Predictability of CRP and D-Dimer levels for in-hospital outcomes and mortality of COVID-19

Abstract

Background: Systemic inflammation elicited by a cytokine storm is considered a hallmark of coronavirus disease 2019 (COVID-19). This study aims to assess the clinical utility of the C-reactive protein (CRP) and D-Dimer levels for predicting in-hospital outcomes in COVID-19. Methods: A retrospective cohort study was performed to determine the association of CRP and D-Dimer with the need for invasive mechanical ventilation (IMV), dialysis, upgrade to an intensive care unit (ICU) and mortality. Independent t-test and multivariate logistic regression analysis were performed to calculate mean differences and adjusted odds ratios (aOR) with its 95% confidence interval (CI), respectively. Results: A total of 176 patients with confirmed COVID-19 diagnosis were included. On presentation, the unadjusted odds for the need of IMV (OR 2.5, 95% CI 1.3-4.8, p = 0.012) and upgrade to ICU (OR 3.2, 95% CI 1.6-6.5, p = 0.002) were significantly higher for patients with CRP (>101 mg/dl). Similarly, the unadjusted odds of in-hospital mortality were significantly higher in patients with high CRP (>101 mg/dl) and high D-Dimer (>501 ng/ml), compared to corresponding low CRP (<100 mg/dl) and low D-Dimer (<500 ng/ml) groups on day-7 (OR 3.5, 95% CI 1.2-10.5, p = 0.03 and OR 10.0, 95% CI 1.2-77.9, p = 0.02), respectively. Both high D-Dimer (>501 ng/ml) and high CRP (>101 mg/dl) were associated with increased need for upgrade to the ICU and higher requirement for IMV on day-7 of hospitalization. A multivariate regression model mirrored the overall unadjusted trends except that adjusted odds for IMV were high in the high CRP group on day 7 (aOR 2.5, 95% CI 1.05-6.0, p = 0.04). Conclusion: CRP value greater than 100 mg/dL and D-dimer levels higher than 500 ng/ml during hospitalization might predict higher odds of in-hospital mortality. Higher levels at presentation might indicate impending clinical deterioration and the need for IMV.

Antibiotic Prescribing Patterns at COVID-19 Dedicated Wards in Bangladesh: Findings from a Single Center Study

“…Inflammatory markers, such as CRP and d-dimer, performed after hospital admission, were found to be positively associated with both disease severity and multiple antibiotic prescribing among survey patients. This finding corroborates previous research findings where it was found that increased CRP and d-dimer is positively associated with poor patient outcomes [ 14 ].…”

An investigation of risk factors of in-hospital death due to COVID-19: a case-control study in Rasht, Iran

“…Furthermore, mean CRP levels were significantly higher in the groups of patients needing critical care than those with the less progressed disorder at admission and on day 7. Although, in contrast to our results, the researchers failed to find a significant relationship between on-admission CRP levels and the odds of mortality, increased levels of this factor (> 101 mg/dl) on day 7 was associated with elevated COVID-19 mortality risk (OR = 3.7; 95% CI = 1.1-12.5) than the patients with < 100 mg/dl CRP levels after adjusting for comorbidities at baseline and medications consumption [32].…”

“…A systematic review and meta-analysis on 16 studies, including 1896 survivors and 849 non-survivors COVID-19 cases, documented that serum levels of CRP of non-survivor patients was significantly greater than the survivors (standard difference in means = 1.371) [30]. A retrospective cohort study of 176 patients with COVID-19 showed partially similar results to the present findings [32]. Although no significant differences in serum CRP levels of COVID-19 survivors and non-survivors were found on admission, on day 7, a greater mean CRP was related to elevated mortality.…”

“…Interestingly, D-dimer levels concurrent with hs-CRP levels were likely to be lower after treatments in majority of patients with acceptable clinical prognosis [40]. Moreover, in contrast to our study, no significant difference in the mean levels of D-dimer of survivors and non-survivors neither on day 1 nor on day 7 of hospitalization was detected in a retrospective cohort study [32] which is described earlier. They showed that mean levels of this factor was related to a raised need for critical care on day 7.…”

“…They showed that mean levels of this factor was related to a raised need for critical care on day 7. Although there was not any significant association between D-dimer levels at admission and mortality odds due to COVID-19, increased level of this biomarker (higher than 501 ng/ml) was shown to be related to a decreased mortality odds on and day 7 of hospitalization compared to the patients with D-dimer levels < 500 ng/ml (OR = 11.9; 95% CI = 1.2-109.9) [32].…”