This document summarizes a study that found elevated levels of C-reactive protein (CRP) may predict the risk of COVID-19 worsening from a mild to severe case. The study looked at 209 patients in China with mild COVID-19. 16 patients saw their condition worsen, with higher CRP levels and older age as distinguishing factors. CRP levels over 26.9 mg/L had the best accuracy at predicting worsening, which could help identify patients for early treatment.

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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.

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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%.
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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
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