More Related Content
Similar to Elevated level of c reactive protein may predict risk for worsening covid 19 - infectious disease advisor (20)
Elevated level of c reactive protein may predict risk for worsening covid 19 - infectious disease advisor
- 1. 5/18/20, 11:18 PMElevated Level of C Reactive Protein May Predict Risk for Worsening COVID-19 - Infectious Disease Advisor
Page 1 of 3https://www.infectiousdiseaseadvisor.com/home/topics/covid19/high-crp…sociated-with-increased-likelihood-of-progression-to-severe-covid-19/
Home » Topics » COVID19
A small fraction of nonsevere patients with COVID-19 developed
to severe cases in the first 2 weeks after symptom onset.
Therefore, health care institutions should pay close attention to
the mild patients, early identify, and give appropriate treatment
to reduce mortality.
Elevated Level of C Reactive Protein
May Predict Risk for Worsening
COVID-19
Sweta Gupta
Higher levels of C reactive protein (CRP) may be
a predictive marker in determining which
patients with mild coronavirus disease 2019
(COVID-19) will progress to a severe case,
according to study results published in Open
Forum Infectious Diseases.
In this case series, researchers used data from
patients admitted to a public health treatment
center in Changsha, China from January 17, 2020
to February 20, 2020. All patients were
diagnosed with laboratory-confirmed COVID-19
and were deemed as nonsevere case on
admission. Knowing that a subset of mild cases
will develop into severe COVID-19, researchers described the clinical characteristics of the
patients, analyzed related factors, and explored any predictable marker of disease aggravation.
Progression from a mild to severe case of COVID-19 was defined using 1 of the following criteria:
respiratory rate ≥ 30/min; oxygen saturation ≤ 93%; PaO2/FiO2 ≤ 300 mmHg; progression of lung
lesions > 50% within 24 to 48 hours; implementation of mechanical ventilation; shock; or,
admission to intensive care unit.
Of the 209 adults patients included in the study, 16 patients (62.5% men) progressed to severe
cases after admission by February 20, 2020, including 2 patients who became critically ill. The
median duration from the onset of symptoms to disease progression was 9.5 days (range, 3-12
days). The most common comorbidities were hypertension (n=5), cerebrovascular disease (n=2),
and cardiovascular disease (n=1). The most common symptoms were fever (87.5%), cough (56.3%),
anorexia (56.3%), and fatigue (56.3%).
May 15, 2020
York, NY.
PP-XLK-USA-0812-02 © 2019 Pfizer Inc. November 2019
All rights reserved. XALKORI® is a registered trademark of Pfizer Inc.
- 2. 5/18/20, 11:18 PMElevated Level of C Reactive Protein May Predict Risk for Worsening COVID-19 - Infectious Disease Advisor
Page 2 of 3https://www.infectiousdiseaseadvisor.com/home/topics/covid19/high-crp…sociated-with-increased-likelihood-of-progression-to-severe-covid-19/
responsibility for their application or use in any way. 2. Data on file.
Pfizer Inc. New York, NY.
PP-XLK-USA-0812-01 © 2019 Pfizer Inc. November 2019
All rights reserved. XALKORI® is a registered trademark of Pfizer Inc.
All 16 patients showed pulmonary exudative lesion on chest computed tomographic scans, 10 of
whom showed ground glass opacity in the lungs. Noninvasive ventilation, high-flow oxygen therapy,
and invasive mechanical ventilation were adopted in 6.3%, 18.8% and 6.3% of patients,
respectively.
Compared with patients with a mild case of COVID-19, the patients with worsening condition were
significantly older (median age, 54 vs 42 years; P =.021). Patients with a severe case of COVID-19
also showed higher ratios of symptoms than those with mild cases including fatigue, chills, anorexia,
dyspnea, and headache. In addition, patients with severe COVID-19 had lower lymphocyte
proportion (median, 23.9% vs 27.7%; P =.021), as well as higher levels of CRP (median, 43.8 vs 12.1
mg/L; P <.001) and aspartate aminotransferase (median, 29.2 vs 23.2 U/L; P =.010).
In the univariate analysis, the association between the progression of mild to severe case of
COVID-19 and clinical characteristics were as follows:
Hypertension (odds ratio [OR], 3.533; 95% CI, 1.123-11.120; P =.031).
Creatine kinase (OR, 1.006; 95% CI, 1.000-1.012; P =.047).
Lymphocyte proportion (OR, 0.932; 95% CI, 0.876-0.991; P =.025).
Aspartate aminotransferase (OR, 1.044; 95% CI, 1.001-1.088; P =.044).
CRP (OR, 1.049; 95% CI, 1.028-1.070; P <.001).
In the multivariate analysis, only CRP was significantly associated with the progression to a severe
case of COVID-19 (OR, 1.056; 95% CI, 1.025-1.089; P <.001).
The receiver operating characteristic curve analysis indicated a moderate accuracy, with an area
under the curve of 0.844 (95% CI, 0.761–0.926; P <.001) for CRP to predict the possibility of
patients developing a severe case of COVID-19. The optimal threshold value was 26.9 mg/L and
was associated with a sensitivity of 81.3% and specificity of 79.3%.
Related Articles
Successful Management of Severe COVID-19 in Otherwise Healthy Pediatric Patient
Guideline Issued for Nonsevere, Severe COVID-19 Therapy
Dyspnea May Be Key to Distinguishing COVID-19 From Other Common Illnesses
Although more studies are needed with larger sample size, researchers concluded that because the
elevated CRP occurred before the disease progressed, CRP “could be a valuable marker to predict
the possibility of aggravation of non-severe COVID-19 [in] patients, which can help health care
workers identify those patients at an early stage for early treatment.”
Reference
- 3. 5/18/20, 11:18 PMElevated Level of C Reactive Protein May Predict Risk for Worsening COVID-19 - Infectious Disease Advisor
Page 3 of 3https://www.infectiousdiseaseadvisor.com/home/topics/covid19/high-crp…sociated-with-increased-likelihood-of-progression-to-severe-covid-19/
Wang G, Wu C, Zhang Q, et al. C reactive protein level may predict the risk of COVID-19
aggravation [published online April 29, 2020]. Open Forum Infect Dis. doi:10.1093/ofid/ofaa153
TOPICS: COVID19 DIAGNOSTIC TESTING EMERGING DISEASES
RESPIRATORY
Emerging Diseases
Geriatric Illnesses
GI Illness
HIV/AIDS
Nosocomial Infections
Practice Management
Sexually Transmitted Diseases
Skin Infections
Practice Management
RESOURCES
Drug Database
Clinical Charts
Submissions
Medical Calculators
Meetings
Practice Management
CME
Reprints/Permissions
SITE INFORMATION
About Us
Advertise
Contact Us
Staff
OTHER HAYMARKET
MEDICAL WEBSITES
Cancer Therapy Advisor
Clinical Advisor
Clinical Pain Advisor
Dermatology Advisor
Endocrinology Advisor
Gastroenterology Advisor
Hematology Advisor
McKnight’s Senior Living
Medical Bag
MPR
myCME
Neurology Advisor
Oncology Nurse Advisor
Psychiatry Advisor
Pulmonology Advisor
Renal and Urology News
Rheumatology Advisor
The Cardiology Advisor
Copyright © 2020 Haymarket Media, Inc. All Rights Reserved
This material may not be published, broadcast, rewritten or redistributed in any form without prior authorization.
Your use of this website constitutes acceptance of Haymarket Media’s Privacy Policy and Terms & Conditions.
Back to TopTOPICS