Prognostic Value of C-Reactive Protein in Patients With Coronavirus 2019

  1. Xiaomin Luo
  2. Wei Zhou
  3. Xiaojie Yan
  4. Tangxi Guo
  5. Benchao Wang
  6. Hongxia Xia
  7. Lu Ye
  8. Jun Xiong
  9. Zongping Jiang
  10. Yu Liu
  11. Bicheng Zhang
  12. Weize Yang

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Abstract

Background

An elevated serum C-reactive protein (CRP) level was observed in most patients with coronavirus disease 2019 (COVID-19).

Methods

Data for COVID-19 patients with clinical outcome in a designated hospital in Wuhan, China, were retrospectively collected and analyzed from 30 January 2020 to 20 February 2020. The prognostic value of admission CRP was evaluated in patients with COVID-19.

Results

Of 298 patients enrolled, 84 died and 214 recovered. Most nonsurvivors were male, older, or with chronic diseases. Compared with survivors, nonsurvivors showed significantly elevated white blood cell and neutrophil counts, neutrophil to lymphocyte ratio (NLR), systemic immune inflammation index (defined by platelet count multiplied by NLR), CRP, procalcitonin, and D-dimer and showed decreased red blood cell, lymphocyte, and platelet counts. Age, neutrophil count, platelet count, and CRP were identified as independent predictors of adverse outcome. The area under the receiver operating characteristic (ROC) curve (AUC) of CRP (0.896) was significantly higher than that of age (0.833), neutrophil count (0.820), and platelet count (0.678) in outcome prediction (all P < .05). With a cutoff value of 41.4, CRP exhibited sensitivity of 90.5%, specificity of 77.6%, positive predictive value of 61.3%, and negative predictive value of 95.4%. CRP was also an independent discriminator of severe/critical illness on admission with an AUC (0.783) comparable to age (0.828) and neutrophil count (0.729) (both P > .05).

Conclusions

In patients with COVID-19, admission CRP correlated with disease severity and tended to be a good predictor of adverse outcome.

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  1. ScreenIT

    SciScore for 10.1101/2020.03.21.20040360: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: 11 This study was approved by the Ethics Committee of Renmin Hospital of Wuhan University (approval number: WDRM 2020-K094).
    Consent: Written consent was not required for the retrospective character of this study.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    There are some limitations in our study. First, aging, chronic diseases, and secondary infection in some cases might exert effects on the increased serum CRP level besides SARS-CoV-2 infection itself. Such superimposed effects, however, would better reflect the features of patients with severe COVID-19. Second, some patients with critical illness were not admitted to intensive care unit as they should be due to shortage of resources, which undoubtedly had a negative impact on the outcome of those patients. Third, patients were not recruited consecutively due to exclusion of some cases without serum CRP detection on admission, which might bring about selective bias. Fourth, serum CRP level correlates with the degree of inflammatory response,24 therefore, changes in CRP over time might provide more information about disease prognosis. However, no continuous CRP values over time were included in this study since it was designed to explore the potential of admission CRP in outcome prediction. In conclusion, our results suggested that admission serum CRP level performed well in discriminating disease severity and predicting adverse outcome in patients with COVID-19. Patients with markedly elevated admission CRP should be provided more attention and strengthened treatment. The findings from this single-center study need to be validated by multi-center research with larger samples.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1093/cid/ciaa641
  3. Version published to 10.1101/2020.03.21.20040360 on medRxiv