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Association of C-reactive protein with mortality in Covid-19 patients: a secondary analysis of a cohort study
Fei Li1, Mingjun He1, Mingchao Zhou2
1Department of Rehabilitation Medicine, Dapeng New District Nan'ao People's Hospital, No. 6, Renmin Road, Nanao Street, Dapeng New District, Shenzhen, 518121, Guangdong, China.
Insights
Elevated C-reactive protein (CRP) levels are linked to increased COVID-19 mortality risk. The association shows a saturation effect, with risk rising sharply for lower CRP levels and flattening at higher levels.
Area of Science:
- * Biomedical research
- * Clinical epidemiology
- * Infectious disease
Background:
- * Coronavirus disease 2019 (COVID-19) is a global health crisis with significant mortality.
- * Inflammatory markers, such as C-reactive protein (CRP), are being investigated for their role in disease severity and outcomes.
- * Understanding the relationship between CRP and COVID-19 mortality is crucial for risk stratification and patient management.
Purpose of the Study:
- * To investigate the association between serum C-reactive protein (CRP) levels and mortality risk in patients with COVID-19.
- * To determine if the association between CRP and mortality follows a linear or non-linear pattern.
- * To identify potential thresholds for CRP levels that may indicate higher mortality risk.
Main Methods:
- * Retrospective cohort study of 3545 patients admitted with SARS-CoV-2 infection between March 1 and April 16, 2020.
- * Data on all-cause mortality collected up to May 7, 2020.
- * Mortality risk estimated using Cox proportional hazards models, analyzing CRP increments.
Main Results:
- * A total of 918 (25.9%) patients died during the study period.
- * For CRP levels below 15.6 mg/L, each 10 mg/L increase in CRP was associated with a 1.57-fold increased mortality risk (adjusted HR: 1.57, 95% CI: 1.30-1.91).
- * For CRP levels at or above 15.6 mg/L, each 10 mg/L increase in CRP showed a smaller, non-significant increase in mortality risk (adjusted HR: 1.11, 95% CI: 0.99-1.24).
- * The association between CRP and COVID-19 mortality demonstrated a curve with a saturation effect, indicating that the impact of rising CRP on mortality risk diminishes at higher levels.
Conclusions:
- * Serum C-reactive protein is a significant predictor of mortality in COVID-19 patients.
- * The mortality risk associated with CRP exhibits a saturation effect, with a pronounced increase at lower CRP levels and a less steep increase at higher levels.
- * A CRP level of 15.6 mg/L may represent a threshold beyond which the incremental mortality risk associated with further CRP elevation is reduced.
Abstract:
Our study aimed to explore the association between serum C-reactive protein (CRP) and COVID-19 mortality. This is a retrospective cohort study of all patients admitted to 4 hospitals within the Montefiore Health System between March 1 and April 16, 2020, with SARS-CoV-2 infection. All-cause mortality were collected in 7 May 2020. The mortality risk was estimated using Cox proportional hazards models. Of the 3545 patients with a median age of 63.7 years, 918 (25.9%) died within the time of cohort data collection after admission. When the CRP was < 15.6 mg/L, the mortality rate increased with an adjusted HR of 1.57 (95% CI 1.30-1.91, P < 0.0001) for every 10 mg/L increment in the CRP. When the CRP was ≥ 15.6 mg/L, the mortality rate increased with an adjusted HR of 1.11 (95% CI 0.99-1.24, P = 0.0819) for every 10 mg/L increment in the CRP. For patients with COVID-19, the association between the CRP and the mortality risk was curve and had a saturation effect. When the CRP was small, the mortality rate increased significantly with the increase of CRP. When CRP > 15.6 mg/L, with the increase of CRP, the mortality rate increases relatively flat.
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