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Bruno AM, Allshouse AA, Benson AE, Yost CC, Metz TD, Varner MW, Silver RM, Branch DW. Thrombotic Markers in Pregnant Patients with and without SARS-CoV-2 Infection. Am J Perinatol 2024; 41:e3202-e3209. [PMID: 37967868 DOI: 10.1055/a-2211-5052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is associated with coagulation abnormalities and increased risk for venous and arterial thrombi. This study aimed to evaluate D-dimer levels and lupus anticoagulant (LAC) positivity in pregnant individuals with and without Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. STUDY DESIGN This was a prospective cohort study of pregnant individuals delivering at a single academic institution from April 2020 to March 2022. Individuals with a positive SARS-CoV-2 result during pregnancy were compared with a convenience sample of those without a positive SARS-CoV-2 result. For individuals with SARS-CoV-2 infection, severity was assessed based on the National Institutes of Health classification system. The primary outcome was D-dimer level measured during delivery admission. The secondary outcomes were LAC positivity and thromboembolic events. Outcomes were compared between individuals with and without a positive SARS-CoV-2 result, and further by disease severity. RESULTS Of 98 participants, 77 (78.6%) were SARS-CoV-2 positive during pregnancy. Among individuals with SARS-CoV-2 infection, severity was asymptomatic in 20 (26.0%), mild in 13 (16.9%), moderate in 4 (5.2%), severe in 38 (49.4%), and critical in 2 (2.6%). The D-dimer concentration at delivery did not significantly differ between those with a SARS-CoV-2 positive result compared with those without (mean 2.03 µg/mL [95% confidence interval {CI} 1.72-2.40] vs. 2.37 µg/mL [95% CI 1.65-3.40]; p = 0.43). Three individuals (4%) with SARS-CoV-2 infection and none (0%) without infection were LAC positive (p = 0.59). There were no clinically apparent thromboses in either group. D-dimer concentrations and LAC positive results did not differ by COVID-19 severity. CONCLUSION Thrombotic markers did not differ in pregnant individuals by SARS-CoV-2 infection; however, high rates of LAC positivity were detected. KEY POINTS · Thrombotic markers did not differ in pregnant individuals by SARS-CoV-2 infection.. · Higher than expected rates of LAC positivity were detected.. · There were no clinically apparent thromboses..
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Affiliation(s)
- Ann M Bruno
- Department of Obstetrics & Gynecology, University of Utah Health, Salt Lake City, Utah
- Department of Obstetrics & Gynecology, Intermountain Health, Salt Lake City, Utah
| | - Amanda A Allshouse
- Department of Obstetrics & Gynecology, University of Utah Health, Salt Lake City, Utah
| | - Ashley E Benson
- Department of Obstetrics & Gynecology, Oregon Health and Science University, Portland, Oregon
| | - Christian Con Yost
- Department of Obstetrics & Gynecology, University of Utah Health, Salt Lake City, Utah
- Molecular Medicine Program, Molecular Medicine Program, University of Utah, Salt Lake City, Utah
| | - Torri D Metz
- Department of Obstetrics & Gynecology, University of Utah Health, Salt Lake City, Utah
- Department of Obstetrics & Gynecology, Intermountain Health, Salt Lake City, Utah
| | - Michael W Varner
- Department of Obstetrics & Gynecology, University of Utah Health, Salt Lake City, Utah
| | - Robert M Silver
- Department of Obstetrics & Gynecology, University of Utah Health, Salt Lake City, Utah
| | - D Ware Branch
- Department of Obstetrics & Gynecology, University of Utah Health, Salt Lake City, Utah
- Department of Obstetrics & Gynecology, Intermountain Health, Salt Lake City, Utah
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Vashakidze N, Mateshvili A, Pachkoria E, Ratiani L. Management of COVID-19-Associated Acute Respiratory Distress Syndrome (ARDS) During Pregnancy Following In Vitro Fertilization (IVF). Cureus 2024; 16:e57223. [PMID: 38686259 PMCID: PMC11056601 DOI: 10.7759/cureus.57223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2024] [Indexed: 05/02/2024] Open
Abstract
Coronavirus disease 2019 (COVID-19), the disease caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is recognized for its heterogeneous clinical presentation, complex pathophysiology, and broad spectrum of manifestations. Obstetric patients have been a subject of considerable interest due to their potential vulnerability to more severe infection and adverse pregnancy outcomes, exemplified by this report of a 43-year-old pregnant female with severe COVID-19 infection and respiratory complications. This case report aims to contribute to the existing scientific knowledge by presenting a detailed clinical profile of a patient with COVID-19 who achieved pregnancy through in vitro fertilization (IVF) and discussing the management and outcomes of the infection. The neonate's negative COVID-19 tests suggest no intrauterine transmission; prompt medical interventions, including mechanical ventilation and targeted antibiotic therapy, were implemented to stabilize her condition. Close collaboration among the multidisciplinary team and careful monitoring of vital functions and laboratory parameters were crucial in managing the patient's complex condition. Thus, this case highlights the importance of a comprehensive and multidisciplinary approach in managing severe COVID-19 cases in pregnancy, emphasizing the need for prompt recognition of complications and timely intervention.
