C - reactive protein Level Reduction and Mortality in Patients with COVID-19 Treated with Dexamethasone: Are We Undertreating Patients with Severe Obesity

ABSTRACT

Background:Dexamethasone reduces the mortality in patients with severe COVID-19. We evaluated the decline in C-reactive protein (CRP) after the treatment with standard dose dexamethasone and its association with mortality and body mass index (BMI).Material and Methods&Results:This was a retrospective cohort of 678 patients with COVID-19 admitted to the public healthcare system of New York City between July 1st and December 31st, 2020 with laboratory-confirmed COVID-19, who received at least one dose of dexamethasone and had more than one measurement of CRP. Mortality was compared among groups stratified by BMI and CRP response. The reference group had BMI 25-34.9 kg/m2 and CRP response. Male sex, increasing age and CRP non-response were associated with higher in-hospital mortality. Patients with BMI 25-34.9 kg/m2 and CRP non-response (OR 2.71 [1.43-5.15];p=0.002) and BMI > 35 kg/m2 and CRP non-response (OR 2.64 [1.05-6.62];p=0.038) were associated with higher mortality.Conclusion:CRP non-response was associated with a higher likelihood for death after adjusting for other confounding factors. The CRP non-response rate was significantly higher in patients with severe obesity.