Evaluating CRP and Oxygen Requirements as Predictors of Poor Outcomes in COVID-19 Patients with Bacterial Pneumonia
DOI:
https://doi.org/10.36497/jri.v46i2.1198Keywords:
bacterial co-infection,, COVID-19, CRP, outcome statusAbstract
Background: The COVID-19 pandemic has presented significant challenges in the management of bacterial pneumonia co-infections, particularly among elderly populations. These co-infections, most commonly caused by pathogens such as Streptococcus pneumoniae and Staphylococcus aureus, are associated with increased disease severity, higher mortality rate, and poorer outcomes. Data on bacterial co-infections and their impact on patient recovery remain limited, especially in Indonesia. Therefore, this study investigated the associations of age, oxygen supplementation, oxygen saturation, and clinical markers (procalcitonin and CRP) with outcomes in COVID-19 patients with bacterial pneumonia co-infections.
Methods: This cross-sectional predictive study utilized secondary data from medical records of COVID-19 patients with bacterial pneumonia co-infection at the Regional General Hospital of West Nusa Tenggara Province and Universitas Mataram Hospital. Consecutive sampling was used to include patients with confirmed COVID-19 and bacterial pneumonia. Bivariate and multivariate analyses were conducted to assess the association between age, oxygen supplementation, procalcitonin levels, CRP levels, and recovery outcomes.
Results: The study analyzed data from 77 COVID-19 patients with bacterial pneumonia co-infection. Significant predictors of poor outcomes included elevated C-reactive protein (CRP) levels (>75 mg/L) and high oxygen supplementation (>6 L/min). Patients with elevated CRP had a sixfold higher risk of death, and higher oxygen requirements were strongly associated with increased mortality. Lower oxygen saturation was also linked to worse outcomes. Findings highlight CRP levels and oxygen needs as critical factors in predicting mortality. Elevated CRP and higher oxygen supplementation were significantly associated with death, providing insights into the management of co-infected COVID-19 patients.
Conclusion: CRP levels and oxygen requirements are key predictors of poor outcomes in COVID-19 patients with bacterial pneumonia.
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1. WHO. Coronavirus Disease 2019 (COVID-19) World Health Situation Report - 6 [Internet]. 2020 [cited 2025 Apr 3]. Available from: https://cdn.who.int/media/docs/default-source/searo/indonesia/covid19/who-situation-report-6.pdf?sfvrsn=83d038dc_2
2. McCullers JA. The co-pathogenesis of influenza viruses with bacteria in the lung. Nat Rev Microbiol. 2014;12(4):252–62.
3. Hughes S, Troise O, Donaldson H, Mughal N, Moore LSP. Bacterial and fungal coinfection among hospitalized patients with COVID-19: a retrospective cohort study in a UK secondary-care setting. Clinical Microbiology and Infection. 2020;26(10):1395–9.
4. Garcia-Vidal C, Sanjuan G, Moreno-García E, Puerta-Alcalde P, Garcia-Pouton N, Chumbita M, et al. Incidence of co-infections and superinfections in hospitalized patients with COVID-19: a retrospective cohort study. Clinical Microbiology and Infection. 2021;27(1):83–8.
5. Cajanding R. Oxygen use and saturation targets in patients with COVID‐19: Are we giving too much or aiming too low? Nurs Crit Care. 2022;27(2):282–5.
6. Bouayed MZ, Laaribi I, Chatar CEM, Benaini I, Bouazzaoui MA, Oujidi Y, et al. C-Reactive Protein (CRP): A poor prognostic biomarker in COVID-19. Front Immunol. 2022;13:1040024.
7. Xie J, Covassin N, Fan Z, Singh P, Gao W, Li G, et al. Association Between Hypoxemia and Mortality in Patients With COVID-19. Mayo Clin Proc. 2020;95(6):1138–47.
8. Sadeghi-Haddad-Zavareh M, Bayani M, Shokri M, Ebrahimpour S, Babazadeh A, Mehraeen R, et al. C-Reactive Protein as a Prognostic Indicator in COVID-19 Patients. Interdiscip Perspect Infect Dis. 2021;2021:5557582.
9. Luo X, Zhou W, Yan X, Guo T, Wang B, Xia H, et al. Prognostic Value of C-Reactive Protein in Patients With Coronavirus 2019. Clinical Infectious Diseases. 2020;71(16):2174–9.
10. Afifah AR, Liana P, Fertilita S, Salim NA, Verdiansah V, Hilda F, et al. C-Reactive Protein as The Predictor of Mortality for COVID-19 Patients in Indonesia. INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY. 2023;29(2):180–4.
11. Daher A, Balfanz P, Aetou M, Hartmann B, Müller-Wieland D, Müller T, et al. Clinical course of COVID-19 patients needing supplemental oxygen outside the intensive care unit. Sci Rep. 2021;11(1):2256.
12. Hidayat M, Handayani D, Nurwidya F, Laksmi Andarini S. Hyperinflammation Syndrome in COVID-19 Disease: Pathogenesis and Potential Immunomodulatory Agents. Turkish Journal of Immunology. 2021;9(1):1–11.
13. Tanzarella ES, Vargas J, Menghini M, Postorino S, Pozzana F, Vallecoccia MS, et al. An Observational Study to Develop a Predictive Model for Bacterial Pneumonia Diagnosis in Severe COVID-19 Patients—C19-PNEUMOSCORE. J Clin Med. 2023;12(14):4688.
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Copyright (c) 2026 Moulid Hidayat, Rina Lestari, Indana Eva Ajmala, Prima Belia Fathana, Hana Khairina Putri Faisal, Fariz Nurwidya, Gabrielle Adani
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