Association of C-reactive Protein with Disease Severity and Clinical Outcomes in Hospitalized Patients with COVID-19: A Multicentre study from Lahore, Pakistan

Abstract

Background: C-reactive protein (CRP) is an acute-phase inflammatory biomarker that has been associated with disease severity and adverse outcomes in patients with COVID-19. Early identification of patients at higher clinical risk is particularly important in resource-limited healthcare settings. Objective: To assess the association of CRP levels with disease severity, ICU admission, ventilatory support, and in-hospital mortality among patients with PCRconfirmed COVID-19 in three public-sector tertiary care hospitals in Lahore, Pakistan. Methodology: This retrospective multicenter study was conducted at Fatima Memorial Hospital, Jinnah Hospital, and Sir Ganga Ram Hospital, Lahore from April 1 to July 31, 2020. The final analytical sample comprised 635 patients with PCRconfirmed COVID-19. Demographic characteristics, comorbidities, CRP levels, disease severity, ICU admission, ventilatory support, and in-hospital outcomes were analyzed using SPSS version 24.0. Consecutive sampling was used. Results: Of 635 patients, 145 (22.8%) had moderate disease and 490 (77.2%) had severe disease. Median CRP was higher in the severe group than in the moderate group (180 vs 58 mg/L). ICU admission occurred in 522 patients (82.2%). In-hospital mortality was 31.5% (200/635); 191 of 200 patients who died (95.5%) had severe disease, with a median CRP of 210 mg/L (IQR 170–280 mg/L). Conclusion: Higher CRP levels were associated with severe disease and in-hospital mortality in this cohort. Because the study did not evaluate adjusted prognostic performance, receiver operating characteristic curve/area under curve, sensitivity, or specificity, interpret these findings should be interpreted as associations rather than evidence of independent predictive validity.