Rapid rise in CRP levels predicts COVID-19 results

Review by Emily Henderson, Bachelor of ScienceNovember 6, 2020

Predicting the course of illness in COVID-19 patients after admission is essential for improving treatment. Researchers at Brigham and Women’s Hospital are known to be associated with disease severity by examining C-reactive protein (CRP) trends in 100 COVID-19 patients admitted to the hospital. The level of inflammation in the patient was analyzed.

They predict that CRP levels rise sharply during the first 48-72 hours of hospitalization, followed by respiratory deterioration and intubation, while more stable CRP levels are found in patients with stable conditions. I found it to be observed.The survey results have been published at Cell Reports Medicine..

Single CRP lab values ​​from admission have not been very practical in predicting who will get sick, but tracking the rate of change from day 1 to day 2 or 3 is It turned out to be a very powerful and very clinically predictable test. All of these patients appeared to be clinically similar at admission, but as early as 24 hours after admission, measured with these biomarkers, the immune system of patients entering the ICU a few days later was I was already inflamed. “

Edy Yong Kim, MD, PhD, Research Author, Lung and Emergency Medicine, Brigham and Women’s Hospital

Inflammation is a broad term for the release of chemicals involved in the immune response. The CRP test integrates signals from various proteins involved in inflammation called cytokines and provides doctors with a snapshot of the patient’s inflammatory activity within hours.

Other tests, such as cytokine assays, can provide more specific information about which proteins are active in the inflammatory pathway, but these tests can take 1-2 days to process and COVID- 19 The patient’s condition can worsen before receiving the results. Therefore, the CRP test serves as a practical addition to the standard protocol for assessing the expected clinical trajectory of COVID-19 patients.

“Our findings have changed Brigham’s guidelines to require daily CRP tracking for the first three days of hospitalization, allowing vulnerable patients to be identified and carefully monitored for inflammation,” Kim emphasized. Says. With the current increase in positive cases, the importance of putting the findings into practice as soon as possible.

Results from a study population of 100 Brigham patients also provide insight into the underlying mechanisms of COVID-19 infection. In particular, an increase in a cytokine called IL-6 during the first 24-48 hours correlated with CRP levels and disease progression.

Fifteen patients treated with the IL-6 receptor tocilizumab during this acute phase had rapidly and persistently decreased CRP levels. Large-scale randomized trials have not shown that tocilizumab benefits patients with COVID-19, but Kim did not administer the drug early enough to a subset of the most profitable patients. It states that it may be due to the fact.

Alternatively, CRP is associated with IL-6, but CRP may reflect other inflammatory pathways other than IL-6, thus targeting other inflammatory cytokines or pathways other than IL-6. You can consider that.

“Even if you administer an immunomodulator that suppresses the rise in inflammation, it may already be too late for clinical trials, as early as the third day,” Kim said.

“But here there is some evidence that increased inflammation directly causes respiratory failure. This is because immunomodulators were given very early, that is, on the first and second days of the hospital. This means that if you have the potential to prevent respiratory failure. “

Ultimately, Kim hopes that the findings will help frontline workers better understand the variability of the condition of COVID-19 patients. “The clinical instincts of doctors and nurses on COVID-19 are not fully developed because the disease is still so new,” Kim said.

“But when I showed these results to Brigham’s front-line doctors and nurses, they felt they were in line with what they intuitively saw in the spring. The reality of what they are doing in the lab. I’m always happy to hear that it reflects what’s happening in the world. Too. “