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Affiliation(s)
- Nika Vashakidze
- Faculty of Medicine, Tbilisi State Medical University, Tbilisi, GEO
| | - Ana Mateshvili
- Faculty of Medicine, Tbilisi State Medical University, Tbilisi, GEO
| | - Elene Pachkoria
- Department of Infectious Diseases, The First University Clinic of Tbilisi State Medical University, Tbilisi, GEO
| | - Levan Ratiani
- Department of Anesthesiology and Reanimatology/Department of Infectious Diseases, The First University Clinic of Tbilisi State Medical University, Tbilisi, GEO
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Januszewski M, Ziuzia-Januszewska L, Kudan M, Pluta K, Klapaczyński J, Wierzba W, Maciejewski T, Jakimiuk AA, Jakimiuk AJ. Liver damage profile in COVID-19 pregnant patients. Cell Commun Signal 2024; 22:5. [PMID: 38166966 PMCID: PMC10762912 DOI: 10.1186/s12964-023-01285-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/19/2023] [Indexed: 01/05/2024] Open
Abstract
INTRODUCTION SARS-CoV-2 unsparingly impacts all areas of medicine. Pregnant women are particularly affected by the pandemic and COVID-19 related liver damage seems to be another threat to maternal and fetal health. The aim of this study is to define liver damage profile including bile acids serum levels in COVID-19 pregnant patients and to determine predictors of disease aggravation and poor obstetrics outcomes. METHODS This study has been carried out in the Obstetrics and Gynecology Department, at the National Medical Institute in Warsaw, Poland between 01.02.2021 and 01.11.2022 The study cohort comprises 148 pregnant patients with COVID-19 and 102 pregnant controls who has been tested negative for SARS-CoV-2. RESULTS COVID-19 pregnant patients presented liver involvement at admission in 41,9%. Hepatotoxic damage accounted for 27 (19.85%), cholestatic type was diagnosed in 11 (8.09%) and mixed type of liver injury was presented in 19 (13.97%) of patients. Higher serum levels of AST, ALT, GGT, total bilirubin and bile acids as well as mixed type of liver injury at admission were correlated with severe form of an illness. AST and ALT above upper reference limit as well as hepatotoxic type of liver damage predisposed pregnant patients with COVID-19 to poor obstetrics outcomes. CONCLUSION Hepatic damage in pregnant women with COVID-19 is a common, mild, transaminase-dominant, or mixed type of injury, and often correlates with elevated inflammatory markers. SARS-CoV-2 test should be performed as a part of differential diagnosis in elevated liver function tests. Although bile acids serum levels were commonly elevated they seems to be clinically irrelevant in terms of pregnancy outcomes. Video Abstract.
