Correlation between C-Reactive Protein (CRP) and lymphocyte levels in the acute phase with spirometry test in severe Coronavirus Disease 2019 (COVID-19) survivors after twelve weeks

Agustina Dwiningtyas; Ida Bagus Ngurah Rai; Ketut Suryana; I Gede Ketut Sajinadiyasa; Ida Ayu Jasminarti; Ni Wayan Candrawati; Eka Arisanti

doi:10.53730/ijhs.v6nS9.12742

Authors

Agustina Dwiningtyas
agustina.dwiningtyas@yahoo.com
Department of Pulmonology and Respiratory, Faculty of Medicine, Udayana University, Sanglah Central General Hospital Denpasar, Bali, Indonesia, 80114
Ida Bagus Ngurah Rai Department of Pulmonology and Respiratory, Faculty of Medicine, Udayana University, Sanglah Central General Hospital Denpasar, Bali, Indonesia, 80114
Ketut Suryana Department of Pulmonology and Respiratory, Faculty of Medicine, Udayana University, Sanglah Central General Hospital Denpasar, Bali, Indonesia, 80114
I Gede Ketut Sajinadiyasa Department of Pulmonology and Respiratory, Faculty of Medicine, Udayana University, Sanglah Central General Hospital Denpasar, Bali, Indonesia, 80114
Ida Ayu Jasminarti Department of Pulmonology and Respiratory, Faculty of Medicine, Udayana University, Sanglah Central General Hospital Denpasar, Bali, Indonesia, 80114
Ni Wayan Candrawati Department of Pulmonology and Respiratory, Faculty of Medicine, Udayana University, Sanglah Central General Hospital Denpasar, Bali, Indonesia, 80114
Eka Arisanti Department of Pulmonology and Respiratory, Faculty of Medicine, Udayana University, Sanglah Central General Hospital Denpasar, Bali, Indonesia, 80114

Keywords:

COVID-19, CRP, Lymphocyte, FVC, FEV1/FVC, FEF25-75

Abstract

---The examination of pulmonary functions after COVID-19 exposure is still limited, thus making it difficult for clinicians to determine the patient's evaluation steps after confirmed COVID-19. This study aims to identify the relationship between inflammatory parameters, consisting of CRP and lymphocyte levels during the acute phase with FVC, FEV1/FVC, and FEF25-75 values in severe COVID-19 survivors after twelve weeks. This study of observational analytics uses a cross-sectional study design conducted on COVID-19 survivors. Data analysis used the S.P.S.S. program. The bivariate analysis showed that there was a significant relationship between CRP levels and FVC values (p=0,028; PR=2,82) and there was no significant relationship between CRP and FEV1/FVC values (p=1,905; PR=2,53) and FEF 25-75 (p=0,436;PR=1,45), there was no lymphocyte association with FEV1/FVC (p=0.670;PR=1.33), FVC (p=0,323;PR=1,56), and FEF 25-75 (p=0,207; PR=1,83). The results of the multivariate test found that CRP levels (p=0,036; PR=2,95), age >65 years (p=0,028;PR=4.16), history of DM (p=0,004;PR=10,47) are correlate with FVC ≤ 80%. History of DM is a predictor that correlate to FEV1/FVC ≤75% (p=0,004;PR=10,47). CRP levels are a parameter significantly related to FVC values, while lymphocytes are not related to spirometry tests on severe COVID-19 survivors after twelve weeks.

Downloads

Download data is not yet available.

References

Abul, Abbas., Andrew, Lichtman., S.P. (2020) Basic Immunology: Functions And Disorders Of The Immune System, Sixth Edition.

Ahmed, H., Patel, K., Greenwood, D.C., Halpin, S., Lewthwaite, P., Salawu, A., Eyre, L., Breen, A., O'Connor, R., Jones, A. and Sivan, M. (2020) 'Long-term clinical outcomes in survivors of severe acute respiratory syndrome and Middle East respiratory syndrome coronavirus outbreaks after hospitalization or I.C.U. Admission: A systematic review and meta-analysis, Journal of rehabilitation medicine, 52(5). Available at: https://doi.org/10.2340/16501977-2694.

