PT - JOURNAL ARTICLE AU - Anna Kaal AU - Lars Snel AU - Martijn Dane AU - Nathalie van Burgel AU - Thomas Ottens AU - Winifred Broekman AU - Lahssan el Bouazzaoui AU - Nikki Kolfschoten AU - Emile Schippers AU - Ewout Steyerberg AU - Soufian Meziyerh AU - Cees van Nieuwkoop TI - Diagnostic yield of bacteriological tests and predictors of severe outcome in adult patients with COVID-19 presenting to the emergency department AID - 10.1136/emermed-2020-211027 DP - 2021 Sep 01 TA - Emergency Medicine Journal PG - 685--691 VI - 38 IP - 9 4099 - http://emj.bmj.com/content/38/9/685.short 4100 - http://emj.bmj.com/content/38/9/685.full SO - Emerg Med J2021 Sep 01; 38 AB - Background Guidelines recommend maximal efforts to obtain blood and sputum cultures in patients with COVID-19, as bacterial coinfection is associated with worse outcomes. The aim of this study was to evaluate the yield of bacteriological tests, including blood and sputum cultures, and the association of multiple biomarkers and the Pneumonia Severity Index (PSI) with clinical and microbiological outcomes in patients with COVID-19 presenting to the emergency department (ED).Methods This is a substudy of a large observational cohort study (PredictED study). The PredictED included adult patients from whom a blood culture was drawn at the ED of Haga Teaching Hospital, The Netherlands. For this substudy, all patients who tested positive for SARS-CoV-2 by PCR in March and April 2020 were included. The primary outcome was the incidence of bacterial coinfection. We used logistic regression analysis for associations of procalcitonin, C reactive protein (CRP), ferritin, lymphocyte count and PSI score with a severe disease course, defined as intensive care unit admission and/or 30-day mortality. The area under the receiver operating characteristics curve (AUC) quantified the discriminatory performance.Results We included 142 SARS-CoV-2 positive patients. On presentation, the median duration of symptoms was 8 days. 41 (29%) patients had a severe disease course and 24 (17%) died within 30 days. The incidence of bacterial coinfection was 2/142 (1.4%). None of the blood cultures showed pathogen growth while 6.3% was contaminated. The AUCs for predicting severe disease were 0.76 (95% CI 0.68 to 0.84), 0.70 (0.61 to 0.79), 0.62 (0.51 to 0.74), 0.62 (0.51 to 0.72) and 0.72 (0.63 to 0.81) for procalcitonin, CRP, ferritin, lymphocyte count and PSI score, respectively.Conclusion Blood cultures appear to have limited value while procalcitonin and the PSI appear to be promising tools in helping physicians identify patients at risk for severe disease course in COVID-19 at presentation to the ED.The deidentified participant data that support the findings of this study are available from the corresponding author, upon reasonable request. Email address: a.g.kaal@hagaziekenhuis.nl.