Background: Data for predicting severity of patients with COVID-19 infection are sparse and still under investigation. We retrospectively studied whether the admission serum C-reactive protein level (CRP) can serve as nearly predictor of disease severity during COVID-19 infection in comparison with other hematologic and inflammatory markers.
Methods: We included all consecutive patients who were admitted in Cheikh Khalifa International University Hospital, Casablanca, Morocco, between February to April 2020, with a confirmed diagnosis of COVID-19 infection using SARS-CoV-2 viral nucleic acid via RT-PCR. The complete blood count and serum CRP level were routinely measured on admission. All clinical and laboratory data of patients were collected and analyzed. The classification of the disease severity was in accordance with the clinical classification of the WHO interim guidance, and the management of patients were adapted to the national management guideline. We estimated receiver operating characteristic (ROC) curves of blood routine parameters as well as their association with COVID-19 disease severity.
Results: 145 COVID-19 patients were included in the study. The median age (range) was 50 (32-63) years, and 75 (51.7%) were men. 101 patients were classified in the non-severe group and 44 patients in the severe group. Based on disease severity, significant differences were observed in the age, gender, comorbidities, and respiratory symptom. Similarly, the biological analysis found significant differences for the neutrophil count, lymphocyte count, eosinophil count, and CRP level. However, according to ROC curves of these laboratory biomarkers, the AUC of CRP at 0.872 was significantly higher than all other parameters. Further, CRP was independently associated with severity of COVID-19 disease (OR = 1.11, 95% IC (1.01-1.22) and or = 1.13, 95% IC (1.04-1.23)).
Conclusions: This study found that the CRP level at admission represent a simple and independent factor that can be useful for early detection of severity during COVID-19 and the easy guidance of primary care.
Uvod: Podaci za predviđanje težine stanja pacijenata sa infekcijom COVID-19 su retki i još uvek se istražuju. Retrospektivno smo istražili da li nivo C-reaktivnog proteina (CRP) može da posluži kao rani indikator ozbiljnosti bolesti pri infekciji virusom COVID-19 u poređenju sa drugim hematološkim i upalnim markerima.
Metode: Uključili smo sve pacijente koji su uzastopno primljeni u Međunarodnu univerzitetsku bolnicu Šeik Kalifa u Kazablanki, Maroko, u periodu od februara do aprila 2020. godine, sa dijagnozom COVID-19 infekcije potvrđenom pomoću virusne nukleinske kiseline COVID-19 putem RT-PCR. Kompletna krvna slika i nivo seruma CRP rutinski su mereni na prijemu. Svi klinički i laboratorijski podaci pacijenata su prikupljeni i analizirani. Klasifikacija težine bolesti bila je u skladu sa kliničkom klasifikacijom privremenih uputstava SZO, a lečenje pacijenata prilagođeno međunarodnim smernicama. Izvršili smo procenu ROC krive parametara analize krvi kao i njihovu povezanost sa težinom bolesti COVID-19.
Rezultati: U istraživanje je uključeno 145 pacijenata sa infekcijom COVID-19. Srednja vrednost starosti bila je 50 godina (32-63 godine), a 75 pacijenata (51,7%) bili su muškarci. U lakšu grupu svrstan je 101 pacijent, a u težu 44. Na osnovu težine bolesti primećene su značajne razlike u starosti, polu, komorbiditetima i respiratornim simptomima. Slično tome, biološka analiza otkrila je značajne razlike u broju neutrofila, broju limfocita, broju eozinofila i nivou CRP-a. Međutim, prema ROC krivama ovih laboratorijskih biomarkera, AUC (oblast ispod krive) CRP-a na 0,872 bio je značajno veći od svih ostalih parametara. Dalje, CRP je nezavisno povezan sa težinom bolesti COVID-19 (OR = 1,11, 95% IC (1,01-1,22) i or = 1,13, 95% IC (1,04-1,23)).
Zaključak: Ovo istraživanje je otkrilo da nivo CRP-a pri prijemu predstavlja jednostavan i nezavisan faktor koji može biti koristan za rano otkrivanje težine bolesti COVID-19 i lako sprovođenje primarne nege.
Keywords: C-reactive protein; COVID-2019; SARS-CoV-2; early predictor; severity.
2020 Maryame Ahnach, Saad Zbiri, Sara Nejjari, Fadwa Ousti, Chafik Elkettani, published by CEON/CEES.