Predictive value of C-reactive protein for disease severity and survival in COVID-19 patients: a systematic review and meta-analysis

Abstract

Coronavirus disease 2019 (COVID-19) is an infectious disease that can develop multiple complications and even be life-threatening. The aim of this study is to summarize current evidence of C-reactive protein’s (CRP) predictive value for disease severity and survival of COVID-19 patients, focusing on curing patients and reducing the risk of death. We systematically searched related studies from four large databases: Web of Science, PubMed, China National Knowledge Infrastructure (CNKI), and Wanfang Database, all published between December 2019 and June 2021. Then, we implemented meta-analysis using random-effects models through STATA 15.1 and Review Manager 5.3. We also implemented sensitivity analysis and used funnel plots to check publication bias. From the systematic search of the four databases, we were able to identify 18 studies containing a total of 3052 patients. Meta-analysis results showed that 1) CRP levels were lower in non-severe patients than in severe patients (Standardized Mean Difference ( SMD) = − 0.87 mg/L, 95% Confidence Interval (CI) = [ − 1.27, − 0.47], p < 0.001); 2) CRP levels were lower in non-intensive care unit (ICU) patients than in ICU patients ( SMD = − 1.39 mg/L, 95% CI = [− 1.68, − 1.11], p < 0.001), and 3) CRP levels were lower in survivors than in non-survivors ( SMD =− 1.32 mg/L, 95% CI = [− 1.95, − 0.69], p < 0.001). Sensitivity analysis showed these results were stable. Funnel plots indicated no publication bias. The CRP level may timely reflect disease severity and predict survival of COVID-19 patients and may be worthy of further popularization and application in clinic practice.

Association of Coagulopathy and Inflammatory Biomarkers with Severity in SARS-CoV-2-Infected Individuals of the Al-Qunfudhah Region of Saudi Arabia

“…In addition, the association of CRP with the most mutated and highly transmissible Omicron variants of SARAS-CoV-2 has also been reported [47]. Elevated CRP (mean ± SD: HS/MS, 102.4 ± 22.9/21.3 ± 6.9), and ferritin (mean ± SD: HS/MS, 875.8 ± 126.8/593.4 ± 67.3) were significantly (p-value < 0.001) associated with higher severity in the Qufudhah population, which was in line with other studies [12,[40][41][42][43][44][45][46][47]. CRP (ad-OR: 1.30; 95%CI: 1.137, 1.50) and ferritin (ad-OR: 1.048; 95%CI: 1.03, 1.066) were significantly (p < 0.001) associated with HS (Table 3).…”

“…The predictive value of CRP for COVID-19 severity has been highlighted in many previous studies [43] along with other laboratory parameters, especially using machine learning and neural networking approaches for accurate prediction and deduction of decision trees [44][45][46]. In addition, the association of CRP with the most mutated and highly transmissible Omicron variants of SARAS-CoV-2 has also been reported [47].…”

Serum interleukin-6, procalcitonin, and C-reactive protein at hospital admission can identify patients at low risk for severe COVID-19 progression

“…PCT and CRP were also significantly associated with severe disease progression in one of the first COVID-19 studies ( Zhang et al, 2020 ). In later meta-analyses, both markers were shown to predict mortality as well as a severe course of the disease ( Chi et al, 2022 ; Kumar et al, 2022 ). The results of these mainly retrospective studies could be confirmed in this prospective study.…”

Presepsin as a prognostic biomarker in COVID-19 patients: combining clinical scoring systems and laboratory inflammatory markers for outcome prediction

“…G), CAR (H), and LCR (I). Abbreviations qSOFA, quick sequential organ failure assessment; NEWS2, National Early Warning Score 2; PSI, Pneumonia Severity Index; CRP, C-reactive protein; NLR, Neutrophil-to-lymphocyte ratio; CAR, C-reactive protein-to-albumin ratio; LCR, Lymphocyte-to-C-reactive protein ratio inflammatory response, and neutrophil-to-lymphocyte ratio (NLR) is also highly regarded [54][55][56][57][58][59]. In our study, CRP (AUC was 0.781) and PCT (AUC was 0.768) showed better predictive efficacy for 28-day mortality in COVID-19 patients compared to NLR (AUC was 0.677).…”