Ali, N. (2020) ‘Elevated level of C‐reactive protein may be an early marker to predict risk for severity of COVID‐19’, Journal of Medical Virology, 92(11), p. 2409. Available at: https://doi.org/10.1002/JMV.26097.

Alqahtani, F.Y., Aleanizy, F.S., Mohamed, R.A.E.H., Al-Maflehi, N., Alrfaei, B.M., Almangour, T.A., Alkhudair, N., Bawazeer, G., Shamlan, G. and Alanazi, M.S. (2022) ‘Association Between Obesity and COVID-19 Disease Severity in Saudi Population’, Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 15, pp. 1527–1535. Available at: https://doi.org/10.2147/DMSO.S365491.

Bazdyrev, E., Rusina, P., Panova, M., Novikov, F., Grishagin, I. and Nebolsin, V. (2021) ‘Lung fibrosis after covid-19: Treatment prospects’, Pharmaceuticals, 14(8), pp. 1–15. Available at: https://doi.org/10.3390/ph14080807.

Le Bert, N., Tan, A.T., Kunasegaran, K., Tham, C.Y.L., Hafezi, M., Chia, A., Chng, M.H.Y., Lin, M., Tan, N., Linster, M., Chia, W.N., Chen, M.I.C., Wang, L.F., Ooi, E.E., Kalimuddin, S., Tambyah, P.A., Low, J.G.H., Tan, Y.J. and Bertoletti, A. (2020) ‘SARS-CoV-2-specific T cell immunity in cases of COVID-19 and SARS, and uninfected controls’, Nature, 584(7821), pp. 457–462. Available at: https://doi.org/10.1038/s41586-020-2550-z.

Brake, S.J., Barnsley, K., Lu, W., McAlinden, K.D., Eapen, M.S. and Sohal, S.S. (2020) ‘Smoking Upregulates Angiotensin-Converting Enzyme-2 Receptor: A Potential Adhesion Site for Novel Coronavirus SARS-CoV-2 (Covid-19)’, Journal of clinical medicine, 9(3). Available at: https://doi.org/10.3390/JCM9030841.

Caballero, A.E., Ceriello, A., Misra, A., Aschner, P., McDonnell, M.E., Hassanein, M., Ji, L., Mbanya, J.C. and Fonseca, V.A. (2020) ‘COVID-19 in people living with diabetes: An international consensus’, Journal of Diabetes and Its Complications, 34(9), p. 107671. Available at: https://doi.org/10.1016/J.JDIACOMP.2020.107671.

Coates, A.L., Graham, B.L., McFadden, R.G., McParland, C., Moosa, D., Provencher, S. and Road, J. (2013) 'Spirometry in primary care, Canadian Respiratory Journal, 20(1), pp. 13–22. Available at: https://doi.org/10.1155/2013/615281.

Dennis, A., Wamil, M., Alberts, J., Oben, J., Cuthbertson, D.J., Wootton, D., Crooks, M., Gabbay, M., Brady, M., Hishmeh, L., Attree, E., Heightman, M., Banerjee, R. and Banerjee, A. (2021) 'Multiorgan impairment in low-risk individuals with post-COVID-19 syndrome: A prospective, community-based study, B.M.J. Open, 11(3), pp. 2–7. Available at: https://doi.org/10.1136/bmjopen-2020-048391.

Ding, T., Zhang, J., Wang, T., Cui, P., Chen, Z., Jiang, J. (2020) ‘A Multi-hospital Study in Wuhan, China: Protective Effects of Non-menopause and Female Hormones on SARS-CoV-2 infection’, medRxiv, p. 2020.03.26.20043943. Available at: https://doi.org/10.1101/2020.03.26.20043943.

Guler, S.A., Ebner, L., Aubry-Beigelman, C., Bridevaux, P.O., Brutsche, M., Clarenbach, C., Garzoni, C. (2021) ‘Pulmonary function and radiological features 4 months after COVID-19: First results from the national prospective observational Swiss COVID-19 lung study’, European Respiratory Journal, 57(4). Available at: https://doi.org/10.1183/13993003.03690-2020.

