Using the kinetics of C-reactive protein response to improve the differential diagnosis between acute bacterial and viral infections

Coster, Dan; Wasserman, Asaf; Fisher, Eyal; Rogowski, Ori; Zeltser, David; Shapira, Itzhak; Bernstein, Daniel; Meilik, Ahuva; Raykhshtat, Eli; Halpern, Pinchas; Berliner, Shlomo; Shenhar‐Tsarfaty, Shani; Shamir, Ron

doi:10.1007/s15010-019-01383-6

Cited by 51 publications

(40 citation statements)

References 33 publications

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“…CRP is a type of protein produced by the liver that is elevated in response to inflammation [13][14][15]. Generally, CRP level is much higher in bacterial infections than in viral infections [16][17][18]. To our surprise, many COVID-19 patients in this study showed elevated CRP levels, which is in agreement with other studies [12,19].…”

Section: Discussionsupporting

confidence: 90%

C-Reactive Protein Level May Predict the Risk of COVID-19 Aggravation

Wang

Zhang

et al. 2020

Open Forum Infectious Diseases

255

190

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Background. Clinical findings indicated that a fraction of coronavirus disease 2019 patients diagnosed as mild early may progress to severe cases. However, it is difficult to distinguish these patients in the early stage. The present study aimed to describe the clinical characteristics of these patients, analyze related factors, and explore predictive markers of the disease aggravation.Methods. Clinical and laboratory data of nonsevere adult COVID-19 patients in Changsha, China, were collected and analyzed on admission. A logistic regression model was adopted to analyze the association between the disease aggravation and related factors. The receiver operating characteristic curve (ROC) was utilized to analyze the prognostic ability of C-reactive protein (CRP).Results. About 7.7% (16/209) of nonsevere adult COVID-19 patients progressed to severe cases after admission. Compared with nonsevere patients, the aggravated patients had much higher levels of CRP (median [range], 43.8 [12.3-101.9] mg/L vs 12.1 [0.1-91.4] mg/L; P = .000). A regression analysis showed that CRP was significantly associated with aggravation of nonsevere COVID-19 patients, with an area under the curve of 0.844 (95% confidence interval, 0.761-0.926) and an optimal threshold value of 26.9 mg/L.Conclusions. CRP could be a valuable marker to anticipate the possibility of aggravation of nonsevere adult COVID-19 patients, with an optimal threshold value of 26.9 mg/L.

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Section: Discussionsupporting

confidence: 90%

C-Reactive Protein Level May Predict the Risk of COVID-19 Aggravation

Wang

Zhang

et al. 2020

Open Forum Infectious Diseases

255

190

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“…Inflammatory markers, which have been widely used in diagnosing infections and predict disease progression [ 26 ], were investigated in several reports since the beginning of the COVID-19 pandemic. CRP, which is a protein produced by the liver, was found to be a relatively good predictor for the development of pneumonia in MERS-CoV infections [ 27 ] and has recently been found to be a valuable marker to anticipate the possibility of aggravation of non-severe adult COVID-19 patients, with an optimal threshold value of 26.9 mg/L [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Outcome of Hospitalized COVID-19 Patients in a MERS-CoV Endemic Area

