C-Reactive Protein as an early predictor of COVID-19 severity
C-Reactive Protein and COVID-19 severity.
Sažetak
Background
Data for predicting severity of patients with COVID-19 infection are sparse and still under investigation. We retrospectively studied whether the admission serum C-reactive protein level (CRP) can serve as an early predictor of disease severity during COVID-19 infection in comparison with other hematologic and inflammatory markers.
Methods
We included all consecutive patients who were admitted in Cheikh Khalifa International University Hospital, Casablanca, Morocco, between February to April 2020, with a confirmed diagnosis of COVID-19 infection using SARS-CoV-2 viral nucleic acid via RT-PCR. The complete blood count and serum CRP level were routinely measured on admission. All clinical and laboratory data of patients were collected and analyzed. The classification of the disease severity was in accordance with the clinical classification of the WHO interim guidance, and the management of patients were adapted to the national management guideline. We estimated receiver operating characteristic (ROC) curves of blood routine parameters as well as their association with COVID-19 disease severity.
Results
145 COVID-19 patients were included in the study. The median age (range) was 50 (32–63) years, and 75 (51.7%) were men. 101 patients were classified in the non-severe group and 44 patients in the severe group. Based on disease severity, significant differences were observed in the age, gender, comorbidities, and respiratory symptom. Similarly, the biological analysis found significant differences for the neutrophil count, lymphocyte count, eosinophil count, and CRP level. However, according to ROC curves of these laboratory biomarkers, the AUC of CRP at 0.872 was significantly higher than all other parameters. Further, CRP was independently associated with severity of COVID-19 disease (OR = 1.11, 95% IC (1.01-1.22) and OR = 1.13, 95% IC (1.04-1.23)).
Conclusion
This study found that the CRP level at admission represent a simple and independent factor that can be useful for early detection of severity during COVID-19 and the easy guidance of primary care.
Reference
2. World health Organization. Coronavirus disease 2019 (COVID-19): Situation report-128.2020. https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200527-covid-19-sitrep-128.pdf?sfvrsn=11720c0a_2.
3. World Health Organization. Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected: interim guidance, 13 March 2020. https://apps.who.int/iris/handle/10665/331446.
4. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, Zhang L, Fan G, Xu J, Gu X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395: 497-506.
5. LiL Q, Huang T, WangY Q, Wang ZP, Liang Y, Huang TB, Zhang HY, Sun W, and WangY. COVID-19 patients’ clinical characteristics, discharge rate, and fatality rate of meta-analysis. J Med Virol 2020 ; 92 (6) : 577-583.
6. Lippi G, Plebani M. Laboratory abnormalities in patients with COVID-2019 infection. Clin Chem Lab Med 2020; 58 (7):1131-1134.
7. Zhang J, Yu M,Tong S et al. Predictive factors for disease progression in hospitalized patients with Coronavirus Disease 2019 in Wuhan, China. J Clin virol 2020. https://doi.org/10.1016/j.jcv.2020.104392.
8. Tan L, Kang X, Ji Xet al. Validation of predictors of disease severity and outcomes in COVID-19 patients: a descriptive and retrospective study. Med 2020. https://doi.org/10.1016/j.medj.2020.05.002.
9. Zhou Y, Fu B, Zheng X, Wang D, Zhao C, qi Y et al. Aberrant pathogenic GM-CSF+ T cells and inflammatory CD14+ CD16+ monocytes in severe pulmonary syndrome patients of a new coronavirus. Bio Rxiv 2020. https://doi.org/10.1101/ 2020.02.12.945576.
10. Warusevitane A, Karunatilake D, Sim J, Smith C, Roffe C. Early diagnosis of pneumonia in severe stroke: clinical features and the diagnostic role of C-reactive protein. PloS one 2016. http://dx.doi.org/10.1371/journal.pone.0150269.
11. Liu F, Li L, Xu M et al. Prognostic value of interleukin-6, C-reactive protein, and procalcitonin in patients with COVID-19. J Clin Virol 2020. https://doi.org/10.1016/j.jcv.2020.104370.
12. Peng F, Tu L et al. Management and Treatment of COVID-19: The Chinese Experience. Can J Cardiol 2020; 36 (6): 915-930. https://doi.org/10.1016/j.cjca.2020.04.010.
