C-Reactive Protein (CRP): A poor prognostic biomarker

IntroductionSince December 2019, the COVID-19 epidemic, now known to all, continues to be rampant, with the number of infected cases increasing exponentially (1).Complications of COVID-19 mainly involve the respiratory, renal and cardiovascular systems. In severe cases, secondary infections lead to pneumonia and acute respiratory distress syndrome, which may precede the patient’s death. Multi-organ failure in individuals with COVID-19 could be a consequence of decompensation of their comorbidities and/or deregulated immune response. A patient’s pre-existing conditions may affect the prognosis of the disease, requiring immediate attention to accurately detect and evaluate individuals infected with SARS-CoV-2 (2).Several studies have noted an abnormal imbalance in the analytical data of different biological markers. These biomarkers include C-reactive protein (CRP), leukocytes, lymphocytes, platelets, D-dimers, Interleukin 6 IL-6 among others.The objective of this study is to determine whether 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, Intensive Care, and Resuscitation Department of the Mohammed VI University Hospital of Oujda and to compare our results with those reported in the literature.MethodsType of studyThis is a monocentric, descriptive and analytical retrospective cohort study carried out in the Department of Anesthesia and Intensive Care of the Mohammed VI University Hospital of Oujda, in collaboration with the Laboratory of Epidemiology, Clinical Research, and Public Health (LERCSP) of the Faculty of Medicine and Pharmacy of Oujda, conducted over a period of 19 months, between March 2020 and October 2021.Inclusion criteria:We included:- Confirmed cases of COVID-19 defined by a positive reverse transcriptase polymerase chain reaction (RT-PCR) test of a nasopharyngeal swab sample.- Patients at least 18 years of age- Patients with a plasma C-reactive protein (CRP) bioassay on admissionExclusion criteria:We excluded:- Patients with elevated CRP levels on admission explained by a pathology outside of COVID-19 (proven infection, neoplasia,…).- Patients who were hospitalized for < 48 hours.- Patients with missing or absent biological data.Data collection and statistical analysis:First, a descriptive analysis of the socio-demographic characteristics was performed to describe the study sample at inclusion. The results are expressed as numbers and percentages for the categorical variables and mean and standard deviation for the quantitative variables. A univariate analysis of the different variables was performed. The Chi-square test was used for categorical variables and the Student’s t-test for quantitative variables.To study the relevance of initial CRP in predicting mortality, patients were divided into two groups according to a baseline admission CRP value set at 100mg/L, chosen based on the optimum cut-off value identified by drawing AUC curves. And the Cox proportional hazards model with “delayed entry” was used for analysis of right-censored cohort data and to account for potential confoundersAll variables with an association with a significance level (p-value)
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