The Effect of Acute Phase Reactants on the Survival of COVID-19 Patients in Intensive Care

Main Article Content

Semiha Orhan
Bilge Banu Tasdemir Mecit
Elif Dizen Kazan
Sinan Kazan
Petek Şarlak Konya
Kemal Yetiş Gulsoy


inflammatory, acute phase reactant, COVID-19, intensive care


Study Objectives: The aim of this study was to investigate the relationship between the biomarkers of serum CRP, PCT, D-dimer, ferritin, and lymphocytes, and the survival of COVID-19 patients admitted to the Intensive Care Unit (ICU). Methods: The effect of acute phase reactants on survival were retrospectively examined in 399 patients diagnosed with COVID-19 and followed up in the ICU of Afyonkarahisar Health Sciences University Medical Faculty Hospital between 20 March 2020 and 31 December 2020. Results: The 399 patients included in the study comprised 273 (68.4%) males and 126 (31.6%) females with a median age of 68 years (IQR: 15 years). Mortality developed in 225 (56.4%) patients in ICU and 174 (43.6%) were discharged. In the ROC analysis applied to CRP, PCT, D-dimer, ferritin levels, and lymphocyte count, the AUC values were determined in the range of 0.389-0.635. D-dimer was the parameter with the highest AUC value. In the survival analysis according to the cutoff values determined for CRP, PCT, D-dimer, and lymphocyte count, these four parameters were determined to have an effect on survival (p = 0.038, p = 0.001, p = 0.012, and p = 0.018, respectively). Ferritin levels were found to be similar between the groups of survivors and non-survivors (p = 0.492). Conclusion: High serum CRP, PCT, D-dimer levels, and low lymphocyte count were determined to be associated with poor outcomes in the 399 patients admitted to the ICU with a diagnosis of severe COVID-19 pneumonia.


Download data is not yet available.
Abstract 17 | PDF Downloads 14


1. Wan S, Yi Q, Fan S, Lv J, Zhang X, Guo L, et al. Characteristics of lymphocyte subsets and cytokines in peripheral blood of 123 hospitalized patients with 2019 novel corona virus pneumonia (NCP). medRxiv. 2020.
2. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel corona virus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; 395: 507–13. doi: 10.1016/S0140-6736(20)30211-7.
3. Xu Z, Shi L, Wang Y, Zhang J, Huang L, Zhang C, et al. Pathological findings of COVID‐19 associated with acute respiratory distress syndrome. Lancet Respir Med. 2020;8:420‐22. doi: 10.1016/S2213-2600(20)30076-X.
4. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223): 497‐506.
6. Cummings MJ, Baldwin MR, Abrams D, Jacobson SD, Meyer BJ, Balough EM, et al. Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study. Lancet (London, England). 2020;395(10239):1763-70. doi: 10.1016/S0140-6736(20)31189-2
7. Siddiqi HK, Mehra MR. COVID-19 illness in native and immunosuppressed states: a clinical therapeutic staging proposal. J Heart Lung Transplant 2020; 39 (5): 405–7 doi: 10.1016/j.healun.2020.03.012.
8. Pepys MB, Hirschfield GM, C-reactive protein: a critical update, J. Clin. Invest. 2013; 1805–12,
9. Mooiweer E, Luijk B, Bonten MJ, Ekkelenkamp MB. C-Reactive protein levels but not CRP dynamics predict mortality in patients with pneumococcal pneumonia, J. Infect. 62 (2011) 314–16,
10. Huang I, Pranata R, Lim MA, Oehadianand A, Alisjahban B. C-reactive protein, procalcitonin, D-dimer, andferritin in severe coronavirus disease-2019: a meta-analysis Ther Adv Respir Dis 2020, Vol. 14: 1–14. Doi.10.1177/1753466620937175
11. Liu F, Li L, Xu MD, Wu J, Luo D, Zhu YS et al. Prognostic value of interleukin-6, C-reactive protein, and procalcitonin in patients with COVID-19. J Clin Virol. 2020;127:104370. doi: 10.1016/j.jcv.2020.104370.
12. Li H, Xiang X, Ren H, Xu L, Zhao L, Chen X. et al. Serum amyloid A is a biomarker of severe corona virus disease and poor prognosis. J Infect 2020; 80: 646–55. doi: 10.1016/j.jinf.2020.03.035.
13. Sproston NR, Ashworth JJ. Role of C-reactive protein at sites of inflammation and infection. Front Immunol 2018; 9: 1–11. doi: 10.3389/fimmu.2018.00754
14. Saeed K, Dale AP, Leung E, Cusack T, Mohamed F, Lockyer G, et al., Procalcitonin levels predict infectious complications and response to treatment in patients undergoing cytoreductive surgery for peritoneal malignancy, Eur. J. Surg. Oncol. 2016;42, 234–43,
15. Schuetz P, Wirz Y, Sager R, Christ-Crain M, Stolz D, Tamm M et al. Effect of procalcitonin-guided antibiotic treatment on mortality in acute respiratory infections: a patient level meta-analysis. Lancet Infect Dis 2018; 18: 95–107. doi: 10.1016/S1473-3099(17)30592-3.
16. Lippi G, Favaloro EJ. D-dimer is associated with severity of corona virus disease 2019: a pooled analysis.Thromb Haemost. 2020;120(5):876-8. doi: 10.1055/s-0040-1709650
17. Zhang L, Yan X, Fan Q, Liu H, Liu X, Liu Z, et al. D-dimer levels on admission to predict in-hospital mortality in patients with Covid-19, J. Thromb Haemost. 2020;18(6):1324-29. doi: 10.1111/jth.14859.
18. Gao Y, Li T, Han M, Li X, Wu D. Xu Y et al. Diagnostic utility of clinical laboratory data determinations for patients with the severe COVID‐19. J MedVirol. 2020;92:791–6. doi: 10.1002/jmv.25770.
19. Ruan Q, Yang K, Wang W, Jiang L, Songet J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med. 2020;46(5):846–8. doi: 10.1007/s00134-020-05991-x.
20. Tan C, Huang Y, Shi F, Tan K, Ma Q, Chen Y, et al., C-reactive protein correlates with computed tomographic findings and predicts severe COVID-19 early. J MedVirol, 2020;92(7):856-62. doi: 10.1002/jmv.25871.
21. Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020;8(5):475–81. doi: 10.1016/S2213-2600(20)30079-5.