, D-dimer, procalcitonin, severity
 WHO. WHO Coronavirus (COVID-19) Dashboard; 2021.
 Ahmed S, Jafri L, Hoodbhoy Z, Siddiqui I. Prognostic Value of Serum Procalcitonin in COVID-19 Patients: A Systematic Review. Indian J Crit Care Med. 2021 Jan;25(1):77– 84.
 Ye W, Chen G, Li X, Lan X, Ji C, Hou M, et al. Dynamic changes of D-dimer and neutrophil-lymphocyte count ratio as prognostic biomarkers in COVID-19. Respir Res. 2020;21(1):1–7.
 Hey J, Thompson-Leduc P, Kirson NY, Zimmer L, Wilkins D, Rice B, et al. Procalcitonin guidance in patients with lower respiratory tract infections: a systematic review and meta-analysis. Clin Chem Lab Med. 2018 Jul;56(8):1200–9.
 Liu F, Li L, Xu M, Wu J, Luo D, Zhu Y, et al. Prognostic value of interleukin-6, Creactive protein, and procalcitonin in patients with COVID-19. J Clin Virol. 2020 Jun;127:104370.
 Y.L. Chan, C.P. Tseng, P.K. Tsay, S.S. Chang, T.F. Chiu, and J.C. Chen, “Procalcitonin as a marker of bacterial infection in the emergency department: an observational study.,” Critical care (London, England). vol. 8, no. 1, pp. 1–9, 2004
 Rostami M, Mansouritorghabeh H. D-dimer level in COVID-19 infection: a systematic review. Expert Rev Hematol. 2020 Nov;13(11):1265–75.
 Zhu L, Yang P, Zhao Y, Zhuang Z, Wang Z, Song R, et al. Single-Cell Sequencing of Peripheral Mononuclear Cells Reveals Distinct Immune Response Landscapes of COVID-19 and Influenza Patients. Immunity. 2020 Sep;53(3):685–696.e3.
 Soraya GV, Ulhaq ZS. Crucial laboratory parameters in COVID-19 diagnosis and prognosis: an updated meta-analysis. Med Clín (Barc). 2020;155(4):143–51.
 Favaloro EJ, Thachil J. Reporting of D-dimer data in COVID-19: some confusion and potential for misinformation. Clin Chem Lab Med. 2020 Jul;58(8):1191–9.
 T.P. Asmarawati, A.N. Rosyid, S.D. Suryantoro, et al., “The clinical impact of bacterial co-infection among moderate, severe and critically ill COVID-19 patients in the second referral hospital in Surabaya.,” F1000Research. vol. 10, no. July, pp. 1–16, 2021
 F. Heidari-Beni, A. Vahedian-Azimi, S. Shojaei, et al., “The Level of Procalcitonin in Severe COVID-19 Patients: A Systematic Review and Meta-Analysis.,” Adv Exp Med Biol. vol. 1321, pp. 277–286, 2021
 Zhang L, Yan X, Fan Q, Liu H, Liu X, Liu Z, et al. D-dimer levels on admission to predict in-hospital mortality in patients with Covid-19. J Thromb Haemost. 2020 Jun;18(6):1324–9.
 Du WN, Zhang Y, Yu Y, Zhang RM. D-dimer levels is associated with severe COVID-19 infections: A meta-analysis. Int J Clin Pract. 2021 Aug;75(8):e14031.
 Grobler C, Maphumulo SC, Grobbelaar LM, Bredenkamp JC, Laubscher GJ, Lourens PJ, et al. Covid-19: The Rollercoaster of Fibrin(Ogen), D-Dimer, Von Willebrand Factor, P-Selectin and Their Interactions with Endothelial Cells, Platelets and Erythrocytes. Int J Mol Sci. 2020 Jul;21(14):5168.
 Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S, et al. Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China. JAMA Intern Med. 2020 Jul;180(7):934–43.
 Ponti G, Maccaferri M, Ruini C, Tomasi A, Ozben T. Biomarkers associated with COVID-19 disease progression. Crit Rev Clin Lab Sci. 2020 Sep;57(6):389–99.