Research Article
BibTex RIS Cite

One Year Analysis of Hematological and Inflammatory Parameters to Predict the Severity of COVID-19 Infection in Pregnant Women

Year 2022, Volume: 8 Issue: 1, 146 - 157, 25.02.2022
https://doi.org/10.19127/mbsjohs.1064479

Abstract

Objective: The study aims to demonstrate the usability of admission hematological parameters in the prognosis of COVID-19 infection in pregnant population and to introduce the cut-offs values of these parameters for pregnant women.
Methods: The cohort of this retrospective study consisted of 71 COVID-19 PCR positive pregnant women who were hospitalized in Ordu University Medical Faculty Training and Research Hospital between 1 May 2020 and 1 May 2021. The pregnant women were divided into two groups based on the severity of the disease.
Results: White blood cell count, neutrophil count and C-reactive protein (CRP) levels was significantly higher (p=0.000, p=0.000), whereas red blood cell count and lymphocyte count were significantly lower (p=0.002, p=0.002) in severe group. High NLR (neutrophil-to-lymphocyte ratio) (p=0.000), dNLR (derived neutrophil-to-lymphocyte ratio) (p=0.000), MLR (monocyte-to-lymphocyte ratio) (p=0.004), PLR (platelet-to-lymphocyte ratio) (p=0.008), NPR (neutrophil-to-platelet ratio) (p=0.005), NLRNPR (neutrophil-to-lymphocyte ratio/neutrophil-to-platelet ratio) (p=0.008) and SII (Systemic immune inflammation index) (p=0.000) were found in severe group.
Conclusion: This paper revealed that severe COVID-19 disease in pregnant women is mainly associated with hematological parameters. Among these parameters NLR, dNLR and SII have largest AUC in ROC, with cutoff values 5.3, 3.52 and 994.8 respectively. Further investigations regarding the use of hematologic tests as prognostic factor of COVID-19 disease severity in pregnant women are needed to assess the risk of serious disease, to predict the prognosis of COVID-19 and to reduce perinatal and maternal morbidity/mortality.

