Inflammatory markers in expectant COVID-19 positive patients: A relationship with clinical severity in a tertiary care referral facility.
DOI:
https://doi.org/10.37506/vg8p3044Keywords:
COVID-19 in pregnancy, , inflammatory markers,, C-reactive protein, Neutrophil lymphocyte ratio, stillbirthAbstract
Background: SARS-Co-V2 infection which was declared as a pandemic by the WHO has caused significant impact on morbidity and mortality to the mother and the fetus, especially the delta variant of the COVID-19. Hence it is important to identify the subgroup of women who are prone to adverse complications and prevent maternal and perinatal mortality. Inflammatory biomarker is one such tool to identify the high-risk expectant mothers.
Methods and results: A total of 158 patients were identified in this retrospective study and they were classified based on the clinical signs and symptoms as per the society of maternal fetal medicine. 96.2% belonged to the non-severe group and 3.8% belonged to the severe infection group. Cough and fever were the most common symptoms. Inflammatory markers which were done on admission were correlated with the clinical disease severity. The difference in mean values of CRP, LDH and ferritin between the severe and non-severe group was significant statistically. The markers IL-6 and d-dimer were raised but did not correlate with disease severity. Neutrophil lymphocyte ratio (NLR) calculated from the blood counts was abnormal in all the patients in the severe group and statistically significant. Overall, the maternal outcome was good and maternal mortality rate was 1.89% (3/158). Neonatal outcome was good with stillbirth rate of 3.16% which was higher when compared to non-covid stillbirth rates (0.5%).
Conclusion: inflammatory biomarkers like CRP and LDH are sensitive in predicting the adverse maternal fetal outcome. NLR is a simple ratio that has a good positive predictive value in identifying the need for more vigilant monitoring in expectant COVID-19 positive patients.
References
Wang Z, Xiong G. Clinical characteristics and laboratory results of pregnant women with COVID-19 in Wuhan, China, International journal of gynecology and obstetrics2020; Volume 150,issue 3: 312-317
https://doi.org/10.1002/ijgo.13265
Salzberger B. Successful containment of COVID-19: the WHO report on the COVID-19 outbreak in China. Infection;2020: volume 48:151-153
Halscott T. Society for Maternal-Fetal Medicine. Management Considerations for Pregnant patients with COVID-19.2020:4.30.20
Syeda S, Baptiste C, Breslin N.The clinical course of COVID in pregnancy, Seminars in Perinatalogy;2020: volume 44(7): 151284. doi: 10.1016/j.semperi.2020.151284
Sun. G ,Zang Y,Liao Q..Blood Test Results of Pregnant COVID-19 Patients: An Updated Case-Control Study, Frontiers in Cellular and Infection Microbiology;2020.:volume 10:560899| https://doi.org/10.3389/fcimb.2020.560899
Hyun Mi Kim, Ki Tae Kwon et al. Prediction of adverse fetal outcomes among women in the third trimester of pregnancy with coronavirus disease 2019.infection &chemotherapy 2022 Sep; 54(3): 493–503. doi: 10.3947/ic.2022.0065
Breslin N., Baptiste C., Miller R. COVID-19 in pregnancy: early lessons. American J Obstet Gynecol MFM. 2020. doi: 10.1016/j.ajogmf.2020.100111.
Zeng Huang Y, Guo Y,Yin M, Chen X et al, Association of inflammatory markers with the severity of COVID-19: A meta-analysis. International J Infectious Disease 2020;96:467-74.
Andrea Lombardi, Silvia Duiella, Letizia Li Piani et al, Inflammatory biomarkers in pregnant women with COVID-19: A retrospective cohort study. Scientific reports 2021;11:13350 doi.org/10.1038/s41598-021-92885-7.
Lili S Wei, Megan E Trostle, Meghana A et al, R The association of inflammatory markers in pregnant women with COVID-19 disease severity. American J Obstet Gynecol supplement to Jan 2022 S747-S748
Jenephy Thalita Rosa,Carolinne de Jesus, Ana Paula et al, Association of D-Dimer, C-Reactive Protein, and Ferritin with COVID-19 Severity in Pregnant Women: Important Findings of a Cross-Sectional Study in Northern Brazil. Int J environ Res Public Health.2023 JUL;20 (14):6415 doi:10.3390/ijerph20146415
MerveAldikactiogluTalmac, Pinar Yalcin Bahat, AysegulBestel, Nazli Aylin Vural, Ozan Karadeniz & Ibrahim PolatBremmeKA, Assessment of D-dimer levels in pregnant women diagnosed with COVID-19: A case-control study. J Matern Fetal Neonatal Med 2023 Dec;36(2):2231123. doi: 10.1080/14767058.2023.2231123
Katarina A Bremme. Haemostatic changes in pregnancy. BestPract Res Clin Haematol 2003 Jun;16(2):153-68. DOI: 10.1016/s1521-6926(03)00021-5
Rostami M, Mansouritorghabeh H. D-dimer level in COVID-19 infection: a systematic review. Expert Rev Hematol. 2020 Nov;13(11): 1265-1275.doi:10.1080/17474086.2020.1831383
Muhammed EminDüz, AydınBalcı, ElifMenekşe . D-dimer levels and COVID-19 severity: Systematic Review and Meta-Analysis. TuberkToraks 2020;68(4):353-360. Doi • 10.5578/tt.70351
ErcanS¸, € OzkanS,Y€ ucelN,etal. Establishing reference intervals for D-dimer to trimesters. J Matern Fetal Neonatal Med. 2015;28(8):983–987. doi: 10.3109/ 14767058.2014.940891.