13. World Health Organization. Laboratory testing for 2019 novel coronavirus (2019nCoV) in suspected human cases. 2020 January 17; https://www.who.int/publications-detail/laboratory-testing-for-2019-novelcoronavirus-in-suspected-human-cases.
14. Ministry of Health of Morocco. Coronavirus disease COVID-19. 2020. http://www.covidmaroc.ma/Pages/ProfessionnelSanteAR.aspx.
15. Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020; 323(11): 1061-1069.
16. Zhu N, Zhang D, Wang W, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med 2020; 382:727–733.
17. Zhao Q, Meng M, Kumar R et al. Lymphopenia is associated with severe coronavirus disease 2019 (COVID-19) infections : A systemic review and meta-analysis. Int J Infect Dis 2020; 96 : 131–135.
18. Luo X, Zhou W, Yan X et al. Prognostic value of C-reactive protein in patients with COVID-19. Clin Infect Dis2020. https://doi.org/10.1093/cid/ciaa641.
19. Wang L. C-reactive protein levels in the early stage of COVID-19 . Med Mal Infect. 2020; 50 : 332–334.
20. Zhang J, Yu M, Tong S, Liu L, Tang L. Predictive factors for disease progression in hospitalized patients with coronavirus disease 2019 in Wuhan, China. J Clin Virol 2020. https://doi:10.1016/j.jcv.2020.104392.
21. Qin C, Zhou L, Hu Z, et al. Dysregulation of immune response in patients with COVID-19 in Wuhan, China. Clin Infect Dis 2020. https://doi:10.1093/cid/ciaa248.
22. Yuki K , Fujiogi M, Koutsogiannaki S. COVID-19 pathophysiology: A review. Clinical Immunology 2020; 215. https://doi.org/10.1016/j.clim.2020.108427.
23. Mortensen RF. C-reactive protein, inflammation, and innate immunity. Immunol Res 2001; 24 (2):163–176.
24. Nehring SM, Goyal A, Bansal P, Patel BC. C Reactive Protein (CRP). Treasure Island (FL): StatPearls publishing; 2020; PMID : 28722873NBK441843.
25. Marnell L, Mold C, Du Clos TW. C-reactive protein: ligands, receptors and role in inflammation. Clin Immunol 2005; 117:104–11.
26. Coster D, Wasserman A, Fisher E, et al. Using the kinetics of C-reactive protein response to improve the differential diagnosis between acute bacterial and viral infections. Infection 2020; 48:241–8.
27. Ballou SP, Kushner I. C-reactive protein and the acute phase response. Adv Intern Med1992; 37:313–36.
28. Chalmers S, Khawaja A, Wieruszewski PM, Gajic O, Odeyemi Y. Diagnosis and treatment of acute pulmonary inflammation in critically ill patients: the role of inflammatory biomarkers. World J Crit Care Med 2019;8(5):59–71. http://dx.doi.org/10.5492/wjccm.v8.i5.59.
29. Chen W, Zheng KI, et al. Plasma CRP level is positively associated with the severity of COVID-19. Ann Clin Microbiol Antimicrob 2020 ; 19 (1) :18 ; https://doi.org/10.1186/s12941-020-00362-2.
30. Wang G, Wu C et al. C-Reactive Protein Level May Predict the Risk of COVID- 19 Aggravation. Open Forum Infect Dis 2020; 7 (5). https://doi: 10.1093/ofid/ofaa153.
31. Tan C, Huang Y et al. C-reactive protein correlates with computed tomographic findings and predicts severe COVID-19 early. J Med Virol 2020;1-7.
Sva prava zadržana (c) 2020 Maryame Ahnach, Saad Zbiri, Sara Nejjari, ousti fadwa, chafik Elkettani
Ovaj rad je pod Creative Commons Autorstvo 4.0 međunarodnom licencom.
The published articles will be distributed under the Creative Commons Attribution 4.0 International License (CC BY). It is allowed to copy and redistribute the material in any medium or format, and remix, transform, and build upon it for any purpose, even commercially, as long as appropriate credit is given to the original author(s), a link to the license is provided and it is indicated if changes were made. Users are required to provide full bibliographic description of the original publication (authors, article title, journal title, volume, issue, pages), as well as its DOI code. In electronic publishing, users are also required to link the content with both the original article published in Journal of Medical Biochemistry and the licence used.
Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.