References

  • 1. World Health Organization. Coronavirus disease (COVID-19) pandemic. 2020. (cited 2021 May 1). Available from: URL: http:/ www.who.int/emergencies/diseases/novel-coronavirus-2019.
  • 2. Turkey Ministry of Health. Coronavirus data. 2020. (cited 2021 May 1). Available from: URL: http:/ covid19.saglik.gov.tr.
  • 3. Kucirka LM, Lauer SA, Laeyendecker O, Boon D, Lessler J. Variation in False-Negative Rate of Reverse Transcriptase Polymerase Chain Reaction-Based SARS-CoV-2 Tests by Time Since Exposure. Ann Intern Med. 2020;173:262-7.
  • 4. Moutchia J, Pokharel P, Kerri A, McGaw K, Uchai S, Nji M, et al. Clinical laboratory parameters associated with severe or critical novel coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis. PLoS One. 2020;15:e0239802.
  • 5. Jamieson DJ, Theiler RN, Rasmussen SA. Emerging infections and pregnancy. Emerg Infect Dis. 2006;12:1638-43.
  • 6. Sun G, Zhang Y, Liao Q, Cheng Y. Blood Test Results of Pregnant COVID-19 Patients: An Updated Case-Control Study. Front Cell Infect Microbiol. 2020;10:560899.
  • 7. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395:507-13.
  • 8. Chen H, Guo J, Wang C, Luo F, Yu X, Zhang W, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet. 2020;395:809-15.
  • 9. Saccone G, Sen C, Di Mascio D, Galindo A, Grünebaum A, Yoshimatsu J, et al. Maternal and Perinatal Outcomes of Pregnant Women with SARS-COV 2 infection. Ultrasound Obstet Gynecol. 2021;57:232-41.
  • 10. Martínez-Urbistondo D, Beltrán A, Beloqui O, Huerta A. The neutrophil–lymphocyte ratio as a marker of systemic endothelial dysfunction in asymptomatic subjects. Nefrología (Madrid). 2016;36:397-403.
  • 11. Shah N, Parikh V, Patel N, Patel N, Badheka A, Deshmukh A, et al. Neutrophil lymphocyte ratio significantly improves the Framingham risk score in prediction of coronary heart disease mortality: insights from the National Health and Nutrition Examination Survey-III. Int J Cardiol. 2014;171:390-7.
  • 12. Qu R, Ling Y, Zhang YH, Wei LY, Chen X, Li XM, et al. Platelet-to-lymphocyte ratio is associated with prognosis in patients with coronavirus disease-19. J Med Virol. 2020;92:1533-41. 13. Pedersen SF, Ho YC. SARS-CoV-2: a storm is raging. J Clin Invest. 2020;130:2202-5.
  • 14. Hu B, Yang XR, Xu Y, Sun YF, Sun C, Guo W, et al. Systemic immune-inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma. Clin Cancer Res. 2014;20:6212-22.
  • 15. Bao J, Li C, Zhang K, Kang H, Chen W, Gu B. Comparative analysis of laboratory indexes of severe and non-severe patients infected with COVID-19. Clin Chim Acta. 2020;509:180-94.
  • 16. Ghahramani S, Tabrizi R, Lankarani KB, Kashani SMA, Rezaei S, Zeidi N, et al. Laboratory features of severe vs. non-severe COVID-19 patients in Asian populations: a systematic review and meta-analysis. Eur J Med Res. 2020;25:30.
  • 17. Soraya GV, Ulhaq ZS. Crucial laboratory parameters in COVID-19 diagnosis and prognosis: An updated meta-analysis. Med Clin (Barc). 2020;155:143-51.
  • 18. Simadibrata DM, Calvin J, Wijaya AD, Ibrahim NAA. Neutrophil-to-lymphocyte ratio on admission to predict the severity and mortality of COVID-19 patients: A meta-analysis. Am J Emerg Med. 2021;42:60-9.
  • 19. Henry B, Cheruiyot I, Vikse J, Mutua V, Kipkorir V, Benoit J, et al. Lymphopenia and neutrophilia at admission predicts severity and mortality in patients with COVID-19: a meta-analysis. Acta Biomed. 2020;91:e2020008.
  • 20. Li X, Liu C, Mao Z, Xiao M, Wang L, Qi S, et al. Predictive values of neutrophil-to-lymphocyte ratio on disease severity and mortality in COVID-19 patients: a systematic review and meta-analysis. Crit Care. 2020;24:647.