Huang, C., Huang, L., Wang, Yeming, Li, X., Ren, L., Gu, X., Kang, L., Guo, L., Liu, M. (2021) '6-month consequences of COVID-19 in patients discharged from hospital: a cohort study, The Lancet, 397(10270), pp. 220–232. Available at: https://doi.org/10.1016/S0140-6736(20)32656-8.

Huang, I. and Pranata, R. (2020) 'Lymphopenia in severe coronavirus disease-2019 (COVID-19): Systematic review and meta-analysis, Journal of Intensive Care, 8(1), pp. 1–10. Available at: https://doi.org/10.1186/S40560-020-00453-4/FIGURES/4.

Jin, J.M., Bai, P., He, W., Wu, F., Liu, X.F., Han, DM, Liu, S. and Yang, J.K. (2020) ‘Gender Differences in Patients With COVID-19: Focus on Severity and Mortality’, Frontiers in Public Health, 8. Available at: https://doi.org/10.3389/fpubh.2020.00152.

Kaur, A., Di Mascio, M., Barabasz, A., Rosenzweig, M., McClure, H.M., Perelson, A.S., Ribeiro, R.M. and Johnson, R.P. (2008) ‘Dynamics of T- and B-Lymphocyte Turnover in a Natural Host of Simian Immunodeficiency Virus’, Journal of Virology, 82(3), pp. 1084–1093. Available at: https://doi.org/10.1128/jvi.02197-07.

Klain, A., Indolfi, C., Dinardo, G., Decimo, F. and Miraglia Del Giudice, M. (2022) ‘Covid-19 and spirometry in this age’, Italian Journal of Pediatrics, 48(1), pp. 4–9. Available at: https://doi.org/10.1186/s13052-022-01199-5.

Laher, N., Bocchinfuso, S., Chidiac, M., Doherty, C., Persson, A. and Warren, E. (2021) ‘The Biopsychosocial Impact of COVID-19 on Older Adults’, Gerontology and Geriatric Medicine, 7, pp. 1–9. Available at: https://doi.org/10.1177/23337214211034274.

Li, X., Wang, C., Kou, S., Luo, P., Zhao, M. and Yu, K. (2020) 'Lung ventilation function characteristics of survivors from severe COVID-19: a prospective study, Critical care (London, England), 24(1). Available at: https://doi.org/10.1186/S13054-020-02992-6.

Liang, L., Yang, B., Jiang, N., Fu, W., He, X., Zhou, Y., Ma, W.L. and Wang, X. (2020) ‘Three-month Follow-up Study of Survivors of Coronavirus Disease 2019 after Discharge’, Journal of Korean Medical Science, 35(47). Available at: https://doi.org/10.3346/JKMS.2020.35.E418.

Liu, S. ping, Zhang, Q., Wang, W., Zhang, M., Liu, C., Xiao, X., Liu, Z., Hu, W. mu and Jin, P. (2020) ‘Hyperglycemia is a strong predictor of poor prognosis in COVID-19’, Diabetes research and clinical practice, 167. Available at: https://doi.org/10.1016/J.DIABRES.2020.108338.

Lv, D., Chen, X., Wang, X., Mao, L., Sun, J., Wu, G., Lin, Z., Lin, R., Yu, J., Wu, X. and Jiang, Y. (2020) 'Pulmonary function of patients with 2019 novel coronavirus induced-pneumonia: a retrospective cohort study, Annals of palliative medicine, 9(5), pp. 3447–3452. Available at: https://doi.org/10.21037/APM-20-1688.

Méndez, R., Latorre, A., González-Jiménez, P., Feced, L., Bouzas, L., Yépez, K., Ferrando, A., Zaldívar-Olmeda, E., Reyes, S. and Menéndez, R. (2021) ‘Reduced diffusion capacity in COVID-19 survivors’, Annals of the American Thoracic Society, 18(7), pp. 1253–1255. Available at: https://doi.org/10.1513/ANNALSATS.202011-1452RL/SUPPL_FILE/DISCLOSURES.PDF.

Mo, X., Jian, W., Su, Z., Chen, M., Peng, H., Peng, P., Lei, C., Chen, R., Zhong, N. and Li, S. (2020) ‘Abnormal pulmonary function in COVID-19 patients at time of hospital discharge’, The European Respiratory Journal, 55(6). Available at: https://doi.org/10.1183/13993003.01217-2020.

