C-reactive protein and clinical outcomes in patients with COVID-19

Abstract

Background A systemic inflammatory response is observed in coronavirus disease 2019 (COVID-19). Elevated serum levels of C-reactive protein (CRP), a marker of systemic inflammation, are associated with severe disease in bacterial or viral infections. We aimed to explore associations between CRP concentration at initial hospital presentation and clinical outcomes in patients with COVID-19. Methods and results Consecutive adults aged ≥18 years with COVID-19 admitted to a large New York healthcare system between 1 March and 8 April 2020 were identified. Patients with measurement of CRP were included. Venous thrombo-embolism (VTE), acute kidney injury (AKI), critical illness, and in-hospital mortality were determined for all patients. Among 2782 patients hospitalized with COVID-19, 2601 (93.5%) had a CRP measurement [median 108 mg/L, interquartile range (IQR) 53–169]. CRP concentrations above the median value were associated with VTE [8.3% vs. 3.4%; adjusted odds ratio (aOR) 2.33, 95% confidence interval (CI) 1.61–3.36], AKI (43.0% vs. 28.4%; aOR 2.11, 95% CI 1.76–2.52), critical illness (47.6% vs. 25.9%; aOR 2.83, 95% CI 2.37–3.37), and mortality (32.2% vs. 17.8%; aOR 2.59, 95% CI 2.11–3.18), compared with CRP below the median. A dose response was observed between CRP concentration and adverse outcomes. While the associations between CRP and adverse outcomes were consistent among patients with low and high D-dimer levels, patients with high D-dimer and high CRP have the greatest risk of adverse outcomes. Conclusions Systemic inflammation, as measured by CRP, is strongly associated with VTE, AKI, critical illness, and mortality in COVID-19. CRP-based approaches to risk stratification and treatment should be tested.

Chest CT and Clinical Features of COVID-19 Patients in the Early Stage of the Epidemic: An Observational Study from China

“…Han et al found that serum LDH and CRP were signi cantly correlated with the severity of COVID-19. And Smilowitz NR et al also came to the conclusion that CRP was strongly associated with critical illness and mortality in COVID-19 [44]. In our study, CRP elevation appeared to be higher in the severe/critical group than in the moderate group (P = 0.076).…”

Prevalence and Impact of Atrial Fibrillation in Hospitalized Patients with COVID-19: A Systematic Review and Meta-Analysis

“…Inflammation may also trigger arrhythmias through determining a more severe clinical course of COVID-19. Inflammatory burden during COVID-19 was associated with greater disease severity [ 59 ] and increased risk of death [ 60 ]. On the other hand, the association between critically ill status and the onset of AF is well established, particularly during infections [ 7 ]; indeed, AF in our study was associated with a five-fold greater chance of having a critical clinical state.…”

Therapeutic Anticoagulation in Critically Ill Patients with Covid-19 – Preliminary Report

“…Observational studies identified an association between the novel coronavirus disease 2019 (Covid- 19), inflammation, hypercoagulability, and thrombosis. [1][2][3][4] Critically ill patients with Covid-19 are at high risk of venous and arterial thrombotic events despite standard dose pharmacological thromboprophylaxis. [5][6][7][8] Higher levels of circulating biomarkers reflecting systemic inflammation and coagulation activation (e.g., D-dimer, C-reactive protein) are independently associated with a greater risk of respiratory failure, thrombosis, and death.…”