  • 21. Kazemi Aski S, Norooznezhad AH, Shamshirsaz AA, Mostafaei S, Aleyasin A, Nabavian SM, et al. Clinical features and risk factors associated with acute respiratory distress syndrome in pregnant women diagnosed with COVID-19: a multi-center case-control study. J Matern Fetal Neonatal Med. 2021;8:1-5.
  • 22. Liu J, Liu Y, Xiang P, Pu L, Xiong H, Li C, et al. Neutrophil-to-lymphocyte ratio predicts critical illness patients with 2019 coronavirus disease in the early stage. J Transl Med. 2020;18:206.
  • 23. Bg S, Gosavi S, Ananda Rao A, Shastry S, Raj SC, Sharma A, el at. Neutrophil-to-Lymphocyte, Lymphocyte-to-Monocyte, and Platelet-to-Lymphocyte Ratios: Prognostic Significance in COVID-19. Cureus. 2021;13:e12622.
  • 24. Zeng F, Li L, Zeng J, Deng Y, Huang H, Chen B, et al. Can we predict the severity of coronavirus disease 2019 with a routine blood test? Pol Arch Intern Med. 2020;130:400-6.
  • 25. Yang AP, Liu JP, Tao WQ, Li HM. The diagnostic and predictive role of NLR, d-NLR and PLR in COVID-19 patients. Int Immunopharmacol. 2020;84:106504.
  • 26. Liang W, Liang H, Ou L, Chen B, Chen A, Li C, et al. Development and Validation of a Clinical Risk Score to Predict the Occurrence of Critical Illness in Hospitalized Patients With COVID-19. JAMA Intern Med. 2020;180:1081-9.
  • 27. Liu Y, Du X, Chen J, Jin Y, Peng L, Wang HHX, et al. Neutrophil-to-lymphocyte ratio as an independent risk factor for mortality in hospitalized patients with COVID-19. J Infect. 2020;81:e6-e12.
  • 28. Yang M, Ng MH, Li CK. Thrombocytopenia in patients with severe acute respiratory syndrome (review). Hematology (Amsterdam, Netherlands). 2005;10:101-5.
  • 29. Fu L, Wang B, Yuan T, Chen X, Ao Y, Fitzpatrick T, et al. Clinical characteristics of coronavirus disease 2019 (COVID-19) in China: A systematic review and meta-analysis. J Infect. 2020;80:656-65.
  • 30. Sun S, Cai X, Wang H, He G, Lin Y, Lu B, et al. Abnormalities of peripheral blood system in patients with COVID-19 in Wenzhou, China. Clin Chim Acta. 2020;507:174-80.
  • 31. Song C-Y, Xu J, He J-Q, Lu Y-Q. COVID-19 early warning score: a multi-parameter screening tool to identify highly suspected patients. MedRxiv. 2020;3:1-22.
  • 32. Ma Y, Shi N, Fan Y, Wang J, Zhao C, Li G, et al. Predictive value of the neutrophil-to-lymphocyte ratio (NLR) for diagnosis and worse clinical course of the COVID-19: findings from ten provinces in China. Lancet. 2020;1-43.
  • 33. Yan X, Li F, Wang X, Yan J, Zhu F, Tang S, et al. Neutrophil to lymphocyte ratio as prognostic and predictive factor in patients with coronavirus disease 2019: A retrospective cross-sectional study. J Med Virol. 2020;92:2573-81.
  • 34. Guo T-M, Tong Y, Chen J, Huang L, Cheng B, Zhou J, et al. Clinical Features Predicting Mortality Risk in Older Patients with COVID-19. Lancet. 2020;1-26.
  • 35. Erol Koç EM, Fındık RB, Akkaya H, Karadağ I, Tokalıoğlu EÖ, Tekin ÖM. Comparison of hematological parameters and perinatal outcomes between COVID-19 pregnancies and healthy pregnancy cohort. J Perinat Med. 2020;49:141-7.
  • 36. Rebuzzi SE, Signori A, Banna GL, Maruzzo M, De Giorgi U, Pedrazzoli P, et al. Inflammatory indices and clinical factors in metastatic renal cell carcinoma patients treated with nivolumab: the development of a novel prognostic score (Meet-URO 15 study). Ther Adv Med Oncol. 2021;13:17588359211019642.
  • 37. Noor A, Akhtar F, Tashfeen S, Anwar N, Saleem B, Khan SA, et al. Neutrophil-to-Lymphocyte Ratio, derived Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio and Lymphocyte-to-Monocyte Ratio as risk factors in critically ill COVID-19 patients, a single centered study. J Ayub Med Coll Abbottabad. 2020;32:595-601.
  • 38. López-Escobar A, Madurga R, Castellano JM, Ruiz de Aguiar S, Velázquez S, Bucar M, et al. Hemogram as marker of in-hospital mortality in COVID-19. J Investig Med. 2021;69:962-9

