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Early and Significant Reduction in C-Reactive Protein Levels After Corticosteroid Therapy Is Associated With Reduced
Zhu Cui1, Zachary Merritt1, Andrei Assa2
1Division of General Internal Medicine, Department of Internal Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York.
Insights
A 50% reduction in C-reactive protein (CRP) within 72 hours of corticosteroid treatment may predict lower inpatient mortality in COVID-19 patients. This finding offers a potential early biomarker for treatment response.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Biomarkers
Background:
- Corticosteroids show potential benefit in some coronavirus disease 2019 (COVID-19) patients.
- Predictors for therapeutic response to corticosteroids in COVID-19 remain unclear.
- C-reactive protein (CRP) is a common biomarker, and its reduction may indicate treatment efficacy.
Purpose of the Study:
- To investigate if a reduction in CRP levels after corticosteroid initiation can predict inpatient mortality in COVID-19 patients.
- To identify CRP response as a potential early biomarker for corticosteroid therapy effectiveness.
Main Methods:
- Retrospective cohort study of COVID-19 patients admitted between March 10, 2020, and May 2, 2020.
- Patients receiving corticosteroids were classified as CRP responders (≥50% CRP reduction) or non-responders (<50% CRP reduction) within 72 hours.
- Outcomes assessed included CRP response and differences in mortality between responders and non-responders.
Main Results:
- Of 324 patients treated with corticosteroids, CRP responders showed a significantly reduced risk of death compared to non-responders (25.2% vs. 47.8%).
- The unadjusted odds ratio for mortality in non-responders was 0.37 (95% CI, 0.21-0.65; P <.001).
- This protective effect remained significant after adjusting for confounders (adjusted OR, 0.27; 95% CI, 0.14-0.54; P <.001).
Conclusions:
- A reduction of 50% or more in CRP levels within 72 hours of starting corticosteroids may predict lower inpatient mortality in COVID-19.
- This CRP reduction can serve as an early indicator of successful corticosteroid therapy in COVID-19 patients.
Background:
Corticosteroids may be beneficial in a subset of patients with coronavirus disease 2019 (COVID-19), but predictors of therapeutic response remain unknown. C-reactive protein (CRP) is a routinely measured biomarker, and reduction in its levels after initiation of therapy may predict inpatient mortality.
Methods:
In this retrospective cohort study, the charts of patients who were admitted to Montefiore Medical Center between March 10, 2020, and May 2, 2020 for the management of COVID-19 were examined. Of all patients who met inclusion criteria, patients who received corticosteroid treatment were categorized as CRP responders (≥50% CRP level reduction) and CRP nonresponders (<50% CRP level reduction) based on change in CRP within 72 hours of corticosteroid treatment initiation. The outcomes of interest were two-fold: (1) CRP response after treatment with corticosteroid, and (2) differences in mortality among patients with CRP response compared those without.
Results:
Of 2,707 patients admitted during the study period, 324 received corticosteroid treatment. Of patients who received corticosteroid treatment, CRP responders had reduced risk of death compared with risk among CRP nonresponders (25.2% vs 47.8%; unadjusted odds ratio [OR], 0.37; 95% CI, 0.21-0.65; P <.001). This effect remained strong and significant after adjustment for potential confounders (adjusted OR, 0.27; 95% CI, 0.14-0.54; P <.001).
Conclusion:
Reduction in CRP by 50% or more within 72 hours of initiating corticosteroid therapy potentially predicts inpatient mortality. This may serve as an early biomarker of response to corticosteroid therapy in patients with COVID-19.
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