Serum C-reactive protein greater than 75 mg/dL as an early available laboratory predictor of severe COVID-19: A systematic review

INTRODUCTION

Severe COVID-19 management is still challenging. Having a laboratory factor to predict the severity of a patient's condition can be very useful in how to approach each patient. There have been studies concentrating on the correlation between serum C-reactive protein (CRP) level and COVID-19 severity but we aim to reach a threshold for CRP in disease severity determination.

METHODS

We conducted a thorough search on PubMed, Web of Science and Google Scholar databases from early 2019 to October 2021, and 323 studies were assessed for eligibility in three phases. We used the Newcastle-Ottawa Scale to examine the validity of the studies. The t-test was applied for the CRP level cutoffs.

RESULTS

Eventually, 11 articles and 1615 patients were included in this systematic review. Our analysis evaluated combined mean, median, and standard deviation of severe patients' CRP to be respectively 73.37, 53.80, and 47.936. Based on the combined mean, 75 mg/dL was suggested as an initial threshold for baseline CRP in hospitalized patients for developing severe conditions.

CONCLUSION

This study recommends that COVID-19 patients with on-admission serum CRP levels of 75 mg/dL and more are likely associated with severe conditions. Thus, anti-inflammatory agents and further following may be helpful in these patients.

Severity of SARS-CoV-2 reinfection in vaccinated healthcare workers

Background and Objectives

The most appropriate approach to control the SARS-CoV-2 epidemic is the widespread adoption of vaccination. Several vaccines against SARS-CoV-2 have been developed and authorized for use in various geographical regions. The aim of this study is to evaluate the efficacy of the vaccination agents presently utilized by healthcare workers (HCWs), and to investigate whether different COVID-19 vaccines would result in the alleviation of symptoms and the severity of clinical presentation.

Materials and Methods

This multi-center survey was conducted on 329 vaccinated HCWs who were reinfected with COVID-19 between January 8, 2021 and April 8, 2021, in Tehran, Iran.

Results

Overall, 92.1% and 70.8% of the participants had received 2 and 3 cumulative doses of COVID-19 vaccines, respectively. There were no differences between first/second and third-dose vaccines with the severity of SARS-CoV-2 infection. Expectedly, vaccination resulted in a less severe clinical presentation of SARS-CoV-2 infection, as reported by the participants.

Conclusion

The results suggest that the efficacy of the vaccination agents presently utilized by HCWs was acceptable with no significant difference in vaccine type. Participants receiving at least two doses of vaccines in this survey exceeded 90%, which is comparably higher than studies conducted in other countries.

Importance of pre-operative COVID-19 screening test in elective surgeries

Background and Objectives: Since the COVID-19 pandemic initiation, more than 28 million elective surgeries were post-poned with a cancellation rate of 72.3%. However, studies suggested that the patient treatment should be conducted within12 weeks of diagnosis because delay in treatment might have had adverse impacts on patients' health status, prognosis, and pathologic stage. Hence, the current study aimed to assess the importance of a pre-operative COVID-19 screening test for the patients were candidates for elective surgery. Materials and Methods: This cross-sectional study was conducted on 141 patients who were candidates for any type of elective surgeries or cesarean section at a tertiary university-based hospital, between June 2020, and September 2020. Results: The mean age of participants was 41.38 ± 11.66 years. Of them, 91.5% were women and 8.5% were men. The COVID-19 polymerase chain reaction (PCR) screening tests were positive in 12 (8.5%) patients. From whose PCR tests were positive, only five people (less than half) had symptoms of COVID-19 such as fever (three patients), a distinctive smell (two patients), and cough (one patient). Suspected exposure to COVID-19 was reported in four of them. Conclusion: In this study, we found that more than half of PCR positive COVID-19 patients were asymptomatic. Therefore, to have a safe hospital environment, and improve patient health outcomes, the COVID-19 screening test should be applied before any interventions.

COVID-19, An early investigation from exposure to treatment outcomes in Tehran, Iran

BACKGROUND

There is a growing need for information regarding the recent coronavirus disease of 2019 (COVID-19). We present a comprehensive report of COVID-19 patients in Iran.

MATERIALS AND METHODS

One hundred hospitalized patients with COVID-19 were studied. Data on potential source of exposure, demographic, clinical, and paraclinical features, therapy outcome, and postdischarge follow-up were analyzed.

RESULTS

The median age of the patients was 58 years, and the majority of the patients (72.7%) were above 50 years of age. Fever was present in 45.2% of the patients on admission. The most common clinical symptoms were shortness of breath (74%) and cough (68%). Most patients had elevated C-reactive protein (92.3%), elevated erythrocyte sedimentation rate (82.9%), and lymphocytopenia (74.2%) on admission. Lower lobes of the lung were most commonly involved, and ground-glass opacity (81.8%) was the most frequent finding in computed tomography scans. The administration of hydroxychloroquine improved the clinical outcome of the patients. Lopinavir/ritonavir was efficacious at younger ages. Of the 70 discharged patients, 40% had symptom aggravation, 8.6% were readmitted to the hospital, and three patients (4.3%) died.

CONCLUSION

This report demonstrates a heterogeneous nature of clinical manifestations in patients affected with COVID19. The most common presenting symptoms are nonspecific, so attention should be made on broader testing, especially in age groups with the greatest risk and younger individuals who can serve as carriers of the disease. Hydroxychloroquine and lopinavir/ritonavir (in younger age group) can be potential treatment options. Finally, patients discharged from the hospital should be followed up because of potential symptom aggravation.