Prognostic Value of C-Reactive Protein in SARS-CoV-2 Infection: A Simplified Biomarker of COVID-19 Severity in Northern Ethiopia

Abstract

Purpose

To evaluate the role of C-reactive protein (CRP) in predicting severe COVID-19 patients.

Methods

A prospective observational cohort study was conducted from July 15 to October 28, 2020, at Kuyha COVID-19 isolation and treatment center hospital, Mekelle City, Northern Ethiopia. A total of 670 blood samples were collected serially. SARS-CoV-2 infection was confirmed by RT-PCR from nasopharyngeal swabs and CRP concentration was determined using Cobas Integra 400 Plus (Roche). Data were analyzed using STATA version 14. P-value <0.05 was considered statistically significant.

Results

Overall, COVID-19 patients had significantly elevated CRP at baseline when compared to PCR-negative controls [median 11.1 (IQR: 2.0–127.8) mg/L vs 0.9 (IQR: 0.5–1.9) mg/L; p=0.0004)]. Those with severe COVID-19 clinical presentation had significantly higher median CRP levels compared to those with non-severe cases [166.1 (IQR: 48.6–332.5) mg/L vs 2.4 (IQR: 1.2–7.6) mg/L; p<0.00001)]. Moreover, COVID-19 patients exhibited higher median CRP levels at baseline [58 (IQR: 2.0–127.8) mg/L] that decreased significantly to 2.4 (IQR: 1.4–3.9) mg/L after 40 days after symptom onset (p<0.0001). Performance of CRP levels determined using ROC analysis distinguished severe from non-severe COVID-19 patients, with an AUC value of 0.83 (95% CI: 0.73–0.91; p=0.001; 77.4% sensitivity and 89.4% specificity). In multivariable analysis, CRP levels above 30 mg/L were significantly associated with an increased risk of developing severe COVID-19 for those who have higher ages and comorbidities (ARR 3.99, 95% CI: 1.35–11.82; p=0.013).

Conclusion

CRP was found to be an independent determinant factor for severe COVID-19 patients. Therefore, CRP levels in COVID-19 patients in African settings may provide a simple, prompt, and inexpensive assessment of the severity status at baseline and monitoring of treatment outcomes.

Keywords:

• CRP
• COVID-19
• SARS-CoV-2
• biomarker

Data Sharing Statement

The data used to support the findings of this study are included in the article.

Ethics Approval and Consent to Participate

Participants enrolled provided written consent to participate in the Profile-CoV study. The study protocol was reviewed and approved by the Health Research Ethics Review Committee of Mekelle University College of Health Sciences (#ERC 1769/2020) and the Ethiopian Public Health Institute (#EPHI 6.13/814). The study did not use any personal patient information, and all data were kept confidential following the revised Declaration of Helsinki.

Acknowledgments

We would like to express our gratitude to the staff of the Quiha COVID-19 Isolation and Treatment Centre, Mekelle University College of Health Sciences and Clinical Chemistry Department, at Ethiopian Public Health Institute for their commitment to caring for the patients, and combatting COVID-19 in Ethiopia.

Disclosure

The authors have no competing interests to declare

Additional information

Funding

This research was supported by grants from the European and Developing Countries Clinical Trials Partnership (EDCTP), supported by the European Union (RIA-2020EF-2095) and Joep Lange Institute for Global Health and Development, The Netherlands.