C-reactive protein cut-off for early tocilizumab and dexamethasone prescription in hospitalized patients with COVID-19

Abstract

Dexamethasone and tocilizumab have been associated with reduction in mortality, however, the beneficial effect is not for all patients and the impact on viral replication is not well defined. We hypostatized that C-reactive protein (CRP) could help in the identification of patients requiring anti-inflammatory therapy. Patients admitted for > 48 h in our hospital for a confirmed or suspected infection by SARS-CoV-2 from February 2020 to February 2021 were retrospectively evaluated. The primary outcome was mortality at 30 days. Demographics and the most relevant variables related with the outcome were included. CRP was stratified by percentiles. Univariate and multivariate analysis were performed. A total of 3218 patients were included with a median (IQR) age of 66 (74–78) years and 58.9% were males. The rate of intensive care unit admission was 24.4% and the 30-day mortality rate was 11.8%. Within the first 5 days from admission, 1018 (31.7%) patients received dexamethasone and 549 tocilizumab (17.1%). The crude analysis showed a mortality reduction in patients receiving dexamethasone when CRP was > 13.75 mg/dL and > 3.5 mg/dL for those receiving tocilizumab. Multivariate analysis identified the interaction of CRP > 13.75 mg/dL with dexamethasone (OR 0.57; CI 95% 0.37–0.89, P = 0014) and CRP > 3.5 mg/dL with tocilizumab (0.65; CI95%:0.44–0.95, P = 0.029) as independent predictors of mortality. Our results suggest that dexamethasone and tocilizumab are associated with a reduction in mortality when prescribed to patients with a certain inflammatory activity assessed by C-reactive protein.

Plasma N-Cleaved Galectin-9 Is a Surrogate Marker for Determining the Severity of COVID-19 and Monitoring the Therapeutic Effects of Tocilizumab

“…CRP, sIL-2R, and ferritin levels in both groups and D-dimer levels in TCZ (+) patients were aberrant values. CRP levels in TCZ (+) patients were more than 3.5 mg/dL, which is its cut-off for the beneficial effects of TCZ treatment [ 37 ]. The respiratory functions in TCZ (+) patients were significantly exacerbated compared to those in TCZ (−) according to their S/F ratio.…”

Role of IP-10 to Predict Clinical Progression and Response to IL-6 Blockade With Sarilumab in Early COVID-19 Pneumonia. A Subanalysis of the SARICOR Clinical Trial

“…A potential limitation of IP-10 as a clinical tool is that it is not available for routine determination in most laboratories, even when it is not a complex or expensive procedure, and that interpretation and quantification are not standardized. For this reason, the role of commonly used inflammatory markers such as CRP has been assessed in previous studies [ 7 , 10 ], which have shown a correlation of high CRP levels with clinical evolution. In our study, although a good correlation of CRP with IP-10 levels was observed, we were unable to identify a cutoff value for CRP or other commonly used serum or cellular markers, with a good predictive yield.…”

“…Some serum markers have been evaluated as specific indicators of disease progression, including inflammatory and coagulation markers (such as C-reactive protein [CRP], ferritin, and D-dimer [DD]) and inflammatory cytokines (such as IL-6, IL-2R, IL-10, monocyte chemoattractant protein [MCP]-1 or tumor necrosis factor–α). Previous studies have suggested that CRP [ 6 , 7 ] and IL-6 [ 8 , 9 ] levels in earlier stages of COVID-19 predict clinical evolution and could be used for the selection of candidates for immunomodulatory therapy [ 7 , 10 ]. In fact, clinical trials with anti-IL-6, in which selected patients had elevated biomarkers, have shown benefit.…”

Assessment of Admission COVID-19 Associated Hyperinflammation Syndrome Score in Critically-Ill COVID-19 Patients

“… 8 – 12 Various studies have demonstrated that the determination of hyperinflammation and its degree may have a pivotal role in order to predict prognosis and decide on immunomodulatory therapy early in the intensive care unit (ICU). 7 , 13 , 14 …”

“…[8][9][10][11][12] Various studies have demonstrated that the determination of hyperinflammation and its degree may have a pivotal role in order to predict prognosis and decide on immunomodulatory therapy early in the intensive care unit (ICU). 7,13,14 Despite hyperinflammation is a well-known and important condition in COVID-19, few criteria and scoring systems to detect hyperinflammation have been evaluated. 5,15,16 A recent study by Webb et al 5 proposed to determine specific criteria for COVID-19 associated hyperinflammation syndrome (cHIS).…”