Association between COVID-19 infection, elevated C-reactive protein, and neuropsychiatric symptoms in individuals with metabolic and cardiovascular comorbidities

Elevated serum inflammatory markers are associated with neuropsychiatric symptoms. This process is potentially more intense in individuals with chronic comorbidities such as obesity, systemic arterial hypertension (SAH), and diabetes mellitus (DM). Such conditions already establish a basal inflammatory state, which can be aggravated by acute viral infections, such as COVID-19, worsening neuropsychiatric outcomes. Given this panorama, this cross-sectional study aimed to analyze the association between the presence of pre-existing comorbidities, elevated plasma C-reactive protein (CRP) levels, and symptoms of stress, anxiety, and depression in individuals previously infected by SARS-CoV-2. The research included 350 participants: 114 in the post-COVID-19 group and 236 in the control group. The post-COVID-19 group had a higher prevalence of comorbidities, notably obesity (17.9%; p = 0.044), DM (13.3%; p < 0.01), and SAH (22.1%; p = 0.024). Furthermore, serum CRP levels were significantly higher in the post-COVID-19 group ( p = 0.014) and correlated significantly with all comorbidities. The post-COVID-19 group presented higher stress ( p = 0.02) and severity of depressive symptoms ( p = 0.034). Specifically, the presence of SAH and obesity was associated with a significant increase in stress levels, depression, and anxiety severity ( p = 0.027). In conclusion, the results demonstrate that individuals with pre-existing comorbidities, besides being more prevalent in the post-COVID-19 group, exhibit a higher systemic inflammatory state (high CRP), associated with the exacerbation of neuropsychiatric symptoms. Graphical Abstract of the interaction between SARS-CoV-2 infection, systemic inflammation, and neuropsychiatric outcomes. The diagram illustrates that individuals in the post-COVID-19 group, particularly those with obesity and systemic arterial hypertension (SAH), exhibit significantly elevated C-reactive protein (CRP) levels. This persistent inflammatory state correlates positively with the increased severity of depressive symptoms, anxiety, and stress. The findings highlight a synergistic effect between viral sequelae and cardiometabolic comorbidities in driving mental health repercussions.