Evaluating CRP and Oxygen Requirements as Predictors of Poor Outcomes in COVID-19 Patients with Bacterial Pneumonia

Moulid Hidayat (Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, University of Mataram, West Nusa Tenggara Provincial Hospital, Mataram)
Rina Lestari (Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, University of Mataram, West Nusa Tenggara Provincial Hospital, Mataram)
Indana Eva Ajmala (Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, University of Mataram, West Nusa Tenggara Provincial Hospital, Mataram)
Prima Belia Fathana (Department of Internal Medicine, Faculty of Medicine and Health Science, University of Mataram, West Nusa Tenggara Provincial Hospital, Mataram)
Indah Sapta Wardani (Department of Internal Medicine, Faculty of Medicine and Heath Science, University of Mataram -West Nusa Tenggara Provincial Hospital, Mataram)

Jurnal Respirologi Indonesia
Vol 46 No 2 (2026)

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.