One Year Analysis of Hematological and Inflammatory Parameters to Predict the Severity of COVID-19 Infection in Pregnant Women

Year 2022, Volume: 8 Issue: 1, 146 - 157, 25.02.2022
https://doi.org/10.19127/mbsjohs.1064479

Abstract

Objective: The study aims to demonstrate the usability of admission hematological parameters in the prognosis of COVID-19 infection in pregnant population and to introduce the cut-offs values of these parameters for pregnant women.
Methods: The cohort of this retrospective study consisted of 71 COVID-19 PCR positive pregnant women who were hospitalized in Ordu University Medical Faculty Training and Research Hospital between 1 May 2020 and 1 May 2021. The pregnant women were divided into two groups based on the severity of the disease.
Results: White blood cell count, neutrophil count and C-reactive protein (CRP) levels was significantly higher (p=0.000, p=0.000), whereas red blood cell count and lymphocyte count were significantly lower (p=0.002, p=0.002) in severe group. High NLR (neutrophil-to-lymphocyte ratio) (p=0.000), dNLR (derived neutrophil-to-lymphocyte ratio) (p=0.000), MLR (monocyte-to-lymphocyte ratio) (p=0.004), PLR (platelet-to-lymphocyte ratio) (p=0.008), NPR (neutrophil-to-platelet ratio) (p=0.005), NLRNPR (neutrophil-to-lymphocyte ratio/neutrophil-to-platelet ratio) (p=0.008) and SII (Systemic immune inflammation index) (p=0.000) were found in severe group.
Conclusion: This paper revealed that severe COVID-19 disease in pregnant women is mainly associated with hematological parameters. Among these parameters NLR, dNLR and SII have largest AUC in ROC, with cutoff values 5.3, 3.52 and 994.8 respectively. Further investigations regarding the use of hematologic tests as prognostic factor of COVID-19 disease severity in pregnant women are needed to assess the risk of serious disease, to predict the prognosis of COVID-19 and to reduce perinatal and maternal morbidity/mortality.

