C-Reactive protein as a prognostic indicator in hospitalized patients with COVID-19

Abstract

Recent studies have reported that CRP levels are elevated in patients with COVID-19 and may correlate with severity of disease and disease progression. We conducted a retrospective cohort analysis of the medical records of 268 adult patients, who were admitted to one of the six cohorted COVID ICUs across Emory Healthcare System and had at least two CRP values within the first seven days of admission to study the temporal progression of CRP and its association with all-cause in-hospital mortality. The median CRP during hospitalization for the entire cohort was 130 mg/L (IQR 82–191 mg/L), and the median CRP on ICU admission was 169 (IQR 111–234). The hospitalization-wide median CRP was significantly higher amongst the patients who died, compared to those who survived [206 mg/L (157–288 mg/L) vs 114 mg/L (72–160 mg/L), p<0.001]. CRP levels increased in a linear fashion during the first week of hospitalization and peaked on day 5. Compared to patients who died, those who survived had lower peak CRP levels and earlier declines. CRP levels were significantly higher in patients who died compared to those who survived (p<0.001). Our findings support the utility of daily CRP values in hospitalized COVID-19 patients and provide early thresholds during hospitalization that may facilitate risk stratification and prognostication.

Randomized placebo-controlled pilot clinical trial on the efficacy of ayurvedic treatment regime on COVID-19 positive patients

“…The serum levels of hs-CRP, IL-6 and TNF-α were measured on day 1, after randomization and commencement of treatment, and on day 7. Increase in hs-CRP,IL-6 and TNF-α in response to SARS-CoV-2 infection is indicative of the severity of disease prognosis ( Del Valle et al, 2020 ; Fara et al, 2020 ; Sharifpour et al, 2020 ). Average serum level of hs-CRP was significantly increased in the placebo group on day 7 compared to day 1.…”

“…The cytokine release syndrome, resulting from robust immune activation, leads to multiorgan dysfunction and death ( Del Valle et al, 2020 ). Inflammatory markers, like, IL-6, TNF-α and hs-CRP are used as predictors for risk stratification of COVID-19 cases ( Del Valle et al, 2020 ; Fara et al, 2020 ; Sharifpour et al, 2020 ). Anti-IL-6 antibodies, like, tocilizumab, is being used to treat severe SARS-CoV-2 infections ( Guaraldi et al, 2020 ).…”

“…Elevated IL-6 levels are associated with increased hs-CRP levels, increased disease severity and reduced chances of recovery ( Fara et al, 2020 ). Increased hs-CRP levels are negatively correlated to oxygen saturation and are associated with aggravation in asymptomatic and mildly symptomatic cases and mortality in severe COVID-19 patients, indicating lung injury linked disease course ( Ali, 2020 ; Sharifpour et al, 2020 ). In our study, hs-CRP was also found to be reduced significantly in the treatment group by day 7.…”

Response to Whole-Lung Low-Dose Radiation Therapy (LD-RT) Predicts Freedom from Intubation in Patients Receiving Dexamethasone and/or Remdesevir for COVID-19-Related Acute Respiratory Distress Syndrome (ARDS)

“…As CRP is among the most potent biomarker predictors of mortality and outcomes in COVID-19, the rapid and reproducible decline in CRP seen following LD-RT merits additional investigation. 18…”

A precise score for the regular monitoring of COVID-19 patients condition validated within the first two waves of the pandemic

“…According to the literature, several indicators are the most interesting for predicting a lethal outcome: aspartate aminotransferase [7], conjugated bilirubin [8], creatinine, urea [9], procalcitonin [10], CRP [11] and lymphocytes [12]. These indicators are useful for death prediction both separately and in combination as was shown with use of automatic feature selection tools based on such machine learning algorithms as logistic regression, SVM, random forest, etc.…”