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Affiliation(s)
- Marcin Januszewski
- Department of Obstetrics and Gynecology, National Medical Institute of the Ministry of Interior and Administration, Wołoska 137, 02-507, Warsaw, Poland
| | - Laura Ziuzia-Januszewska
- Department of Otolaryngology, National Medical Institute of the Ministry of Interior and Administration, Wołoska 137, 02-507, Warsaw, Poland
| | - Michal Kudan
- Department of Obstetrics and Gynecology, National Medical Institute of the Ministry of Interior and Administration, Wołoska 137, 02-507, Warsaw, Poland
| | - Kamil Pluta
- Department of Obstetrics and Gynecology, National Medical Institute of the Ministry of Interior and Administration, Wołoska 137, 02-507, Warsaw, Poland
| | - Jakub Klapaczyński
- Department of Hepatology, National Medical Institute of the Ministry of Interior and Administration, Wołoska 137, 02-507, Warsaw, Poland
| | - Waldemar Wierzba
- Department of Obstetrics and Gynecology, National Medical Institute of the Ministry of Interior and Administration, Wołoska 137, 02-507, Warsaw, Poland
| | - Tomasz Maciejewski
- Department of Obstetrics and Gynecology, Institute of Mother and Child, Kasprzaka 17a, 01-211, Warsaw, Poland
| | - Alicja A Jakimiuk
- Department of Plastic Surgery, National Medical Institute of the Ministry of Interior and Administration, Wołoska 137, 02-507, Warsaw, Poland
| | - Artur J Jakimiuk
- Department of Obstetrics and Gynecology, National Medical Institute of the Ministry of Interior and Administration, Wołoska 137, 02-507, Warsaw, Poland.
- Center for Reproductive Health, Institute of Mother and Child, Kasprzaka 17a, 01-211, Warsaw, Poland.
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Zehra SM, Parkar S, Kazi Z, Pethani A, Malik A, Mirza A, Abro F, Jabbar HA, Saleem AF. Impact of COVID-19 on feto-maternal and neonatal health in Karachi, Pakistan, A retrospective cohort study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002139. [PMID: 37566567 PMCID: PMC10420353 DOI: 10.1371/journal.pgph.0002139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 06/15/2023] [Indexed: 08/13/2023]
Abstract
Scientific literature suggests that pregnant women are at greater risk of acquiring a more severe form of COVID-19 exposing both mother and child to a higher risk of obstetric and neonatal complications. These include increased hospitalization rates, ICU admissions, or ventilatory support among pregnant women when compared to COVID-19 negative pregnant womenA case-control study was conducted at the Aga Khan University Hospital, Karachi, Pakistan with the objective of evaluating the clinical presentation of COVID-19 in pregnancy and its effect on maternal and neonatal outcomes. Data was retrospectively collected from April 2020 till January 2022 of obstetric patients with COVID-19 positive cases and were compared with COVID-19 negative cases from the same time. A total of 491 women were included in the study, 244 cases and 247 controls. The most common complication amongst cases was gestational diabetes mellitus (n = 59, 24%), followed by gestational hypertension (n = 16, 31.7%), pre-eclampsia (n = 13, 5%) Pre-rupture of membrane (85.7%). Amongst the COVID positive mothers the most common presenting complaints were fever followed by dry cough, headache, and shortness of breath. It was observed that COVID-19 did not result in increased adverse maternal or neonatal outcomes compared to COVID-19 negative mothers.
