Pancreatic Stone Protein and C-Reactive Protein as Biomarkers of Infection in ICU COVID-19 Patients: A LASSO-Based Predictive Study

Background: Bacterial infections are frequent complications in critically ill COVID-19 patients, and are associated with increased morbidity, antibiotic use, and healthcare burden. Early and accurate identification of infection remains challenging. Pancreatic Stone Protein (PSP) has emerged as a pro...

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Main Authors: Gabriele Melegari, Federica Arturi, Fabio Gazzotti, Elisabetta Bertellini, Benedetta Berselli, Francesca Coppi, Enrico Giuliani, Alberto Barbieri
Format: Article
Language:English
Published: MDPI AG 2025-07-01
Series:COVID
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Online Access:https://www.mdpi.com/2673-8112/5/7/110
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Summary:Background: Bacterial infections are frequent complications in critically ill COVID-19 patients, and are associated with increased morbidity, antibiotic use, and healthcare burden. Early and accurate identification of infection remains challenging. Pancreatic Stone Protein (PSP) has emerged as a promising biomarker of infection. In this study, PSP was evaluated alongside C-reactive protein (CRP). Methods: We conducted a prospective study including 105 critically ill COVID-19 patients admitted to the intensive care unit (ICU). Blood samples were collected at admission to measure PSP and CRP. A LASSO Least Absolute Shrinkage and Selection Operator (LASSO) regression model was used to identify independent predictors of proven or suspected bacterial infection. Mixed-effects models were applied to account for repeated measures and clinical confounders. Results: Among 105 patients, 57 (54%) developed bacterial infections. PSP levels were significantly higher in infected patients (median 100 ng/mL) than in non-infected patients (median 37 ng/mL, <i>p</i> < 0.001). CRP was also elevated in infected patients (median 125 vs. 70 mg/L, <i>p</i> = 0.015). The LASSO model retained PSP as the most informative predictor. In mixed-effects logistic regression, PSP remained significantly associated with infection (OR 1.017, 95% CI 1.006–1.027, <i>p</i> = 0.001). The AUC for PSP was 0.87. Conclusion: PSP appears to be a useful biomarker for early detection of bacterial infection in critically ill COVID-19 patients. Its integration into infection surveillance protocols could support antibiotic stewardship efforts and improve clinical decision-making.
ISSN:2673-8112