Cell Rep Med . Inflammatory Biomarker Trends Predict Respiratory Decline in COVID-19 Patients

[tetano]

Cell Rep Med


. 2020 Oct 29;100144.
doi: 10.1016/j.xcrm.2020.100144. Online ahead of print.
Inflammatory Biomarker Trends Predict Respiratory Decline in COVID-19 Patients


Alisa A Mueller ^{1 2} , Tomoyoshi Tamura ^{2 3} , Conor P Crowley ³ , Jeremy R DeGrado ⁴ , Hibah Haider ³ , Julia L Jezmir ^{2 5} , Gregory Keras ¹ , Erin H Penn ^{1 2} , Anthony F Massaro ^{2 3} , Edy Y Kim ^{2 3}



Affiliations

• PMID: 33163981
• PMCID: PMC7598305
• DOI: 10.1016/j.xcrm.2020.100144

Abstract

In this single-center, retrospective cohort analysis of hospitalized coronavirus disease 2019 (COVID-19) patients, we investigate whether inflammatory biomarker levels predict respiratory decline in patients who initially present with stable disease. Examination of C-reactive protein (CRP) trends reveals that a rapid rise in CRP levels precedes respiratory deterioration and intubation, although CRP levels plateau in patients who remain stable. Increasing CRP during the first 48 h of hospitalization is a better predictor (with higher sensitivity) of respiratory decline than initial CRP levels or ROX indices (a physiological score of respiratory function). CRP, the proinflammatory cytokine interleukin-6 (IL-6), and physiological measures of hypoxemic respiratory failure are correlated, which suggests a mechanistic link. Our work shows that rising CRP predicts subsequent respiratory deterioration in COVID-19 and may suggest mechanistic insight and a potential role for targeted immunomodulation in a subset of patients early during hospitalization.

Keywords: COVID-19; CRP; D-dimer; IL-6; acute respiratory distress syndrome; cytokine storm; ferritin; inflammation; intensive care unit; intubation.