Predicting the course of a COVID-19 patient’s disease after hospital admission is essential to improving treatment.
In a new study, researchers analyzed patients’ levels of inflammation, known to be linked to the severity of illness, by looking at C-reactive protein (CRP) trends in 100 COVID-19 patients admitted to the hospital.
They found that a rapid rise in CRP levels during the first 48-to-72 hours of hospitalization was predictive of subsequent respiratory deterioration and intubation, while steadier CRP levels were observed in patients whose condition remained stable.
This means rapid changes in biomarkers of inflammation may be a key predictor of COVID-19 outcomes.
The research was conducted by a team at Brigham and Women’s Hospital.
Inflammation is a broad term that describes the release of chemicals involved in immune responses.
CRP tests integrate signals from a number of different proteins involved in inflammation, called cytokines, to provide physicians with a snapshot of a patient’s inflammatory activity within a matter of hours.
Other tests, like cytokine assays, can provide more specific information about which proteins may be active in inflammatory pathways, but these tests can take one to two days to process, and COVID-19 patients’ conditions can worsen before the results are received.
CRP tests can therefore serve as practical addition to standard protocols for assessing the anticipated clinical trajectories of COVID-19 patients.
The results, from a study population of 100 Brigham patients, also provide insight into the underlying mechanisms at play in COVID-19 infections.
In particular, an increase in a cytokine called IL-6 during the first 24-48 hours was correlated to CRP levels and the progression of the disease.
Fifteen patients treated during this acute period with the drug tocilizumab, an IL-6 receptor, had rapid, sustained reductions in their CRP levels.
In larger, randomized trials, tocilizumab was not shown to provide benefits to COVID-19 patients, but Kim states that this could be because the drug was not administered early enough to the subset of patients who stand to benefit most.
Alternatively, while CRP is linked to IL-6, CRP can reflect other inflammatory pathways besides IL-6, so targeting other inflammatory cytokines or pathways besides IL-6 could be considered.
Ultimately, the team hopes that the findings will help front-line workers better understand the volatility of COVID-19 patients’ conditions.
One author of the study is Edy Yong Kim, MD, Ph.D., of the Division of Pulmonary and Critical Care Medicine at the Brigham.
The study is published in Cell Reports Medicine.
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