C-Reactive Protein as The Predictor of Mortality for COVID-19 Patients in Indonesia

Authors

  • Astari Rahayu Afifah Medical Profession Program, Faculty of Medicine, Sriwijaya University, Palembang
  • Phey Liana Clinical Pathology Department, Faculty of Medicine, Universitas Sriwijaya, Palembang, Indonesia
  • Soilia Fertilita Department of Histology, Faculty of Medicine, Sriwijaya University, Palembang
  • Nelda Aprilia Salim Department of Internal Medicine, Faculty of Medicine, Sriwijaya University
  • Verdiansah Verdiansah Department of Clinical Pathology, Faculty of Medicine, Sriwijaya University/Dr. Mohammad Hoesin General Hospital, Palembang
  • Fadhilatul Hilda Medical Profession Program, Faculty of Medicine, Sriwijaya University, Palembang
  • Chris Alberto Amin Medical Profession Program, Faculty of Medicine, Sriwijaya University, Palembang
  • Tungki Pratama Umar Medical Profession Program, Faculty of Medicine, Sriwijaya University, Palembang

DOI:

https://doi.org/10.24293/ijcpml.v29i2.1997

Keywords:

COVID-19, C-reactive protein, mortality, survival analysis

Abstract

Coronavirus Disease 2019 (COVID-19) confirmed cases and deaths continue to rise. When a virus infects the body, the immune system tries to eliminate the virus. C-Reactive Protein (CRP) is a substance produced in the body in response to infection and inflammation. The study aimed to determine the role of CRP in predicting COVID-19 patients’ mortality. From the 1st of March to the 31st of August 2020, data on patients confirmed with COVID-19 were collected from medical records. The correlation between CRP levels and patient mortality was determined using a Chi-Square test. A Receiver Operator Curve (ROC) analysis was used to determine the best CRP cut-off point, and a survival analysis was used to assess the patient outcome. This study included a total of 210 eligible patients. Survivors and non-survivors were divided into two groups of patients (159 patients and 51 patients, respectively). The CRP cut-off was 54 mg/L, with an AUC of 0.817 (p<0.001). C-reactive protein levels were related to COVID-19 patient mortality (p=0.000). According to the survival analysis, patients with CRP levels > 54 mg/L had a lower chance of 30-day survival (p=0.0001). This study presented that CRP levels can be used to predict mortality in COVID-19 patients.

Downloads

Download data is not yet available.

References

Farahat RA, Abdelaal A, Umar TP, El-Sakka AA, Benmelouka AY, et al. The emergence of SARS-CoV-2 Omicron subvariants: Current situation and future trends. Le Infez Med, 2022; 30(4): 480.

Astuti I, Ysrafil. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2): An overview of viral structure and host response. Diabetes Metab Syndr Clin Res Rev, 2020; 14(4): 407–12.

World Health Organization. WHO Coronavirus Disease Dashboard [Internet]. World Health Organization. 2022 Available from: https://covid19.who.int/(accessed Jan 7, 2022).

COVID-19 Response Acceleration Task Force. COVID-19 Distribution data of Indonesia [Internet]. The Ministry of Health of Indonesia. 2022. Available from: https://covid19.go.id/peta-sebaran (accessed Jan 9, 2022).

Gao Y, Li T, Han M, Li X, Wu D, et al. Diagnostic utility of clinical laboratory data determinations for patients with severe COVID-19. J Med Virol, 2020; 92(7): 791–6.

Vabret N, Britton GJ, Gruber C, Hegde S, Kim J, et al. Immunology of COVID-19: Current state of the science. Immunity, 2020; 52(6): 910–41.

Lestari NA, Retnoningrum D. Correlation between platelet to lymphocyte ratio with C-reactive protein in COVID-19 patients. Indones J Clinical Pathol Med Laboratory. 2021; 28(1): 17–21.

Sproston NR, Ashworth JJ. Role of C-reactive protein at sites of inflammation and infection. Front Immunol, 2018; 9: 754.

Siordia Jr JA. Epidemiology and clinical features of COVID-19: A review of current literature. J Clin Virol, 2020; 127: 104357.

Hilda F, Liana P, Nurtjahyo A, Hudari H, Sari NP, et al. D-dimer as a sensitive biomarker of survival rate in patients with COVID-19. Eurasian J Med, 2022; 54(3): 219–24.

Shrivastava AK, Singh HV, Raizada A, Singh SK. C-reactive protein, inflammation, and coronary heart disease. Egypt Hear J, 2015; 67(2): 89–97.

Shi Y, Yu X, Zhao H, Wang H, Zhao R, Sheng J. Host susceptibility to severe COVID-19 and establishment of a host risk score: Findings of 487 cases outside Wuhan. Crit Care, 2020; 24(1): 108.