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Affiliation(s)
| | - Sadia Parkar
- Department of Paediatrics, Aga Khan University Hospital, Karachi, Pakistan
| | - Zaubina Kazi
- Department of Paediatrics, Aga Khan University Hospital, Karachi, Pakistan
| | - Asma Pethani
- Department of Paediatrics, Aga Khan University Hospital, Karachi, Pakistan
| | - Ayesha Malik
- Department of Obstetrics & Gynaecology, Aga Khan University Hospital, Karachi, Pakistan
| | - Adnan Mirza
- Department of Paediatrics, Aga Khan University Hospital, Karachi, Pakistan
| | - Falak Abro
- Department of Paediatrics, Aga Khan University Hospital, Karachi, Pakistan
| | | | - Ali Faisal Saleem
- Department of Paediatrics, Aga Khan University Hospital, Karachi, Pakistan
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Paixão JTR, Santos CDJSE, França APFDM, Lima SS, Laurentino RV, Fonseca RRDS, Vallinoto ACR, Oliveira-Filho AB, Machado LFA. 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. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6415. [PMID: 37510647 PMCID: PMC10378832 DOI: 10.3390/ijerph20146415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/26/2023] [Accepted: 06/29/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND The COVID-19 pandemic has had a great impact on pregnant women due to the broad clinical spectrum of the disease. The present study investigated the profile of three biomarkers during hospital admission of pregnant women-D-dimer, C-reactive protein (CRP), and ferritin-and their correlation with the severity and outcome of COVID-19. METHODS The cross-sectional study included 226 pregnant women hospitalized in the city of Belém, Pará, Northern Brazil, from April 2020 to July 2021. Epidemiological and laboratory data were obtained from medical records, and all pregnant women underwent RT-PCR molecular testing for the detection of SARS-CoV-2. RESULTS In total, 121 (53.5%) were positive and 105 (46.5%) were negative for SARS-CoV-2 using RT-PCR. Most pregnant women (49.5%) with COVID-19 were between 26 and 34 years old, were residing in the interior of the state of Pará (51.2%), and were in the third gestational trimester (71.9%). In addition, 71.1% of them were admitted to the ward and 28.9% were admitted to the intensive care unit (ICU), with 90.9% surviving COVID-19. The concentrations of D-dimer (p = 0.0122) and ferritin (p ≤ 0.0001) were significantly higher among pregnant women with COVID-19, especially among those hospitalized in the ICU. CONCLUSION Ferritin and D-dimer seem to serve as important biomarkers for the prognosis of COVID-19 in pregnant women, which was not observed for CRP.
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Affiliation(s)
- Jenephy Thalita Rosa Paixão
- Biology of Infectious and Parasitic Agents Post-Graduate Program, Federal University of Pará, Belém 66075-110, PA, Brazil
- Virology Laboratory, Institute of Biological Sciences, Federal University of Pará, Belém 66075-110, PA, Brazil
| | - Carolinne de Jesus Santos E Santos
- Biology of Infectious and Parasitic Agents Post-Graduate Program, Federal University of Pará, Belém 66075-110, PA, Brazil
- Virology Laboratory, Institute of Biological Sciences, Federal University of Pará, Belém 66075-110, PA, Brazil
| | - Ana Paula Figueiredo de Montalvão França
- Biology of Infectious and Parasitic Agents Post-Graduate Program, Federal University of Pará, Belém 66075-110, PA, Brazil
- Virology Laboratory, Institute of Biological Sciences, Federal University of Pará, Belém 66075-110, PA, Brazil
| | - Sandra Souza Lima
- Virology Laboratory, Institute of Biological Sciences, Federal University of Pará, Belém 66075-110, PA, Brazil
| | - Rogério Valois Laurentino
- Virology Laboratory, Institute of Biological Sciences, Federal University of Pará, Belém 66075-110, PA, Brazil
| | - Ricardo Roberto de Souza Fonseca
- Biology of Infectious and Parasitic Agents Post-Graduate Program, Federal University of Pará, Belém 66075-110, PA, Brazil
- Virology Laboratory, Institute of Biological Sciences, Federal University of Pará, Belém 66075-110, PA, Brazil
| | | | - Aldemir Branco Oliveira-Filho
- Study and Research Group on Vulnerable Populations, Institute for Coastal Studies, Federal University of Pará, Bragança 68600-000, PA, Brazil
| | - Luiz Fernando Almeida Machado
- Biology of Infectious and Parasitic Agents Post-Graduate Program, Federal University of Pará, Belém 66075-110, PA, Brazil
- Virology Laboratory, Institute of Biological Sciences, Federal University of Pará, Belém 66075-110, PA, Brazil
