C-reactive protein as an effector molecule in Covid-19 pathogenesis

Rev Med Virol. 2021 Nov;31(6):e2221. doi: 10.1002/rmv.2221. Epub 2021 Feb 17.


The current pandemic caused by SARS-CoV-2 virus infection is known as Covid-19 (coronavirus disease 2019). This disease can be asymptomatic or can affect multiple organ systems. Damage induced by the virus is related to dysfunctional activity of the immune system, but the activity of molecules such as C-reactive protein (CRP) as a factor capable of inducing an inflammatory status that may be involved in the severe evolution of the disease, has not been extensively evaluated. A systematic review was performed using the NCBI-PubMed database to find articles related to Covid-19 immunity, inflammatory response, and CRP published from December 2019 to December 2020. High levels of CRP were found in patients with severe evolution of Covid-19 in which several organ systems were affected and in patients who died. CRP activates complement, induces the production of pro-inflammatory cytokines and induces apoptosis which, together with the inflammatory status during the disease, can lead to a severe outcome. Several drugs can decrease the level or block the effect of CRP and might be useful in the treatment of Covid-19. From this review it is reasonable to conclude that CRP is a factor that can contribute to severe evolution of Covid-19 and that the use of drugs able to lower CRP levels or block its activity should be evaluated in randomized controlled clinical trials.

Keywords: C-reactive protein; COVID-19; SARS-CoV-2; severe evolution.

Publication types

  • Systematic Review

MeSH terms

  • ADAM17 Protein / antagonists & inhibitors
  • ADAM17 Protein / genetics
  • ADAM17 Protein / immunology
  • Angiotensin-Converting Enzyme 2 / antagonists & inhibitors
  • Angiotensin-Converting Enzyme 2 / genetics
  • Angiotensin-Converting Enzyme 2 / immunology
  • Anti-Inflammatory Agents / therapeutic use*
  • Biomarkers / blood
  • C-Reactive Protein / antagonists & inhibitors*
  • C-Reactive Protein / genetics
  • C-Reactive Protein / immunology
  • COVID-19 / immunology
  • COVID-19 / pathology
  • COVID-19 / virology
  • COVID-19 Drug Treatment*
  • Celecoxib / therapeutic use
  • Complement System Proteins / genetics
  • Complement System Proteins / immunology*
  • Cytokine Release Syndrome / drug therapy*
  • Cytokine Release Syndrome / immunology
  • Cytokine Release Syndrome / pathology
  • Cytokine Release Syndrome / virology
  • Cytokines / antagonists & inhibitors
  • Cytokines / genetics
  • Cytokines / immunology
  • Disease Progression
  • Doxycycline / therapeutic use
  • Gene Expression Regulation
  • Humans
  • Randomized Controlled Trials as Topic
  • SARS-CoV-2 / pathogenicity*
  • Severity of Illness Index
  • Survival Analysis


  • Anti-Inflammatory Agents
  • Biomarkers
  • Cytokines
  • Complement System Proteins
  • C-Reactive Protein
  • ACE2 protein, human
  • Angiotensin-Converting Enzyme 2
  • ADAM17 Protein
  • ADAM17 protein, human
  • Celecoxib
  • Doxycycline