Correlation of systemic inflammation biomarkers and disease severity in pregnant women with COVID-19

Gündüz, Özlem; Seven, Banu; Ozgu-Erdınc, A. Seval; Ayhan, Sule Goncu; Sahin, Dilek; Tekin, Ozlem Moraloglu; Keskin, Huseyin Levent

doi:10.1590/1806-9282.20221614

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Original Article • Rev. Assoc. Med. Bras. 69 (6) • 2023 • https://doi.org/10.1590/1806-9282.20221614 copy

Correlation of systemic inflammation biomarkers and disease severity in pregnant women with COVID-19

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

OBJECTIVE:

The aim of this study was to evaluate the prognostic value of whole blood parameters, systemic inflammatory indices, and systemic inflammatory markers in pregnant women with COVID-19.

METHODS:

In this cross-sectional study, the demographic, clinical, and laboratory data (i.e., whole blood parameters, C-reactive protein, procalcitonin, ferritin, and D-dimer) of 464 pregnant women with COVID-19 who attended a tertiary hospital between January and April 2021 were reviewed. Systemic inflammatory indices (i.e., neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, platelet/neutrophil ratio, and systemic immune inflammation index) were calculated. Asymptomatic and mildly symptomatic pregnant women were classified as Group 1 (n=413), and those with severe disease were classified as Group 2 (n=51).

RESULTS:

Lymphocyte count and lymphocyte percentage in whole blood parameters were significantly lower (p<0.05), and C-reactive protein, ferritin, and procalcitonin values were higher in Group 2 (p<0.05). Systemic inflammatory indices [neutrophil/lymphocyte ratio (4.7±2.9 (1.1–21.2) vs 7.5±4.7 (2.13–23.2)), platelet/lymphocyte ratio (191.1±104.3 (53.0–807.1) vs 269.5±118.9 (105.0–756.0)), systemic immune inflammation index (1,000±663 (209–5,231) vs 1,630±1,314 (345–7,006))] were found statistically significantly higher in severe disease group (p<0.001).

CONCLUSION:

Evidence in this study indicates that neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, and systemic immune inflammation index at first admission are simple, rapid, and inexpensive indices in predicting the prognosis of COVID-19 in pregnant women.

KEYWORDS:
COVID-19; Pregnancy; Inflammation; Neutrophil; Lymphocyte

	Group 1 (n=413) (asymptomatic/mildly symptomatic)	Group 2 (n=51) (severe disease)	p-value
Age^* * Mean±SD (min–max);	28.7±5.5 (17–44)	30.5±5.3 (19–41)	0.030 ^† † independent sample t-test.
Gravida (n)^* * Mean±SD (min–max);	2.24±1.35 (1–10)	2.45±1.39 (1–7)	0.288^† † independent sample t-test.
Parity (n)^* * Mean±SD (min–max);	0.88±1.05 (0–9)	0.98±0.86 (0–3)	0.527^† † independent sample t-test.
Abortus (n)^* * Mean±SD (min–max);	0.35±0.70 (0–5)	0.43±0.78 (0–3)	0.462^† † independent sample t-test.
Gestational week^* * Mean±SD (min–max);	23.5±10.5 (5–41)	27.2±7.2 (8–38)	0.014 ^† † independent sample t-test.

	Group 1 (n =413) (Asymptomatic / mild symptomatic)	Group 2 (n =51) (Severe Disease)	p
Leukocyte (n/mm³)^* * Mean±SD (min–max);	7,345±2,812 (2,680–27,000)	7,256±3,722 (2,780–25,600)	0.830^† † independent sample t-test;
Neutrophil (n/mm³)^* * Mean±SD (min–max);	5,401±2,274 (1,500–18,400)	5,988±3,483 (1,800–23,200)	0.105^† † independent sample t-test;
Lymphocyte (n/mm³)^* * Mean±SD (min–max);	1,330±567 (250–4,170)	873±307 (250–1,750)	<0.001 ^† † independent sample t-test;
Lymphocyte <800/mm³^ n (%);	72 (%17.4)	23 (%45.1)	<0.001 ^‡ ‡ chi-square test.
Lymphocyte (%)^* * Mean±SD (min–max);	19.0±7.1 (1.0–42.8)	13.7±5.4 (3.9–29.0)	<0.001 ^† † independent sample t-test;
Hemoglobin (g/dL)^* * Mean±SD (min–max);	12.2±1.3 (8.0–15.6)	11.8±1.4 (8.8–15.0)	0.052^† † independent sample t-test;
Hemotocrit (%)^* * Mean±SD (min–max);	36.9±3.7 (24.0–47.8)	35.9±4.2 (25.7–45.0)	0.061^† † independent sample t-test;
Thrombocyte (n/mm³)^* * Mean±SD (min–max);	214,990±58,273 (79,000–419,000)	211,294±55,274 (110,000–366,000)	0.668^† † independent sample t-test;
MPV (fL)^* * Mean±SD (min–max);	8.7±1.2 (6.4–16.2)	8.7±1.2 (6.7–13.9)	0.724^† † independent sample t-test;
CRP (mg/L)^* * Mean±SD (min–max);	19.7±21.4 (0.5–156)	61.6±32.0 (0.075–0.142)	<0.001 ^† † independent sample t-test;
CRP >50 mg/L^ n (%);	31 (%7.5)	33 (%64.7)	<0.001 ^‡ ‡ chi-square test.
D-Dimer (μg/L)^* * Mean±SD (min–max);	1,587±1,438 (200–1,240)	1,892±1,242 (200–5,500)	0.147^† † independent sample t-test;
D-Dimer >1,000 μg/L^ n (%);	231 (%55.9)	38 (%74.5)	0.011‡
Ferritin (ng/mL)^* * Mean±SD (min–max);	35.6±42.1 (1–320)	133.1±215.3 (8–1,341)	<0.001 ^† † independent sample t-test;
Ferritin >500 ng/mL^ n (%);	0	2 (%3.9)	<0.001 ^‡ ‡ chi-square test.
Procalcitonin (μg/L)^* * Mean±SD (min–max);	0.05±0.10 (0.03–1.5)	1.47±9.30 (0.03–66.5)	0.002 ^† † independent sample t-test;
NLO^* * Mean±SD (min–max);	4.7±2.9 (1.1–21.2)	7.5±4.7 (2.13–23.2)	<0.001 ^† † independent sample t-test;
PLO^* * Mean±SD (min–max);	191.1±104.3 (53.0–807.1)	269.5±118.9 (105.0–756.0)	<0.001 ^† † independent sample t-test;
TNO^* * Mean±SD (min–max);	45.4±20.0 (10.0–150.3)	42.5±18.5 (10.6–90.0)	0.322^† † independent sample t-test;
SII^* * Mean±SD (min–max);	1,000±663 (209–5,231)	1,630±1,314 (345–7,006)	<0.001 ^† † independent sample t-test;

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[1] *Corresponding author: dr.ozlem-yasar@hotmail.com