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C-Reactive Protein (CRP): A poor prognostic biomarker in COVID-19
Mohamed Zakaria Bouayed1, Ilyass Laaribi1, Charaf Eddine Mohammed Chatar1
1Anesthesia, Intensive Care and Resuscitation Department, MOHAMMED VI University Hospital, Oujda, Morocco.
Insights
High C-reactive protein (CRP) levels in COVID-19 patients admitted to intensive care predict a poorer prognosis. Elevated CRP (≥ 100mg/L) was linked to severe lung involvement, mechanical ventilation, and significantly higher mortality rates.
Area of Science:
- Intensive Care Medicine
- Infectious Diseases
- Biomarkers
Background:
- The COVID-19 pandemic has caused significant global morbidity and mortality.
- Identifying predictive factors for poor prognosis, including biological markers like C-reactive protein (CRP), is crucial for patient management.
- Early identification of critically ill COVID-19 patients aids in personalized treatment strategies.
Purpose of the Study:
- To determine if C-reactive protein (CRP) levels upon intensive care unit (ICU) admission predict unfavorable outcomes in COVID-19 patients.
- To compare findings with existing literature on CRP as a prognostic marker for COVID-19.
Main Methods:
- A retrospective, monocentric study was conducted at the University Hospital of Oujda, Morocco.
- 1035 critically ill COVID-19 patients admitted between March 2020 and October 2021 were analyzed.
- Patients were divided into two groups based on admission CRP levels: < 100 mg/L (Group 1) and ≥ 100 mg/L (Group 2).
Main Results:
- Group 2 (CRP ≥ 100 mg/L) showed significantly more severe lung parenchymal involvement (60.8% vs. 39.2%).
- Mechanical ventilation was required in 79.8% of Group 2 patients compared to 20.2% in Group 1.
- Mortality rates were substantially higher in Group 2 (77.4%) versus Group 1 (22.6%), with high statistical significance (p<0.001).
Conclusions:
- Admission C-reactive protein levels are a significant predictor of poor prognosis in critically ill COVID-19 patients.
- An elevated CRP level (≥ 100 mg/L) is associated with increased severity, need for mechanical ventilation, and higher mortality.
- These findings support the use of CRP for early risk stratification and personalized management of COVID-19 patients in the ICU.
Introduction:
The COVID-19 pandemic continues to be rampant with considerable morbidity and mortality worldwide since its emergence in December 2019. Several studies have focused on identifying different predictive factors of poor prognosis, including biological markers, such as C Reactive Protein among others. The objective of our work was to determine whether the CRP levels on admission to the intensive care unit are predictive of an unfavorable evolution of patients with COVID-19 through the experience of the Anesthesia and Intensive Care Unit of the University Hospital of Oujda and to compare our results with those reported in the literature.
Methods:
We conducted a retrospective, monocentric, descriptive and analytical study in the Department of Anesthesia and Intensive Care of the Mohammed VI University Hospital of Oujda, Morocco, between March 2020 and October 2021, including all critically ill patients admitted to the department during this period and meeting the inclusion criteria. The baseline admission CRP value was arbitrarily set at 100mg/d, thus conditioning the division of our patients into two groups (group 1: CRP < 100mg/L, group 2: CRP ≥ 100mg/L).
Results:
Among our 1035 included patients, 291 patients with had a CRP<100mlg/L (group 1) and 744 presented a CRP level equal or superior to 100mg/L (group 2). Lung parenchymal involvement was more severe or even critical (CT involvement > 75%) in group 2 (60.8%) compared to group 1 (39.2%). In group 2, 79.8% of patients were mechanically ventilated, compared to 20.2% of patients in group 1. Finally, the mortality rate in patients with a CRP ≥ 100mg/l was 77.4%, compared with 22.6% for patients with a CRP < 100mg/l. These findings are all statistically highly significant (p<0.001).
Conclusion:
Given the high contagiousness of the virus and the emergence of several variants, the management of the COVID-19 pandemic has focused more on prevention through vaccination against the virus, but also on an early identification of patients likely to evolve unfavorably for a personalized management.
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