References

  • 1. World Health Organization. Coronavirus disease (COVID-19) pandemic. 2020. (cited 2021 May 1). Available from: URL: http:/ www.who.int/emergencies/diseases/novel-coronavirus-2019.
  • 2. Turkey Ministry of Health. Coronavirus data. 2020. (cited 2021 May 1). Available from: URL: http:/ covid19.saglik.gov.tr.
  • 3. Kucirka LM, Lauer SA, Laeyendecker O, Boon D, Lessler J. Variation in False-Negative Rate of Reverse Transcriptase Polymerase Chain Reaction-Based SARS-CoV-2 Tests by Time Since Exposure. Ann Intern Med. 2020;173:262-7.
  • 4. Moutchia J, Pokharel P, Kerri A, McGaw K, Uchai S, Nji M, et al. Clinical laboratory parameters associated with severe or critical novel coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis. PLoS One. 2020;15:e0239802.
  • 5. Jamieson DJ, Theiler RN, Rasmussen SA. Emerging infections and pregnancy. Emerg Infect Dis. 2006;12:1638-43.
  • 6. Sun G, Zhang Y, Liao Q, Cheng Y. Blood Test Results of Pregnant COVID-19 Patients: An Updated Case-Control Study. Front Cell Infect Microbiol. 2020;10:560899.
  • 7. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395:507-13.
  • 8. Chen H, Guo J, Wang C, Luo F, Yu X, Zhang W, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet. 2020;395:809-15.
  • 9. Saccone G, Sen C, Di Mascio D, Galindo A, Grünebaum A, Yoshimatsu J, et al. Maternal and Perinatal Outcomes of Pregnant Women with SARS-COV 2 infection. Ultrasound Obstet Gynecol. 2021;57:232-41.
  • 10. Martínez-Urbistondo D, Beltrán A, Beloqui O, Huerta A. The neutrophil–lymphocyte ratio as a marker of systemic endothelial dysfunction in asymptomatic subjects. Nefrología (Madrid). 2016;36:397-403.
  • 11. Shah N, Parikh V, Patel N, Patel N, Badheka A, Deshmukh A, et al. Neutrophil lymphocyte ratio significantly improves the Framingham risk score in prediction of coronary heart disease mortality: insights from the National Health and Nutrition Examination Survey-III. Int J Cardiol. 2014;171:390-7.
  • 12. Qu R, Ling Y, Zhang YH, Wei LY, Chen X, Li XM, et al. Platelet-to-lymphocyte ratio is associated with prognosis in patients with coronavirus disease-19. J Med Virol. 2020;92:1533-41. 13. Pedersen SF, Ho YC. SARS-CoV-2: a storm is raging. J Clin Invest. 2020;130:2202-5.
  • 14. Hu B, Yang XR, Xu Y, Sun YF, Sun C, Guo W, et al. Systemic immune-inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma. Clin Cancer Res. 2014;20:6212-22.
  • 15. Bao J, Li C, Zhang K, Kang H, Chen W, Gu B. Comparative analysis of laboratory indexes of severe and non-severe patients infected with COVID-19. Clin Chim Acta. 2020;509:180-94.
  • 16. Ghahramani S, Tabrizi R, Lankarani KB, Kashani SMA, Rezaei S, Zeidi N, et al. Laboratory features of severe vs. non-severe COVID-19 patients in Asian populations: a systematic review and meta-analysis. Eur J Med Res. 2020;25:30.
  • 17. Soraya GV, Ulhaq ZS. Crucial laboratory parameters in COVID-19 diagnosis and prognosis: An updated meta-analysis. Med Clin (Barc). 2020;155:143-51.
  • 18. Simadibrata DM, Calvin J, Wijaya AD, Ibrahim NAA. Neutrophil-to-lymphocyte ratio on admission to predict the severity and mortality of COVID-19 patients: A meta-analysis. Am J Emerg Med. 2021;42:60-9.
  • 19. Henry B, Cheruiyot I, Vikse J, Mutua V, Kipkorir V, Benoit J, et al. Lymphopenia and neutrophilia at admission predicts severity and mortality in patients with COVID-19: a meta-analysis. Acta Biomed. 2020;91:e2020008.
  • 20. Li X, Liu C, Mao Z, Xiao M, Wang L, Qi S, et al. Predictive values of neutrophil-to-lymphocyte ratio on disease severity and mortality in COVID-19 patients: a systematic review and meta-analysis. Crit Care. 2020;24:647.
  • 21. Kazemi Aski S, Norooznezhad AH, Shamshirsaz AA, Mostafaei S, Aleyasin A, Nabavian SM, et al. Clinical features and risk factors associated with acute respiratory distress syndrome in pregnant women diagnosed with COVID-19: a multi-center case-control study. J Matern Fetal Neonatal Med. 2021;8:1-5.