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Hrubaru I, Motoc A, Moise ML, Miutescu B, Citu IM, Pingilati RA, Popescu DE, Dumitru C, Gorun F, Olaru F, Erdelean I, Forga M, Nicolae N, Citu C. The Predictive Role of Maternal Biological Markers and Inflammatory Scores NLR, PLR, MLR, SII, and SIRI for the Risk of Preterm Delivery. J Clin Med 2022; 11:jcm11236982. [PMID: 36498555 PMCID: PMC9738289 DOI: 10.3390/jcm11236982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 11/23/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022] Open
Abstract
In many countries, preterm birth, defined as birth before 37 completed weeks of gestation, is the primary cause of infant death and morbidity. An increasing body of research suggests that inflammation (both clinical and subclinical) plays a significant role in inducing preterm labor or developing pregnancy problems that lead to premature birth. Consequently, the purpose of this research was to determine the predictive value of the Neutrophil-Lymphocyte Ratio (NLR), derived Neutrophil-Lymphocyte Ratio (dNLR), Monocytes-to-Lymphocyte Ratio (MLR), Platelets-to-Lymphocyte Ratio (PLR), Systemic immune-inflammation index (SII), and systemic inflammatory response index (SIRI), for premature delivery. A retrospective study analyzed a total of 243 eligible pregnancies that resulted in a preterm birth during 2020 and 2021. A control group without a history of preterm birth was matched by age and trimester of laboratory analysis at a 1:1 ratio. Although the number of comorbidities was similar among study groups, the body-mass index estimated for the week of gestation was significantly higher among the patients from the prematurity group, as well as the prevalence of urinary tract infections and smoking. Laboratory data showed that patients with a preterm birth had significantly higher white blood cell count and monocytes, but significantly lower lymphocytes, platelets, and hemoglobin. The NLR, dNLR, PLR, and MLR scores showed to be significantly higher among patients from the prematurity group, but SII and SIRI were not significantly different between the study groups. It was observed that the AUC values of NLR, dNLR, PLR, and MLR were higher than 0.600, respectively NLR had the highest value among the tested scores (AUC = 0.694) and the highest sensitivity in this study (71%). The highest sensibility was achieved by dNLR, with 70%, and an AUC value of 0.655 (p-value = 0.022). PLR had the second-highest AUC value (0.682) and the best score in terms of sensitivity (70%) and sensibility (69%) (p-value = 0.015). Lastly, MLR had the lowest significant AUC score (0.607) and lowest sensitivity/sensibility. The significant cut-off values for the inflammatory scores were 9.0 for NLR, 9.8 for dNLR, 250 for PLR, and 4.07 for MLR. After evaluating the importance of these inflammatory scores, further clinical applications should be conducted to confirm the results and improve therapy and care to reduce the burden of premature deliveries.
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Affiliation(s)
- Ingrid Hrubaru
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Andrei Motoc
- Department of Anatomy and Embryology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Marius Liviu Moise
- Department of Radiology, “Premiere” Hospital—“Regina Maria”, Calea Aradului 113, 300643 Timisoara, Romania
- Correspondence:
| | - Bogdan Miutescu
- Department of Gastroenterology and Hepatology, “Premiere” Hospital—“Regina Maria”, Calea Aradului 113, 300643 Timisoara, Romania
| | - Ioana Mihaela Citu
- Department of Internal Medicine I, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Raja Akshay Pingilati
- Malla Reddy Institute of Medical Sciences, Suraram Main Road 138, Hyderabad 500055, India
| | - Daniela-Eugenia Popescu
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
- Department of Neonatology, Premiere Hospital, Regina Maria Health Network, 300645 Timisoara, Romania
| | - Catalin Dumitru
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Florin Gorun
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Flavius Olaru
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Izabella Erdelean
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Marius Forga
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Nicoleta Nicolae
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Cosmin Citu
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
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Kovacevic P, Topolovac S, Dragic S, Jandric M, Momcicevic D, Zlojutro B, Kovacevic T, Loncar-Stojiljkovic D, Djajic V, Skrbic R, Ećim-Zlojutro V. Characteristics and Outcomes of Critically Ill Pregnant/Postpartum Women with COVID-19 Pneumonia in Western Balkans, The Republic of Srpska Report. Medicina (B Aires) 2022; 58:medicina58121730. [PMID: 36556932 PMCID: PMC9781202 DOI: 10.3390/medicina58121730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/27/2022] [Accepted: 11/09/2022] [Indexed: 11/29/2022] Open