Rapp JL, Lieberman-Cribbin W, Tuminello S, Taioli E. Male sex, severe obesity, older age, and chronic kidney disease are associated with COVID-19 severity and mortality in New York City. Chest, 2021; 159(1): 112–5.

Zhang J Jin, Dong X, Cao Y Yuan, Yuan Y Dong, Yang Y Bin, et al. Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy Eur J Allergy Clin Immunol, 2020; 75(7): 1730–41.

Bajaj V, Gadi N, Spihlman AP, Wu SC, Choi CH, Moulton VR. Aging, immunity, and COVID-19: How age influences the host immune response to Coronavirus infections? Front Physiol, 2021; 11: 1793.

Lei F, George K, Roth M. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection?. Lancet, 2020; 8: e21.

Marik PE, DePerrior SE, Ahmad Q, Dodani S. Gender-based disparities in COVID-19 outcomes. J Investig Med, 2021; 69: 814-818.

Kenarkoohi SFA. Sex and gender differences in the outcome of patients with COVID-19. J Med Virol, 2021;93 (1): 151–2.

Hosseinzadeh R, Goharrizi MASB, Bahardoust M, Alvanegh AG, Ataee MR, et al. Should all patients with hypertension be worried about developing severe Coronavirus Disease 2019 (COVID-19)?. Clin Hypertens, 2021; 27(1): 3.

Maluf CB, Barreto SM, Giatti L, Ribeiro AL, Vidigal PG, et al. Association between C-reactive protein and all-cause mortality in the ELSA-Brasil cohort. J Epidemiol Community Health, 2020; 74(5): 421–7.

Shang W, Dong J, Ren Y, Tian M, Li W, et al. The value of clinical parameters in predicting the severity of COVID-19. J Med Virol, 2020; 92(10): 2188–92.

Stallmach A, Kortgen A, Gonnert F, Coldewey SM, Reuken P, Bauer M. Infliximab against severe COVID-19-induced cytokine storm syndrome with organ failure-a cautionary case series. Crit Care, 2020; 24(1): 444.

Luo X, Zhou W, Yan X, Guo T, Wang B, et al. Prognostic Value of C-Reactive Protein in Patients With Coronavirus 2019. Clin Infect Dis, 2020; 71(16): 2174–9.

Liu F, Li L, Xu M, Wu J, Luo D, et al. Prognostic value of interleukin-6, C-reactive protein, and procalcitonin in patients with COVID-19. J Clin Virol, 2020; 127: 104370.

Gao S, Jiang F, Jin W, Shi Y, Yang L, et al. Risk factors influencing the prognosis of elderly patients infected with COVID-19: A clinical retrospective study in Wuhan, China. Aging (Albany NY). 2020;12(13):12504–16.

Herold T, Jurinovic V, Arnreich C, Lipworth BJ, Hellmuth JC, et al. Elevated levels of IL-6 and CRP predict the need for mechanical ventilation in COVID-19. J Allergy Clin Immunol, 2020;146(1):128-136.e4.

Tan C, Huang Y, Shi F, Tan K, Ma Q, et al. C-reactive protein correlates with computed tomographic findings and predicts severe COVID-19 early. J Med Virol, 2020;92(7):856–62.

Potempa LA, Rajab IM, Hart PC, Bordon J, Fernandez-Botran R. Insights into the use of C-reactive protein as a diagnostic index of disease severity in COVID-19 infections. Am J Trop Med Hyg, 2020; 103(2): 561–3.

Giamarellos-Bourboulis EJ, Netea MG, Rovina N, Akinosoglou K, Antoniadou A, et al. Complex immune dysregulation in COVID-19 patients with severe respiratory failure. Cell Host Microbe, 2020; 27(6): 992-1000.e3.

Smilowitz NR, Kunichoff D, Garshick M, Shah B, Pillinger M, et al. C-reactive protein and clinical outcomes in patients with COVID-19. Eur Heart J, 2021; 42(23): 2270–9.

Han H, Ma Q, Li C, Liu R, Zhao L, et al. Profiling serum cytokines in COVID-19 patients reveals IL-6 and IL-10 are disease severity predictors. Emerg Microbes Infect, 2020; 9(1): 1123–30.

Zhu Z, Cai T, Fan L, Lou K, Hua X, et al. Clinical value of immune-inflammatory parameters to assess the severity of Coronavirus disease 2019. Int J Infect Dis, 2020; 95: 332–9.

Downloads

Submitted

2022-04-23

Accepted

2023-01-04

Published

2023-03-31

How to Cite

[1]
Afifah, A.R., Liana, P., Fertilita, S., Salim, N.A., Verdiansah, V., Hilda, F., Amin, C.A. and Umar, T.P. 2023. C-Reactive Protein as The Predictor of Mortality for COVID-19 Patients in Indonesia. INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY. 29, 2 (Mar. 2023), 180–184. DOI:https://doi.org/10.24293/ijcpml.v29i2.1997.

Issue

Section

Articles