  • 22. Liu J, Liu Y, Xiang P, Pu L, Xiong H, Li C, et al. Neutrophil-to-lymphocyte ratio predicts critical illness patients with 2019 coronavirus disease in the early stage. J Transl Med. 2020;18:206.
  • 23. Bg S, Gosavi S, Ananda Rao A, Shastry S, Raj SC, Sharma A, el at. Neutrophil-to-Lymphocyte, Lymphocyte-to-Monocyte, and Platelet-to-Lymphocyte Ratios: Prognostic Significance in COVID-19. Cureus. 2021;13:e12622.
  • 24. Zeng F, Li L, Zeng J, Deng Y, Huang H, Chen B, et al. Can we predict the severity of coronavirus disease 2019 with a routine blood test? Pol Arch Intern Med. 2020;130:400-6.
  • 25. Yang AP, Liu JP, Tao WQ, Li HM. The diagnostic and predictive role of NLR, d-NLR and PLR in COVID-19 patients. Int Immunopharmacol. 2020;84:106504.
  • 26. Liang W, Liang H, Ou L, Chen B, Chen A, Li C, et al. Development and Validation of a Clinical Risk Score to Predict the Occurrence of Critical Illness in Hospitalized Patients With COVID-19. JAMA Intern Med. 2020;180:1081-9.
  • 27. Liu Y, Du X, Chen J, Jin Y, Peng L, Wang HHX, et al. Neutrophil-to-lymphocyte ratio as an independent risk factor for mortality in hospitalized patients with COVID-19. J Infect. 2020;81:e6-e12.
  • 28. Yang M, Ng MH, Li CK. Thrombocytopenia in patients with severe acute respiratory syndrome (review). Hematology (Amsterdam, Netherlands). 2005;10:101-5.
  • 29. Fu L, Wang B, Yuan T, Chen X, Ao Y, Fitzpatrick T, et al. Clinical characteristics of coronavirus disease 2019 (COVID-19) in China: A systematic review and meta-analysis. J Infect. 2020;80:656-65.
  • 30. Sun S, Cai X, Wang H, He G, Lin Y, Lu B, et al. Abnormalities of peripheral blood system in patients with COVID-19 in Wenzhou, China. Clin Chim Acta. 2020;507:174-80.
  • 31. Song C-Y, Xu J, He J-Q, Lu Y-Q. COVID-19 early warning score: a multi-parameter screening tool to identify highly suspected patients. MedRxiv. 2020;3:1-22.
  • 32. Ma Y, Shi N, Fan Y, Wang J, Zhao C, Li G, et al. Predictive value of the neutrophil-to-lymphocyte ratio (NLR) for diagnosis and worse clinical course of the COVID-19: findings from ten provinces in China. Lancet. 2020;1-43.
  • 33. Yan X, Li F, Wang X, Yan J, Zhu F, Tang S, et al. Neutrophil to lymphocyte ratio as prognostic and predictive factor in patients with coronavirus disease 2019: A retrospective cross-sectional study. J Med Virol. 2020;92:2573-81.
  • 34. Guo T-M, Tong Y, Chen J, Huang L, Cheng B, Zhou J, et al. Clinical Features Predicting Mortality Risk in Older Patients with COVID-19. Lancet. 2020;1-26.
  • 35. Erol Koç EM, Fındık RB, Akkaya H, Karadağ I, Tokalıoğlu EÖ, Tekin ÖM. Comparison of hematological parameters and perinatal outcomes between COVID-19 pregnancies and healthy pregnancy cohort. J Perinat Med. 2020;49:141-7.
  • 36. Rebuzzi SE, Signori A, Banna GL, Maruzzo M, De Giorgi U, Pedrazzoli P, et al. Inflammatory indices and clinical factors in metastatic renal cell carcinoma patients treated with nivolumab: the development of a novel prognostic score (Meet-URO 15 study). Ther Adv Med Oncol. 2021;13:17588359211019642.
  • 37. Noor A, Akhtar F, Tashfeen S, Anwar N, Saleem B, Khan SA, et al. Neutrophil-to-Lymphocyte Ratio, derived Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio and Lymphocyte-to-Monocyte Ratio as risk factors in critically ill COVID-19 patients, a single centered study. J Ayub Med Coll Abbottabad. 2020;32:595-601.
  • 38. López-Escobar A, Madurga R, Castellano JM, Ruiz de Aguiar S, Velázquez S, Bucar M, et al. Hemogram as marker of in-hospital mortality in COVID-19. J Investig Med. 2021;69:962-9
There are 37 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Research articles
Authors

Seda Keskin 0000-0002-5640-4552

Deha Denizhan Keskin 0000-0002-6108-7619

Publication Date February 25, 2022
Published in Issue Year 2022 Volume: 8 Issue: 1

Cite

Vancouver Keskin S, Keskin DD. One Year Analysis of Hematological and Inflammatory Parameters to Predict the Severity of COVID-19 Infection in Pregnant Women. Mid Blac Sea J Health Sci. 2022;8(1):146-57.

2310022108  22107  22106  22105  22103  22109 22137 22102  22110    e-ISSN 2149-7796