The Association of C-Reactive Protein and Ferritin Levels with the Severity of COVID-19 in Ajman, UAE

Khulood Ghanim Obaid, Salah Eldin Omar Hussein, Ahmed L. Osman, Noha Kamal Abdmomen, Marwan Ismail, Praveen Kumar Kandakurti, Abdelgadir Alamin Altoum

 
International Journal of Biomedicine. 2022;12(2):237-241.
DOI: 10.21103/Article12(2)_OA6
Originally published June 5, 2022

Abstract: 

Background: SARS-Cov-2, a new strain of coronavirus first identified in Wuhan city, China, has spread worldwide, causing severe illnesses and a high mortality rate. Many studies have shown the association of elevated levels of pro-inflammatory markers, such as ferritin and C-reactive protein (CRP), with the severe course of coronavirus disease The aim of this research was to investigate the association between CRP and ferritin levels, and the severity of COVID-19.
Methods and Results: This cross-sectional study was performed in Thumbay Hospital, Ajman, United Arab Emirates, from January 2021 to October 2021. A total of 100 COVID-19 positive patients were included in this study. Serum CRP and ferritin were measured by immunoturbidimetric assay. We found statistically significant differences between ferritin levels and disease severity (P=0.005), age category (P=0.030), and the clinical wards (P=0.016). Statistically significant differences were found between the ferritin levels in mild to moderate cases (P=0.023) and mild to severe cases (P=0.007). There were significant differences in CRP in mild to moderate cases (P=0.012), and in mild to severe cases (P=0.000). Thus, the results obtained showed that CRP and ferritin levels are considerably greater in severe cases than in mild and moderate cases of COVID-19. The findings of the current study indicate that CRP and serum ferritin levels might be considered as an essential indication of the progression and severity of COVID-19.