AtakanTanacan,a,⁎ NurayYazihan,b Seyit Ahmet Erol,a Ali TanerAnuk,. The impact of COVID-19 infection on the cytokine profile of pregnant women: A prospective case-control study.Cytokine. 2021 Apr; 140: 155431,doi: 10.1016/j.cyto.2021.155431
Sebastián Carranza Lira, Maritza García Espinosa. Differences in the neutrophil/lymphocyte ratio and the platelet/lymphocyte ratio in pregnant women with and without COVID‐19.Int J Gynaecol Obstet. 2022 May; 157(2): 296–302.
Dorina Supák,1 Balázs Mészáros,1 BalázsTuri,. Predicting Potentially Fatal COVID-19 Disease in Pregnant Patients Using the Neutrophil-to-Lymphocyte Ratio (NLR),J Clin Med. 2023 Nov; 12(21): 6896.
Xu JB, Xu C, Zhang RB, et al. Associations of procalcitonin, C-reaction protein and neutrophil-to-lymphocyte ratio with mortality in hospitalized COVID-19 patients in China. Scientific Reports 2020;10(1):15058. DOI: 10.1038/s41598-020-72164-73
Liu J, Liu Y, Xiang P, et al. Neutrophil-to-lymphocyte ratio predicts critical illness patients with 2019 coronavirus disease in the early stage. Journal of Translational Medicine 2020;18(1):206. DOI: 10.1186/s12967-020- 02374-0. 3
Eke RN, Taşkın S, Acar AB, et al. An easy parameter that can predict intensive care unit admission in patients with COVID-19 in the early stage: neutrophil to lymphocyte ratio. International journal of medical science and clinical invention 2021;08(01):5185–5191. DOI: 10.18535/ijmsci/v8i01.01.
Ernesto Antonio, Mark Yudin and Dan Farine et al.COVID-19 during pregnancy: an overview of maternal characteristics, clinical symptoms, maternal and neonatal outcomes of 10,996 cases described in 15 countries. Journal of Perinatal Medicine, 01 Nov 2020, 48(9):900-911.https://doi.org/10.1515/jpm-2020-0364 PMID: 33001856
Carla L. DeSisto, , Bailey Wallace,, Regina M. Simeone, ; Kara Polen,et al Risk for Stillbirth Among Women With and Without COVID-19 at Delivery Hospitalization United States, March 2020–September 2021.Centers for Disease control and prevention. Morbidity and Mortality weekly report.:1640–1645 Weekly / November 26, 2021 / 70(47).
Hoyert DL, Gregory ECW. Cause-of-death data from the fetal death file, 2015–2017. National Vital Statistics Report 2020;69(4):1–20. PMID:32510316
An Vercoutere,1 Mbiton Joel Zina,2 Karolien Benoit, et al,Late miscarriage and stillbirth in asymptomatic and symptomatic hospitalised pregnant women in Belgium during the first and second waves of COVID-19: a prospective nationwide population-based study.BMC Pregnancy Childbirth. 2023; 23: 356.doi: 10.1186/s12884-023-05624-3.
Lydia L Shook, Sara Brigida, James Regan, James P Flynn, SARS-CoV-2 Placentitis Associated With B.1.617.2 (Delta) Variant and Fetal Distress or Demise. The Journal of Infectious Diseases, Volume 225, Issue 5, 1 March 2022, Pages 754–758, https://doi.org/10.1093/infdis/jiac008.
Ipek Gurol-Urganci , Jennifer E Jardine , Fran Carroll , Tim Draycott et al, Maternal and perinatal outcomes of pregnant women with SARS-CoV-2 infection at the time of birth in England: national cohort study. Am J Obstet Gynecol. 2021 Nov;225(5):522.e1-522.e11.doi: 10.1016/j.ajog.2021.05.016. Epub 2021 May 20.
David A Schwartz, Sara B Mulkey,Drucilla J Robertz, SARS-CoV-2 placentitis,stillbirth and maternal COVID-19 vaccination:clinical-pathologic correlations,AJOG: SPECIAL REPORT Volume 228, Issue 3,P261 – 269, MARCH 2023
Downloads
Published
Issue
Section
License
Copyright (c) 2024 Sumangali thirunavukkarasu, Poornima Chinnappa, Latha Maheswari, Murali Alagesan, Karthikeyan Shanmugam

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
https://creativecommons.org/licenses/by-nc/2.0/deed.en