Prognostic Value of C-Reactive Protein in Patients With Coronavirus 2019

Abstract

Background Elevated serum C-reactive protein (CRP) level was observed in most patients with COVID-19. Methods Data of COVID-19 patients with clinical outcome in a designated hospital in Wuhan, China, were retrospectively collected and analyzed from Jan 30 to Feb 20, 2020. The prognostic value of admission CRP was evaluated in patients with COVID-19. Results Out of 298 patients enrolled, 84 died and 214 recovered. Most non-survivors tended to be males, old aged, or with chronic diseases. Compared to survivors, non-survivors showed significantly elevated white blood cell and neutrophil count, neutrophil to lymphocyte ratio (NLR), systemic immune-inflammation index (SII, defined by platelet count multiply by NLR), CRP, procalcitonin, and D-dimer, and decreased red blood cell, lymphocyte, and platelet count. Age, neutrophil count, platelet count, and CRP were identified as independent predictors of adverse outcome. The area under the receiver operating characteristic (ROC) curve (AUC) of CRP (0.896) was significantly higher than that of age (0.833), neutrophil count (0.820), and platelet count (0.678) in outcome prediction (all p<0.05). With a cut-off value of 41.4, CRP exhibited sensitivity 90.5%, specificity 77.6%, positive predictive value 61.3%, and negative predictive value 95.4%. Subgroup analysis revealed that CRP remained robust accuracy in adverse outcome prediction in patients with different disease severity (AUC 0.832, z=10.23, p<0.001; AUC 0.989, z=44.04, p<0.001). CRP was also an independent discriminator of severe/critical illness on admission (AUC 0.783, z=10.69, p<0.001). Conclusions In patients with COVID-19, admission CRP correlated with disease severity and tended to be a good predictor of adverse outcome.

Risk factors for severe disease in patients admitted with COVID-19 to a hospital in London, England: a retrospective cohort study

“…However, some differences also exist. Increasing age was strongly associated with poorer outcomes, corroborating the findings of others [3,[6][7][8]17,18]. In line with previous research [19,20] a strong association between respiratory diseases and death was found.…”

Prognostic Value of Pro-Inflammatory Neutrophils and C-Reactive Protein in Cancer Patient With Coronavirus Disease 2019: A Multi-Center, Retrospective Study

“…Meanwhile, studies have reported that patients infected with COVID-19 show increased levels of pro-inflammatory neutrophils, procalcitonin, CRP and IL-6 (Chen et al, 2020;Zeng et al, 2020). Moreover, studies have reported that the neutrophil count, IL-6 and CRP can be used as predictors of clinical outcome and disease severity Luo et al, 2020;Qin et al, 2020). Recently, some studies have shown that cancer patients with COVID-19 have higher level of CRP, and higher neutrophil counts, D-dimer and LDH are associated with poor prognosis (Mehta et al, 2020;Zhang et al, 2020).…”

“…Moreover, studies have reported that pro-inflammatory factors such as CRP, interleukin 6, neutrophils, etc. were associated with the severity and prognosis of patients with COVID-19 Luo et al, 2020;Moore and June, 2020;Sahu et al, 2020). In patients with COVID-19, high levels of pro-inflammatory factors predicted a poor prognosis (Zeng et al, 2020).…”

Hemostatic Changes in Patients with COVID-19: A Meta-Analysis with Meta-Regressions

“…Twenty-two studies [20,26,74,[82][83][84][85][86][87][88][89][90][91][92][94][95][96][97][98][99][100]102] showed higher D-Dimer levels in 1149 subjects dead with COVID-19 as compared to 4407 subjects survived to COVID-19 (SMD: 3.88; 95%CI: 2.70, 5.07, p < 0.001, Figure 3). The heterogeneity among studies was significant (I 2 : 99.4%, p < 0.001) and was not reduced by the exclusion of one study at a time.…”