Keywords: 
SARS-Cov-2 • C-reactive protein • ferritin
References: 
  1. UAE. Ministry of Health and Prevention. Covid-19. Available from:  https://mohap.gov.ae/en/covid-19
  2. Ludwig S, Zarbock A. Coronaviruses and SARS-CoV-2: A Brief Overview. Anesth Analg. 2020 Jul;131(1):93-96. doi: 10.1213/ANE.0000000000004845. 
  3. Wu YC, Chen CS, Chan YJ. The outbreak of COVID-19: An overview. J Chin Med Assoc. 2020 Mar;83(3):217-220. doi: 10.1097/JCMA.0000000000000270. 
  4. Gao Z, Xu Y, Sun C, Wang X, Guo Y, Qiu S, Ma K. A systematic review of asymptomatic infections with COVID-19. J Microbiol Immunol Infect. 2021 Feb;54(1):12-16. doi: 10.1016/j.jmii.2020.05.001.
  5. Cheng L, Li H, Li L, Liu C, Yan S, Chen H, Li Y. Ferritin in the coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis. J Clin Lab Anal. 2020 Oct;34(10):e23618. doi: 10.1002/jcla.23618.
  6. Huang I, Pranata R, Lim MA, Oehadian A, Alisjahbana B. C-reactive protein, procalcitonin, D-dimer, and ferritin in severe coronavirus disease-2019: a meta-analysis. Ther Adv Respir Dis. 2020 Jan-Dec;14:1753466620937175. doi: 10.1177/1753466620937175. 
  7. Zhou C, Chen Y, Ji Y, He X, Xue D. Increased Serum Levels of Hepcidin and Ferritin Are Associated with Severity of COVID-19. Med Sci Monit. 2020 Sep 26;26:e926178. doi: 10.12659/MSM.926178. 
  8. Feld J, Tremblay D, Thibaud S, Kessler A, Naymagon L. Ferritin levels in patients with COVID-19: A poor predictor of mortality and hemophagocytic lymphohistiocytosis. Int J Lab Hematol. 2020 Dec;42(6):773-779. doi: 10.1111/ijlh.13309. 
  9. Liu T, Zhang J, Yang Y, Ma H, Li Z, Zhang J, Cheng J, Zhang X, Zhao Y, Xia Z, Zhang L, Wu G, Yi J. The role of interleukin-6 in monitoring severe case of coronavirus disease 2019. EMBO Mol Med. 2020 Jul 7;12(7):e12421. doi: 10.15252/emmm.202012421. 
  10. Ciaccio M, Agnello L. Biochemical biomarkers alterations in Coronavirus Disease 2019 (COVID-19). Diagnosis (Berl). 2020 Nov 18;7(4):365-372. doi: 10.1515/dx-2020-0057. 
  11. Smilowitz NR, Kunichoff D, Garshick M, Shah B, Pillinger M, Hochman JS, Berger JS. C-reactive protein and clinical outcomes in patients with COVID-19. Eur Heart J. 2021 Jun 14;42(23):2270-2279. doi: 10.1093/eurheartj/ehaa1103. 
  12. Pepys MB. C-reactive protein predicts outcome in COVID-19: is it also a therapeutic target? Eur Heart J. 2021 Jun 14;42(23):2280-2283. doi: 10.1093/eurheartj/ehab169. 
  13. Deng F, Zhang L, Lyu L, Lu Z, Gao D, Ma X, Guo Y, Wang R, Gong S, Jiang W. Increased levels of ferritin on admission predicts intensive care unit mortality in patients with COVID-19. Med Clin (Barc). 2021 Apr 9;156(7):324-331. doi: 10.1016/j.medcli.2020.11.030. 
  14. Henry BM, de Oliveira MHS, Benoit S, Plebani M, Lippi G. Hematologic, biochemical and immune biomarker abnormalities associated with severe illness and mortality in coronavirus disease 2019 (COVID-19): a meta-analysis. Clin Chem Lab Med. 2020 Jun 25;58(7):1021-1028. doi: 10.1515/cclm-2020-0369. 
  15. Chen G, Wu D, Guo W, Cao Y, Huang D, Wang H, Wang T, Zhang X, Chen H, Yu H, Zhang X, Zhang M, Wu S, Song J, Chen T, Han M, Li S, Luo X, Zhao J, Ning Q. Clinical and immunological features of severe and moderate coronavirus disease 2019. J Clin Invest. 2020 May 1;130(5):2620-2629. doi: 10.1172/JCI137244.
  16. Giamarellos-Bourboulis EJ, Netea MG, Rovina N, Akinosoglou K, Antoniadou A, Antonakos N, et al. Complex Immune Dysregulation in COVID-19 Patients with Severe Respiratory Failure. Cell Host Microbe. 2020 Jun 10;27(6):992-1000.e3. doi: 10.1016/j.chom.2020.04.009. 
  17. Li Y, Hu Y, Yu J, Ma T. Retrospective analysis of laboratory testing in 54 patients with severe- or critical-type 2019 novel coronavirus pneumonia. Lab Invest. 2020 Jun;100(6):794-800. doi: 10.1038/s41374-020-0431-6.
  18. Ruan Q, Yang K, Wang W, Jiang L, Song 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 May;46(5):846-848. doi: 10.1007/s00134-020-05991-x. 
  19. Sun L, Shen L, Fan J, Gu F, Hu M, An Y, Zhou Q, Fan H, Bi J. Clinical features of patients with coronavirus disease 2019 from a designated hospital in Beijing, China. J Med Virol. 2020 Oct;92(10):2055-2066. doi: 10.1002/jmv.25966. 
  20. Wang F, Hou H, Luo Y, Tang G, Wu S, Huang M, Liu W, Zhu Y, Lin Q, Mao L, Fang M, Zhang H, Sun Z. The laboratory tests and host immunity of COVID-19 patients with different severity of illness. JCI Insight. 2020 May 21;5(10):e137799. doi: 10.1172/jci.insight.137799. 
  21. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, Xiang J, Wang Y, Song B, Gu X, Guan L, Wei Y, Li H, Wu X, Xu J, Tu S, Zhang Y, Chen H, Cao B. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020 Mar 28;395(10229):1054-1062. doi: 10.1016/S0140-6736(20)30566-3. Epub 2020 Mar 11. Erratum in: Lancet. 2020 Mar 28;395(10229):1038. Erratum in: Lancet. 2020 Mar 28;395(10229):1038. 

Download Article
Received March 23, 2022.
Accepted April 30, 2022.
©2022 International Medical Research and Development Corporation.