Nandari, N. P. S., Artami, I. A. K., & Dewi, K. V. P. C. (2021). Implementation of fulfillment of rehabilitation rights against persons with disabilities Yayasan Peduli Kemanusiaan Bali related to COVID-19: human rights perspective. International Journal of Social Sciences and Humanities, 5(2), 99–107. https://doi.org/10.29332/ijssh.v5n2.1210

Ojo, A.S., Balogun, S.A., Williams, O.T. and Ojo, O.S. (2020) ‘Pulmonary Fibrosis in COVID-19 Survivors: Predictive Factors and Risk Reduction Strategies’, Pulmonary Medicine, 2020. Available at: https://doi.org/10.1155/2020/6175964.

Okhabska, I., Budzyn, V., Rybchych, I., Zyma, I., & Kalichak, Y. (2022). Management of medical institutions on context of provision medical and preventive care in COVID-19 condition. International Journal of Health Sciences, 6(1), 347–356. https://doi.org/10.53730/ijhs.v6n1.4381

Pambudi, I.G.P.B., Suryana, I.K., Rai, I.B.N., Kusumawardani, I.A.J.D., Candrawati, N.W., Sajinadiyasa, I.G.K. (2022) 'High Neutrophil to Lymphocyte Ratio, C-reactive Protein, Procalcitonin and D-dimer and Risk Factors for Severe COVID-19', Medico-legal Update, 22(1), pp. 41–46.

Patria, Y.N. and Sabirin, R.M. (2021) 'COVID-19 potentially causes long-term deterioration of lung function: A systematic review and meta-analysis, Medical Journal of Indonesia, 30(4), pp. 279–289. Available at: https://doi.org/10.13181/mji.oa.215660.

Peckham, H., de Gruijter, N.M., Raine, C., Radziszewska, A., Ciurtin, C., Wedderburn, L.R., Rosser, E.C., Webb, K. and Deakin, C.T. (2020) 'Male sex identified by global COVID-19 meta-analysis as a risk factor for death and I.T.U. admission', Nature communications, 11(1). Available at: https://doi.org/10.1038/S41467-020-19741-6.

Petrilli, C.M., Jones, S.A., Yang, J., Rajagopalan, H., O'Donnell, L., Chernyak, Y., Tobin, K.A., Cerfolio, R.J., Francois, F. and Horwitz, L.I. (2020) 'Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study, B.M.J. (Clinical research ed.), 369. Available at: https://doi.org/10.1136/BMJ.M1966.

Ribero, M.S., Jouvenet, N., Dreux, M. and Nisole, S. (2020) ‘Interplay between SARS-CoV-2 and the type I interferon response’, PLoS Pathogens, 16(7), pp. 1–22. Available at: https://doi.org/10.1371/journal.ppat.1008737.

Rothan, H.A. and Byrareddy, S.N. (2020) ‘The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak’, Journal of Autoimmunity, 109(February), p. 102433. Available at: https://doi.org/10.1016/j.jaut.2020.102433.

Ruan, Q., Yang, K., Wang, W., Jiang, L. and Song, J. (2020) 'Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China, Intensive Care Medicine, 46(5), pp. 846–848. Available at: https://doi.org/10.1007/S00134-020-05991-X/FIGURES/1.

Sadeghi-Haddad-Zavareh, M., Bayani, M., Shokri, M., Ebrahimpour, S., Babazadeh, A., Mehraeen, R., Moudi, E., Rostami, A., Barary, M., Hosseini, A., Bijani, A. and Javanian, M. (2021) ‘C-Reactive Protein as a Prognostic Indicator in COVID-19 Patients’, Interdisciplinary Perspectives on Infectious Diseases, 2021. Available at: https://doi.org/10.1155/2021/5557582.

Shoaib, N., Noureen, N., Munir, R., Shah, F.A., Ishtiaq, N., Jamil, N., Batool, R., Khalid, M., Khan, I., Iqbal, N. and Zaidi, N. (2021) 'COVID-19 severity: Studying the clinical and demographic risk factors for adverse outcomes, PLOS ONE, 16(8), p. e0255999. Available at: https://doi.org/10.1371/JOURNAL.PONE.0255999.

