Inflammatory biomarkers in pregnant women with COVID-19: a retrospective cohort study

Andrea Lombardi,Antonio Muscatello,Enrico Ferrazzi,Andrea Gori,Ferruccio Ceriotti,Letizia Li Piani,Agnese Comelli,Silvia Duiella,Massimo Oggioni,Alessandra Bandera

doi:10.1038/s41598-021-92885-7

Abstract

Coronavirus disease 2019 (COVID-19) is a pandemic viral disease affecting also obstetric patients and uncertainties exist about the prognostic role of inflammatory biomarkers and hemocytometry values in patients with this infection. To clarify that, we have assessed the values of several inflammatory biomarkers and hemocytometry variables in a cohort of obstetric patients hospitalized with COVID-19 and we have correlated the values at admission with the need of oxygen supplementation during the hospitalization. Overall, among 62 (27.3%) pregnant women and 165 (72.7%) postpartum women, 21 (9.2%) patients received oxygen supplementation and 2 (0.9%) required admission to intensive care unit but none died. During hospitalization leukocytes (p < 0.001), neutrophils (p < 0.001), neutrophils to lymphocytes ratio (p < 0.001) and C reactive protein (p < 0.001) decreased significantly, whereas lymphocytes (p < 0.001), platelets (p < 0.001) and ferritin (p = 0.001) increased. Lymphocyte values at admission were correlated with oxygen need, with a 26% higher risk of oxygen supplementation for each 1000 cells decreases. Overall, in obstetric patients hospitalized with COVID-19, C reactive protein is the inflammatory biomarker that better mirrors the course of the disease whereas D-dimer or ferritin are not reliable predictors of poor outcome. Care to the need of oxygen supplementation should be reserved to patients with reduced lymphocyte values at admission.

Highlights

The pandemic of coronavirus disease 2019 (COVID-2019), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is affecting many women during pregnancy and in the postpartum worldwide
We do not know their evolution during the disease and whether their values can be adopted at admission to guide clinical choices. In this retrospective cohort of obstetric patients admitted with COVID-19 at our tertiary referral centre, we assessed the baseline values and the trend of inflammatory biomarkers and hemocytometry variables and their association with the severity of COVID-19
Among the variables assessed in our study, C reactive protein (CRP) was the inflammatory biomarker which varied more significantly during the course of COVID-19 in obstetric patients, supporting its employment as a tool to monitor the evolution of the disease

Summary

Introduction

The pandemic of coronavirus disease 2019 (COVID-2019), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is affecting many women during pregnancy and in the postpartum worldwide. The role of the above-mentioned markers has not been studied during pregnancy and in the postpartum in women infected by SARS-CoV-2. We do not know their evolution during the disease and whether their values can be adopted at admission to guide clinical choices. In this retrospective cohort of obstetric patients admitted with COVID-19 at our tertiary referral centre, we assessed the baseline values and the trend of inflammatory biomarkers and hemocytometry variables and their association with the severity of COVID-19. Age (years) Ethnicity Caucasic Black Hispanic Arab BMI Gestational age at admission (weeks + days) Time since symptoms (days) Hospitalization length (days) Time for clinical cure (days) Time for virologic cure (days) Symptoms Fever Dyspnoea Cough Coryza Asthenia Anosmia/ageusia Nausea/diarrhoea Pharyngitis Chest X-ray/Chest computed tomography Reduced transparency/Ground glass Interstitial thickening/Crazy paving Consolidation Therapy Lopinavir/Ritonavir Hydroxychloroquine LMWH Remdesivir Oxygen supplementation

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Results

Conclusion