Lab Med Online.  2021 Apr;11(2):81-87. 10.47429/lmo.2021.11.2.81.

Utilization of C-Reactive Protein Test as a Predictor of Lung Injury in Patients with Coronavirus Disease 2019

• Yoo EH
• Kim SG
• Kim YH
• Kang UR
• Jung CY
• Kim KC
• Hong HL
• Kwak SG
• Jeon CH

• KMID: 2525786
• DOI: http://doi.org/10.47429/lmo.2021.11.2.81

Abstract

Background
C-reactive protein (CRP) test can be used at coronavirus disease 2019 (COVID-19) screening clinics as a point of care test. The aim of this study was to determine whether CRP test can be used as an indicator of lung injury.
Methods
In all, 98 patients with COVID-19 were enrolled for this study. We collected medical records and laboratory results of the patients. Chest radiographic findings were classified into five groups. We analyzed the correlation between laboratory tests and the grade of lung injury.
Results
In patients with COVID-19, increased CRP and erythrocyte sedimentation rate (ESR), and lymphocytopenia were noted. CRP , ESR, and segmented neutrophils were found to be positively correlated while albumin and lymphocyte were negatively correlated with lung injury grade. CRP levels showed the highest correlation coefficient of 0.858. Based on the chest radiographs, the sensitivity and specificity of CRP was 100% and 77.8%, respectively. Within the reference range of CRP , abnormal chest radiograph was not recognized. In addition, initial and subsequent increase in CRP levels in patients with unremarkable chest radiograph could be associated with aggravated lung injury.
Conclusions
CRP test showed a sensitivity of 100% in detection of lung injury, and the level was proportional to the extent of lung lesions.Therefore, CRP test will be useful as a predictor of lung injury in patients with COVID-19.

Keyword

Coronavirus disease 2019; C-reactive protein; Lung injury

Figure

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  Fig. 1 (A) Patchy consolidations in both upper lung fields (Grade 1). The lesion was improved, and the patient was discharged without sequelae 17 days later (CRP: 19.5 mg/L). (B) Patchy consolidations in the right lower lung and left middle and lower lung fields (Grade 2). The lesion was improved, and the patient was discharged without sequelae 1 month later (CRP: 44.7 mg/L). (C) Peripherally located consolidations in both lung fields (Grade 3). The patient was discharged without sequelae 1 month later (CRP: 120 mg/L). (D) Diffuse consolidations in both lung fields (Grade 4). The patient died of acute respiratory distress syndrome 10 days later despite aggressive antiviral therapy (CRP: 79.5 mg/L).

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  Fig. 2 Distribution of CRP levels according to the lung injury grade. Kruskal Wallis test was used for determining the significance of CRP levels according to the lung injury grade.

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  Fig. 3 Comparison of the serial CRP values between patients with unchanged (grade 0) and aggravated (grade 1-4) chest radiographic (CXR) findings monitored for 14 days.

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