Abstract
Background and Objectives: Coronavirus disease 2019 (COVID-19) is a novel infectious disease that has spread worldwide. As of 5 March 2020, the COVID-19 pandemic has resulted in approximately 111,767 cases and 6338 deaths in the Republic of Srpska and 375,554 cases and 15,718 deaths in Bosnia and Herzegovina. Our objective in the present study was to determine the characteristics and outcomes of critically ill pregnant/postpartum women with COVID-19 in the Republic of Srpska. Materials and Methods: The retrospective observational study of prospectively collected data included all critically ill pregnant/postpartum women with COVID-19 in a university-affiliated hospital between 1 April 2020 and 1 April 2022. Infection was confirmed by real-time reverse transcriptase polymerase chain reaction (RT-PCR) from nasopharyngeal swab specimens and respiratory secretions. Patients' demographics, clinical and laboratory data, pharmacotherapy, and neonatal outcomes were analysed. Results: Out of the 153 registered pregnant women with COVID-19 treated at the gynaecology department of the University Clinical Centre of the Republic of Srpska, 19 (12.41%) critically ill pregnant/postpartum women (median age of 36 (IQR, 29-38) years) were admitted to the medical intensive care unit (MICU). The mortality rate was 21.05% (four patients) during the study period. Of all patients (19), 14 gave birth (73.68%), and 4 (21.05%) were treated with veno-venous extracorporeal membrane oxygenation (vvECMO). Conclusions: Fourteen infants were born prematurely and none of them died during hospitalisation. A high mortality rate was detected among the critically ill pregnant/postpartum patients treated with mechanical ventilation and vvECMO in the MICU. The preterm birth rate was high in patients who required a higher level of life support (vvECMO and ventilatory support).
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Affiliation(s)
- Pedja Kovacevic
- Medical Intensive Care Unit, University Clinical Centre of The Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina
- Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina
- Correspondence:
| | - Sandra Topolovac
- Medical Intensive Care Unit, University Clinical Centre of The Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina
| | - Sasa Dragic
- Medical Intensive Care Unit, University Clinical Centre of The Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina
- Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina
| | - Milka Jandric
- Medical Intensive Care Unit, University Clinical Centre of The Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina
| | - Danica Momcicevic
- Medical Intensive Care Unit, University Clinical Centre of The Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina
- Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina
| | - Biljana Zlojutro
- Medical Intensive Care Unit, University Clinical Centre of The Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina
| | - Tijana Kovacevic
- Medical Intensive Care Unit, University Clinical Centre of The Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina
- Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina
| | | | - Vlado Djajic
- Medical Intensive Care Unit, University Clinical Centre of The Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina
- Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina
| | - Ranko Skrbic
- Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina
| | - Vesna Ećim-Zlojutro
- Medical Intensive Care Unit, University Clinical Centre of The Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina
- Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina
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Djusad S, Irwinda R, Harzif AK, Surya R, Wibowo N, Saroyo YB, Adjie JMS. Determining laboratory parameters in pregnant women with severe COVID-19. SAGE Open Med 2022; 10:20503121221132168. [PMID: 36277440 PMCID: PMC9579820 DOI: 10.1177/20503121221132168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 09/23/2022] [Indexed: 11/11/2022] Open
Abstract