Barry¹,

Almohaya²,

Alhijji³

et al. 2020

JEGH

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Background: The Kingdom of Saudi Arabia (KSA) reported 170,639 cases and 1430 deaths from COVID-19 since the first case emerged in the country on March 2 through June 25, 2020. The objective of this report is to describe the characteristics and outcome observed among 99 hospitalized COVID-19 patients in the largest academic hospital in KSA, and assess co-infection with the Middle East Respiratory Syndrome Coronavirus (MERS-CoV). Methods: This single-center case series data included select epidemiological, clinical, radiological features and laboratory findings of all confirmed hospitalized cases of COVID-19 in King Saud University Medical City (KSUMC), Riyadh, KSA, from March 22 until May 31, 2020, followed through June 6, 2020. We conducted retrospective analysis of listed data from 99 hospitalized patients and present characteristics and factors associated with severity in percentages and univariate odds ratios. Cases were confirmed using nasopharyngeal or throat swab by real-time Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and MERS-CoV by RT-PCR. Results: The 99 hospitalized COVID-19 patients included in this analysis constitute 16% of 632 positive SARS-CoV-2 among 6633 persons who were tested at the KSUMC (positivity rate, 9.4%). MERS-CoV PCR was negative in all 99 patients tested. The majority of these 99 hospitalized patients were males (66%), had a mean age of 44 years (range, 19–87), and a quarter (25.3%) were health care workers. Patients with comorbid conditions accounted for 52.5% of patients including the 8.1% who were asymptomatic; diabetes mellitus being the most frequent (31.3%), followed by hypertension (22.2%). The most common presenting symptoms were fever (67.7%), cough (60.6%), dyspnea (43.4%), upper respiratory symptoms (27.3%), fatigue (26.3%), diarrhea (19.2%) and loss of smell (9.1%). The clinical conditions among these 99 patients included upper respiratory tract infection (47.5%), abnormal chest X-ray, lymphopenia, high inflammatory markers a fifth (21%) of patients had moderate pneumonia, while 7% had severe pneumonia with 22.2% requiring admission to the intensive care unit and 12.1% died. Late presentation with severe disease, an abnormal chest X-ray, lymphopenia, high inflammatory markers (C-reactive protein, ferritin, and procalcitonin), and end organ damage (high creatinine or high aspartate aminotransferase) were predictors for admission to critical care unit or died. Conclusion: We observed no MERS-CoV co-infection in this early cohort of hospitalized COVID-19 patients who were relatively young, more than half had comorbid conditions, presented with fever and/or cough, an abnormal chest X-ray, lymphopenia, and high inflammatory markers. Given MERS-CoV endemicity in the country, co-monitoring of MERS-CoV and SARS-CoV-2 coinfection is critical.

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“…The majority of the Chinese patients with AAV are positive for MPO-ANCA [5][6][7], which activates and damages glomerular endothelial cells (GEnC) in patients with AAV [7][8][9]. C-reactive protein (CRP) is an acute-phase protein that serves as an inflammatory response biomarker [10,11]. During activity and relapse of AAV disease, serum CRP levels increase rapidly, followed by a decrease during remission of the disease [12,13].…”

Section: Introductionmentioning

confidence: 99%

The plasma level of mCRP is linked to cardiovascular disease in antineutrophil cytoplasmic antibody-associated vasculitis

Liang

Huang

et al. 2020

Arthritis Res Ther

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Background C-reactive protein (CRP) has two natural isomers: C-reactive protein pentamer (pCRP) and C-reactive protein monomer (mCRP). The levels of CRP are significantly elevated in patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). mCRP not only activates the endothelial cells, platelets, leukocytes, and complements, but also has a proinflammatory structural subtype that can localize and deposit in inflammatory tissues. Thus, it regulates a variety of clinical diseases, such as ischemia/reperfusion (I/R) injury, Alzheimer’s disease, age-related macular degeneration, and cardiovascular disease. We hypothesized that plasma mCRP levels are related to cardiovascular disease in AAV. Methods In this cross-sectional study, 37 patients with AAV were assessed. Brain natriuretic peptide (BNP) and mCRP in plasma were assessed by enzyme-linked immunosorbent assay (ELISA). The acute ST-segment elevation myocardial infarction (STEMI) was diagnosed by coronary angiography, and the Gensini score calculated. Echocardiography evaluated the ejection fraction (EF%), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), and left ventricular mass index (LVMI). Estimated glomerular filtration rate (eGFR) was calculated based on serum creatinine, age, and gender. Results The plasma level of mCRP in AAV was significantly higher than that in healthy volunteers (P < 0.001). Then, mCRP and CRP levels were compared with and without STEMI complications in AAV. The plasma level of mCRP was higher, but that of CRP was lower in STEMI. The plasma level of mCRP was correlated with Birmingham vasculitis activity score (BVAS), eGFR, BNP, EF%, LVEDV, LVESV, LVMI, and STEMI complications’ Gensini score in AAV; however, CRP did not correlate with BNP, EF%, LVEDV, LVESV, LVMI, and Gensini score. Conclusions The plasma level of mCRP was related to cardiovascular diseases in AAV patients.

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Using the kinetics of C-reactive protein response to improve the differential diagnosis between acute bacterial and viral infections

Cited by 51 publications

References 33 publications

C-Reactive Protein Level May Predict the Risk of COVID-19 Aggravation

C-Reactive Protein Level May Predict the Risk of COVID-19 Aggravation

Clinical Characteristics and Outcome of Hospitalized COVID-19 Patients in a MERS-CoV Endemic Area

The plasma level of mCRP is linked to cardiovascular disease in antineutrophil cytoplasmic antibody-associated vasculitis

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