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7 September 2021
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COVID-19

CRP is a marker of severity and prognosis in hospitalized COVID-19 patients

CRP has shown to be a useful marker in COVID-19 patient management in hospitals and intensive care units (ICU). Increased CRP levels are linked to lung injury and predict risk for disease severity and worse prognosis, including mortality1,2. Along with other biomarkers and clinical assessment, CRP enables patient stratification from high to low risk cases and identify those who need intensive care. That will enhance not only patient management but also resource management, hospital flow, and staffing3.

In a study comparing CRP levels in hospitalized patients directed to ICU, those who died had significantly higher CRP levels (206 mg/l) compared to those who survived (114 mg/l)4. Serial measurements of CRP were shown to be a valuable tool in the ICU setting enabling risk stratification and prompt prognosis of the patients. CRP levels increased linearly during the first week of hospitalization peaking at day 5. In patients who survived, CRP levels started to decline earlier, and the peak was lower compared to those who died. If CRP increased more than 20 units/day, the odds for mortality increased significantly. The study concluded that the median CRP values during hospitalization were independent predictors of mortality and correlated with the length of stay in ICU. The rate of CRP increase was more predictive than the maximum CRP value during the first days of hospitalization. Therefore, the daily increase rate of CRP during the first seven days of hospitalization could be used as a tool to predict disease progression and the need for early ICU transfer.

References

  1. Ali N. Elevated level of C-reactive protein may be an early marker to predict risk for severity of COVID-19. J Med Virol 2020; 92(11): 2409-2411.
  2. Izcovich A, Ragusa MA, Tortosa F et al. Prognostic factors for severity and mortality in patients infected with COVID-19: A systematic review. PLoS One 2020; 15(11): e0241955.
  3. Keddie S, Ziff O, Chou MKL et al. Laboratory biomarkers associated with COVID-19 severity and management. Clin Immunol 2020; 221: 108614.
  4. Sharifpour M, Rangaraju S, Liu M et al. C-Reactive protein as a prognostic indicator in hospitalized patients with COVID-19. PLoS One 2020; 15(11): e0242400-e0242400.
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