Objective Coronavirus disease causes a wide spectrum of clinical picture in pregnant women. There are still a few studies concerning laboratory parameters to differentiate the severity of coronavirus disease-19 in pregnant patients. This article aims to identify the cut-off on laboratory parameters between pregnant women with asymptomatic/mild/moderate and severe/critical coronavirus disease-19 illness. Methods All coronavirus disease-19 pregnant women coming to Dr. Cipto Mangunkusumo hospital between January and August 2021 were recruited into this cross-sectional study. All data extracted from medical records were classified into demographic characteristics and laboratory parameters. We defined demographic characteristics as age, parity, systolic, and diastolic blood pressure, heart rate, temperature, respiratory rate, and oxygen saturation. Laboratory parameters measured in this study consisted of complete blood count, renal function test including urea, creatinine, liver function test including aspartate transferase, alanine transferase, infection marker test including procalcitonin, C-reactive protein, interleukin-6, cycle threshold values, ferritin, coagulation test including d-dimer, fibrinogen, random blood glucose, albumin, electrolytes. Data analysis was performed using SPSS statistics. Results There were 159 cases assessed in this study consisting of 130 (81.8%) patients with asymptomatic/mild/moderate illness and 29 (18.2%) patients with severe/critical illness of coronavirus disease-19. Of 28 laboratory parameters, 12 of them were significant statistically; thus, it resulted to make a cut-off using receiver operating characteristic curve and show relative risk, and 95% confidence interval. In multivariate analysis that aspartate transferase, D-dimer, and albumin were laboratory parameters impacted to the severity of coronavirus disease-19 in pregnant women. The area under receiver operating characteristic curve was 0.834 (95% CI 0.736-0.932). Conclusion Of all laboratory parameters, urea, aspartate transferase, alanine transferase, procalcitonin, C-reactive protein, lactate dehydrogenase (LDH), ferritin, D-dimer, random blood glucose, cycle threshold values, albumin, and chloride differs between asymptomatic/mild/moderate, and severe/critical illness coronavirus disease-19 in pregnant women; aspartate transferase, D-dimer, and albumin were laboratory parameters impacted the most to the severity of coronavirus disease-19 in pregnant women.
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Affiliation(s)
- Suskhan Djusad
- Suskhan Djusad, Department of Obstetrics
and Gynecology, Dr. Cipto Mangunkusumo Hospital, Jakarta/Faculty of Medicine,
Universitas Indonesia, Jakarta, DKI Jakarta, Indonesia.
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9
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Sarma AA, Aggarwal NR, Briller JE, Davis M, Economy KE, Hameed AB, Januzzi JL, Lindley KJ, Mattina DJ, McBay B, Quesada O, Scott NS. The Utilization and Interpretation of Cardiac Biomarkers During Pregnancy: JACC: Advances Expert Panel. JACC. ADVANCES 2022; 1:100064. [PMID: 38938393 PMCID: PMC11198183 DOI: 10.1016/j.jacadv.2022.100064] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/04/2022] [Accepted: 07/06/2022] [Indexed: 06/29/2024]
Abstract
Cardiac biomarkers are widely used in the nonpregnant population when acute cardiovascular (CV) pathology is suspected; however, the behavior of these biomarkers in the context of pregnancy is less well understood. Pregnant individuals often have symptoms that mimic those of cardiac dysfunction, and complications of pregnancy may include CV disease. This paper will summarize our current knowledge on the use of cardiac biomarkers in pregnancy and provide suggestions on how to use these tools in clinical practice based on the available evidence. Natriuretic peptides and troponin should not be measured routinely in uncomplicated pregnancy, where values should remain low as in the nonpregnant population. In the context of pre-existing or suspected CV disease, these biomarkers retain their negative predictive value. Elevations of both natriuretic peptides and troponin may occur without clear clinical significance in the immediate postpartum period. Elevations of these markers should always prompt further investigation into possible CV pathology.
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Affiliation(s)
- Amy A. Sarma
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Niti R. Aggarwal
- Department of Cardiovascular diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Joan E. Briller
- Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Melinda Davis
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Katherine E. Economy
- Harvard Medical School, Boston, Massachusetts, USA
- Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | | | - James L. Januzzi
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Baim Institute for Clinical Research, Boston, Massachusetts, USA
| | - