Date of Award


Degree Name



Public Health


Jeannie B. Concha


Chronic stress can lead to many systemic complications and low-grade systemic inflammation including increased levels of inflammatory cytokines, such as C-reactive protein (CRP). CRP is a marker of systemic inflammation and is associated with depression and perceived stress. Elevations can result in ineffective immune responses, thereby increasing the risk of complications and mortality from infections. Recent evidence suggests that uncontrolled inflammatory responses associated with COVID 19 are a major determinant of disease severity.  The COVID 19 is transmitted from one person to another through droplets from coughing, sneezing, talking, touching droplets on surfaces and contamination by hand-to-mouth routes. The mechanism by which the COVID 19 virus gain entrance into human system is through attaching to cells like the Angiotensin Converting Enzyme 2 (ACE2), cathepsin L, and Transmembrane serine protease isoform 2.

Purpose: The purpose of the study was to 1a) examine the relationship between CRP as proxy indicator of chronic stress, and Oxygen saturation to predict COVID 19 severity. 1b) and examine the relationship between CRP and the length of hospitalization to predict COVID 19 severity. 2) determine if gender moderates these relationships.

Methods: This retrospective study used medical records from patients admitted to the University Medical Center, El Paso, TX with COVID 19 (n=436 (272M/164F); age 57.3 ± 0.8 years; BMI 29.42 ± 0.3 Kg/m2). Chronic stress was measured by blood CRP level. Severity of COVID 19 infection was determined by the peripheral oxygen saturation (SpO2) measured during the time of hospitalization. Length of hospitalization was determined by the number of days spent in the hospital. Patients were categorized into low CRP (< 3mg/L) vs. high CRP (≥3mg/L) groups and were compared using unpaired t-test and one-way ANOVA.

Results: Patients with low CRP level had greater COVID 19 severity, measured by SpO2 (CRP<3; p-value = .019), and length of hospital stay was not statistically significant. The one-way ANOVA indicates that CRP was not statistically associated with length of hospitalization (p-value = .66). Conclusion: lower levels of CRP are associated with worsened severity via SpO2 in COVID 19 patients. The practical implication is that CRP parameters should be considered in laboratory workup for COVID 19 patients, and treatment should focus on maximizing the healthcare resources during a pandemic. Healthcare resources are in high demand during the pandemic, and the resources can be judiciously maximized by classifying the patients based on the severity of COVID 19 symptoms.




Received from ProQuest

File Size

53 p.

File Format


Rights Holder

Abdulahi aremu Ayanwale