Dominic Stringer1, Philip Braude2, Phyo K Myint3, Louis Evans4, Jemima T Collins5, Alessia Verduri6, Terry J Quinn7, Arturo Vilches-Moraga8, Michael J Stechman9, Lyndsay Pearce10, Susan Moug11, Kathryn McCarthy12, Jonathan Hewitt13, Ben Carter1. 1. Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK. 2. North Bristol NHS Trust, UK. 3. Institute of Applied Health Sciences, University of Aberdeen. 4. Ysbyty Gwynedd, Bangor. 5. Ysbyty Ystrad Fawr, Aneurin Bevan University Health Board. 6. Hospital of Modena Policlinico, Italy. 7. Institute of Cardiovascular and Medical Sciences, University of Glasgow. 8. Department of Ageing and Complex Medicine, Salford Royal NHS Foundation Trust, Salford, University of Manchester, Manchester, UK. 9. Department of Surgery, University Hospital of Wales, Cardiff, UK. 10. Department of Colorectal Surgery, Salford Royal NHS Foundation Trust, Manchester, UK. 11. Department of Surgery, Royal Alexandra Hospital, Paisley, UK. 12. Department of Surgery, North Bristol NHS Trust, Bristol, UK. 13. Cardiff University and Aneurin Bevan University Health Board.
Abstract
BACKGROUND: C-reactive protein (CRP) is a non-specific acute phase reactant elevated in infection or inflammation. Higher levels indicate more severe infection and have been used as an indicator of COVID-19 disease severity. However, the evidence for CRP as a prognostic marker is yet to be determined. The aim of this study is to examine the CRP response in patients hospitalized with COVID-19 and to determine the utility of CRP on admission for predicting inpatient mortality. METHODS: Data were collected between 27 February and 10 June 2020, incorporating two cohorts: the COPE (COVID-19 in Older People) study of 1564 adult patients with a diagnosis of COVID-19 admitted to 11 hospital sites (test cohort) and a later validation cohort of 271 patients. Admission CRP was investigated, and finite mixture models were fit to assess the likely underlying distribution. Further, different prognostic thresholds of CRP were analysed in a time-to-mortality Cox regression to determine a cut-off. Bootstrapping was used to compare model performance [Harrell's C statistic and Akaike information criterion (AIC)]. RESULTS: The test and validation cohort distribution of CRP was not affected by age, and mixture models indicated a bimodal distribution. A threshold cut-off of CRP ≥40 mg/L performed well to predict mortality (and performed similarly to treating CRP as a linear variable). CONCLUSIONS: The distributional characteristics of CRP indicated an optimal cut-off of ≥40 mg/L was associated with mortality. This threshold may assist clinicians in using CRP as an early trigger for enhanced observation, treatment decisions and advanced care planning.
BACKGROUND:C-reactive protein (CRP) is a non-specific acute phase reactant elevated ininfection or inflammation. Higher levels indicate more severe infection and have been used as an indicator of COVID-19 disease severity. However, the evidence for CRP as a prognostic marker is yet to be determined. The aim of this study is to examine the CRP response in patients hospitalized with COVID-19 and to determine the utility of CRP on admission for predicting inpatient mortality. METHODS: Data were collected between 27 February and 10 June 2020, incorporating two cohorts: the COPE (COVID-19 in Older People) study of 1564 adult patients with a diagnosis of COVID-19 admitted to 11 hospital sites (test cohort) and a later validation cohort of 271 patients. Admission CRP was investigated, and finite mixture models were fit to assess the likely underlying distribution. Further, different prognostic thresholds of CRP were analysed in a time-to-mortality Cox regression to determine a cut-off. Bootstrapping was used to compare model performance [Harrell's C statistic and Akaike information criterion (AIC)]. RESULTS: The test and validation cohort distribution of CRP was not affected by age, and mixture models indicated a bimodal distribution. A threshold cut-off of CRP ≥40 mg/L performed well to predict mortality (and performed similarly to treating CRP as a linear variable). CONCLUSIONS: The distributional characteristics of CRP indicated an optimal cut-off of ≥40 mg/L was associated with mortality. This threshold may assist clinicians in using CRP as an early trigger for enhanced observation, treatment decisions and advanced care planning.
Authors: Colin J Crooks; Joe West; Joanne R Morling; Mark Simmonds; Irene Juurlink; Steve Briggs; Simon Cruickshank; Susan Hammond-Pears; Dominick Shaw; Timothy R Card; Andrew Fogarty Journal: Clin Med (Lond) Date: 2022-05 Impact factor: 5.410
Authors: Isinta M Elijah; Endawoke Amsalu; Xuening Jian; Mingyang Cao; Eric K Mibei; Danvas O Kerosi; Francis G Mwatsahu; Wei Wang; Faith Onyangore; Youxin Wang Journal: Biosaf Health Date: 2022-06-27
Authors: Eilidh Bruce; Ben Carter; Terence J Quinn; Alessia Verduri; Oliver Pearson; Arturo Vilches-Moraga; Angeline Price; Aine McGovern; Louis Evans; Kathryn McCarthy; Jonathan Hewitt; Susan Moug; Phyo K Myint Journal: Eur J Public Health Date: 2022-02-01 Impact factor: 3.367