Patients suffering from COVID-19 (Coronavirus Disease 2019) pneumonia are prone tobacterial and mycotic superinfection. According to existing evidence, the prevalence ofsuperinfection is about 8% to 14% (95% CI 5-26%). However, the percentage of patientstreated for superinfection is as high as 80%. There can be multiple reasons for thisdifference.
The inflammatory markers, such as C-reactive protein (CRP), procalcitonin (PCT),
presepsin (PSP), interleukin-6 (IL-6) frequently used as diagnostic tools in COVID-19
(Coronavirus Disease 2019), are usually increased in these patients. This increase is a
result of activation of systemic inflammatory cascade, part of COVID-19 pathophysiologic
pathway. This can escalate to state known as COVID-19 associated hyperinflamation
(COV-HI). In addition, current diagnostic tools for diagnosing HAP/VAP (hospital-acquired
pneumonia and ventilator-associated pneumonia) are often limited in patients with
COVID-19 pneumonia. The current method of choice for superinfection diagnosing is BAL
(Bronchoalveolar Lavage). The COV-HI phenotype (COV-HI: CRP > 150 mg/L, or doubling
within 24 h from greater than 50 mg/L, or ferritin concentration > 1500 ug/L) is
associated with significantly worse course of illness and higher mortality rates. These
inflammatory markers may be used preferentially as prognostication tools, not bacterial
superinfection markers. The intention of this project is to investigate the role of
currently used inflammatory biomarkers. Or eventually, to discover new parameters
associated with superinfection proven by BAL.
Diagnostic Test: Inflammatory markers sampling
Laboratory sampling:
Haematology: complete blood count, reticulocytes, IFP, PT, aPTT, fibrinogen, D-dimer
Biochemical profile: urea, creatinine, bilirubin, ALT, AST, GGT, CK, LD, ferritin,
troponin Inflammation markers IL-6, PCT (procalcitonin), CRP (C-reactive protein), PSP
(presepsin)
BALF (bronchoalveolar lavage fluid) processing protocol:
1. microbiology: microscopic examination, standard cultivation test
2. biochemistry: albumin, total protein
3. Pathology: cytology
4. PCR:
a. Multiplex PCR b. SARS-CoV-2 RNA load
Inclusion Criteria:
1. admission on ICU
2. age more than 18 years
3. COVID-19 pneumonia criteria fulfilled
Exclusion Criteria: none
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University Hospital Brno
Brno, Czechia
Investigator: Jan Maláska
Contact: +420723784101
jan.malaska@gmail.com
Jan Maláska
+420532232009
jan.malaska@gmail.com
Jan Maláska, Principal Investigator
Brno University Hospital