C-Reactive Protein and Association with Disease Severity in Hospitalized Adult Lassa Fever Patients in Nigeria

Dic-Ijiewere, Ebenezer Oseremen; Asogun, Danny; Okojie, Festus Oloruntoba; Omono, Adoghe Patricia; Christopher, Okpunu Eseoleleti; Zumla, Adam; Ahmed, Rizwan; Huemomen, Faith Unuabonah; Okoeguale, Joseph; Erameh, Cyril; Ogbainin, Ephraim; Okogbenin, Sylvanus; Eifediyi, Reuben; Elton, Linzy; Honeyborne, Isobella; Tembo, John; Ntoumi, Francine; Haider, Najmul; McHugh, Timothy D; Zumla, Alimuddin

Abstract

Background

: Lassa fever poses a significant health burden in west Africa. The pathophysiology of Lassa fever and determinants of clinical spectrum of disease remain poorly understood. We performed a study to understand the correlation of blood Inflammatory marker C-reactive protein (CRP), with Lassa fever disease severity.

Methods

: A cross-sectional controlled study of adult Lassa fever patients presenting to the Institute of Lassa Fever Research and Control at Irrua Specialist Teaching Hospital, Nigeria, between January and April 2023. Lassa fever was confirmed using real-time PCR. Disease severity classified as: Severe disease= Blood urea level >100 mg/dL; Moderate categorized <100 mg/dL. CRP was measured using Tecan Infinite F50 ELISA system Disease severity was correlated with CRP levels.

Results

: 64 adult patients with Lassa fever and 60 healthy controls were enrolled. There was no difference in mean age (37.6 vs. 35.2 years, p=0.10) and gender (male 53% vs 56%, p=0.82). CRP levels were significantly elevated in Lassa fever patients (mean: 36.23 mg/L, SD: 4.56, %CV: 12.59) compared to controls (mean: 5.42 mg/L, SD: 0.53, %CV: 9.78) (p=0.000). CRP levels varied with disease severity, being significantly higher in patients with severe disease (28.57 mg/L, SD = 2.34; %CV = 8.19) compared to those with moderately severe disease (12.34 mg/L, SD = 0.98; %CV = 7.94);(p = 0.001).

Conclusions

: Lassa fever inpatients showed significant inflammation and elevated CRP levels which correlated with disease severity. CRP could serve as a potential baseline marker in outbreak situations to trigger management decision making to treat or not to treat in light of limited Ribavirin supplies. Given the inflammatory changes and correlation of elevated CRP levels with LF disease severity, larger controlled studies during outbreaks are required to assess use of CRP for more accurate triaging, including commencement of treatment.

Citation

Dic-Ijiewere, E. O., Asogun, D., Okojie, F. O., Omono, A. P., Christopher, O. E., Zumla, A., Ahmed, R., Huemomen, F. U., Okoeguale, J., Erameh, C., Ogbainin, E., Okogbenin, S., Eifediyi, R., Elton, L., Honeyborne, I., Tembo, J., Ntoumi, F., Haider, N., McHugh, T. D., & Zumla, A. (2025). C-Reactive Protein and Association with Disease Severity in Hospitalized Adult Lassa Fever Patients in Nigeria. IJID Regions, 14, Article 100506. https://doi.org/10.1016/j.ijregi.2024.100506

• Journal Article Type: Article
• Acceptance Date: Nov 29, 2024
• Online Publication Date: Dec 5, 2024
• Publication Date: 2025-03
• Deposit Date: Mar 7, 2025
• Journal: IJID Regions
• Print ISSN: 2772-7076
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 14
• Article Number: 100506
• DOI: https://doi.org/10.1016/j.ijregi.2024.100506
• Keywords: Lassa; Fever; Lassa fever virus; Biomarkers; C-reactive protein (CRP); inflammation; Disease severity
• Public URL: https://keele-repository.worktribe.com/output/1015882
• Publisher URL: https://www.sciencedirect.com/science/article/pii/S2772707624001759?via%3Dihub