C-reactive protein and clinical outcomes in patients with COVID-19.
C-reactive protein and clinical outcomes in patients with COVID-19.
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DOI：
10.1093/eurheartj/ehaa1103
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发表时间：
2021-06-14
影响因子：
39.3
通讯作者：
Berger JS
中科院分区：
文献类型：
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作者：
Smilowitz NR;Kunichoff D;Garshick M;Shah B;Pillinger M;Hochman JS;Berger JS
在2019冠状病毒病（COVID-19）中观察到全身炎症反应。血清C反应蛋白（CRP）水平升高，是全身炎症的标志物，与细菌或病毒感染中的严重疾病相关。我们的目的是探索COVID-19患者首次入院时的CRP浓度与临床结局之间的相关性。确定了2020年3月1日至4月8日期间在纽约一家大型医疗保健系统住院的年龄≥18岁的COVID-19感染成年人。纳入了测量CRP的患者。对所有患者的静脉血栓栓塞（VTE）、急性肾损伤（阿基）、危重病和住院死亡率进行了测定。在2782名因COVID-19住院的患者中，2601名（93.5%）有CRP测量值[中位数108 mg/L，四分位数间距（IQR）53-169]。CRP浓度高于中位数与VTE [8.3% vs. 3.4%;校正比值比（aOR）2.33，95%置信区间（CI）1.61-3.36]、阿基相关（43.0% vs. 28.4%; aOR 2.11，95% CI 1.76-2.52），危重病（47.6% vs. 25.9%; aOR 2.83，95% CI 2.37-3.37）和死亡率（32.2% vs. 17.8%; aOR 2.59，95% CI 2.11-3.18），与CRP低于中位数相比。CRP浓度与不良结局之间存在剂量反应。虽然CRP和不良结局之间的相关性在低和高D-二聚体水平的患者中是一致的，但高D-二聚体和高CRP的患者发生不良结局的风险最大。通过CRP测量的全身性炎症与COVID-19中的VTE、阿基、危重病和死亡率密切相关。应测试基于CRP的风险分层和治疗方法。
A systemic inflammatory response is observed in coronavirus disease 2019 (COVID-19). Elevated serum levels of C-reactive protein (CRP), a marker of systemic inflammation, are associated with severe disease in bacterial or viral infections. We aimed to explore associations between CRP concentration at initial hospital presentation and clinical outcomes in patients with COVID-19. Consecutive adults aged ≥18 years with COVID-19 admitted to a large New York healthcare system between 1 March and 8 April 2020 were identified. Patients with measurement of CRP were included. Venous thrombo-embolism (VTE), acute kidney injury (AKI), critical illness, and in-hospital mortality were determined for all patients. Among 2782 patients hospitalized with COVID-19, 2601 (93.5%) had a CRP measurement [median 108 mg/L, interquartile range (IQR) 53–169]. CRP concentrations above the median value were associated with VTE [8.3% vs. 3.4%; adjusted odds ratio (aOR) 2.33, 95% confidence interval (CI) 1.61–3.36], AKI (43.0% vs. 28.4%; aOR 2.11, 95% CI 1.76–2.52), critical illness (47.6% vs. 25.9%; aOR 2.83, 95% CI 2.37–3.37), and mortality (32.2% vs. 17.8%; aOR 2.59, 95% CI 2.11–3.18), compared with CRP below the median. A dose response was observed between CRP concentration and adverse outcomes. While the associations between CRP and adverse outcomes were consistent among patients with low and high D-dimer levels, patients with high D-dimer and high CRP have the greatest risk of adverse outcomes. Systemic inflammation, as measured by CRP, is strongly associated with VTE, AKI, critical illness, and mortality in COVID-19. CRP-based approaches to risk stratification and treatment should be tested.