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Inflammatory biomarkers in pregnant women with COVID-19: a retrospective cohort study
Andrea Lombardi1,2, Silvia Duiella3, Letizia Li Piani3
1Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy. andrea.lombardi@policlinico.mi.it.
Insights
In obstetric patients with COVID-19, lower lymphocyte counts at admission predict a higher need for oxygen supplementation. C-reactive protein levels reflect disease progression, unlike D-dimer or ferritin.
Area of Science:
- Obstetrics and Gynecology
- Infectious Diseases
- Hematology
Background:
- Coronavirus disease 2019 (COVID-19) poses risks to obstetric patients, with unclear prognostic implications of inflammatory markers and hemocytometry.
- Understanding these markers is crucial for managing COVID-19 in pregnancy and postpartum periods.
Purpose of the Study:
- To assess inflammatory biomarkers and hemocytometry values in hospitalized obstetric patients with COVID-19.
- To correlate admission values with the requirement for oxygen supplementation during hospitalization.
Main Methods:
- Analysis of inflammatory biomarkers and hemocytometry variables in a cohort of obstetric patients admitted with COVID-19.
- Correlation of admission laboratory values with oxygen supplementation needs.
Main Results:
- Leukocytes, neutrophils, neutrophil-to-lymphocyte ratio, and C-reactive protein decreased significantly during hospitalization.
- Lymphocytes, platelets, and ferritin levels increased significantly.
- Lower lymphocyte counts at admission were associated with an increased risk of requiring oxygen supplementation (26% higher risk per 1000 cells decrease).
- C-reactive protein best mirrored disease course; D-dimer and ferritin were not reliable predictors of poor outcomes.
Conclusions:
- Lymphocyte count at admission is a key indicator for predicting oxygen supplementation needs in obstetric patients with COVID-19.
- C-reactive protein is a reliable marker for monitoring disease progression in this population.
- Close monitoring and oxygen supplementation should be prioritized for patients with low admission lymphocyte counts.
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.