Da Silva, A.L.O., Moreira, J.C. and Martins, S.R. (2020) ‘COVID-19 and smoking: a high-risk association’, Cadernos de saude publica, 36(5). Available at: https://doi.org/10.1590/0102-311X00072020.

Simonnet, A., Chetboun, M., Poissy, J., Raverdy, V., Noulette, J., Duhamel, A., Labreuche, J., Mathieu. (2020) ‘High Prevalence of Obesity in Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) Requiring Invasive Mechanical Ventilation’, Obesity, 28(7), pp. 1195–1199. Available at: https://doi.org/10.1002/OBY.22831.

Suryasa, I. W., Rodríguez-Gámez, M., & Koldoris, T. (2021). The COVID-19 pandemic. International Journal of Health Sciences, 5(2), vi-ix. https://doi.org/10.53730/ijhs.v5n2.2937

Ulandari, I.G.A.P.P. and Widyaningsih, P.D. (2021) ‘C-reactive protein as the marker of COVID-19 severity at Sanjiwani general hospital, Gianyar, Bali in 2020’, International Journal of Research in Medical Sciences, 9(3), pp. 676–679. Available at: https://doi.org/10.18203/2320-6012.IJRMS20210864.

WHO. (2022) ‘WHO. Coronavirus Disease 2019 (COVID-19): Situation Report − 105.’, WHO. Coronavirus Disease 2019 (COVID-19): Situation Report − 105., 2019(April), p. 18. Available at: https://doi.org/10.1056/NEJMoa2001316.4.

Yan, X., Huang, H., Wang, C., Jin, Z., Zhang, Z., He, J., Yin, S., Fan, M., Huang, J., Chen, F., Zeng, Y., Han, X. and Zhu, Y. (2021) ‘Follow-up study of pulmonary function among COVID-19 survivors 1 year after recovery’, The Journal of Infection, 83(3), p. 381. Available at: https://doi.org/10.1016/J.JINF.2021.05.034.

Yitbarek, G.Y., Ayehu, G.W., Asnakew, S., Ayele, F.Y., Gare, M.B., Mulu, A.T., Dagnaw, F.T. and Melesie, B.D. (2021) ‘The role of C-reactive protein in predicting the severity of COVID-19 disease: A systematic review’, SAGE Open Medicine, 9, p. 205031212110507. Available at: https://doi.org/10.1177/20503121211050755.

Zhang, H.J., Qi, G.Q., Gu, X., Zhang, X.Y., Fang, Y.F., Jiang, H. and Zhao, Y.J. (2021) ‘Lymphocyte blood levels that remain low can predict the death of patients with COVID-19’, Medicine (United States), 100(28). Available at: https://doi.org/10.1097/MD.0000000000026503.

Zhao, Y., Yang, C., An, X., Xiong, Y., Shang, Y., He, J., Qiu, Y., Zhang, N., Huang, L., Jia, J., Xu, Q., Zhang, L., Zhao, J., Pei, G., Luo, H., Wang, J., Li, Q., Gao, Y. and Xu, A. (2021) ‘Follow-up study on COVID-19 survivors one year after discharge from hospital’, International Journal of Infectious Diseases, 112, p. 173. Available at: https://doi.org/10.1016/J.IJID.2021.09.017.

Zheng, Z., Peng, F., Xu, B., Zhao, J., Liu, H., Peng, J., Li, Q., Jiang, C., Zhou, Y., Liu, S., Ye, C., Zhang, P., Xing, Y., Guo, H. and Tang, W. (2020) 'Risk factors of critical & mortal COVID-19 cases: A systematic literature review and meta-analysis, The Journal of Infection, 81(2), p. e16. Available at: https://doi.org/10.1016/J.JINF.2020.04.021.

Zhu, N., Zhang, D., Wang, W., Li, X., Yang, B., Song, J., Zhao, X., Huang, B., Shi, W., Lu, R., Niu, P., Zhan, F., Ma, X., Wang, D., Xu, W., Wu, G., Gao, G.F. and Tan, W. (2020) ‘A Novel Coronavirus from Patients with Pneumonia in China, 2019’, New England Journal of Medicine, 382(8), pp. 727–733. Available at: https://doi.org/10.1056/nejmoa2001017.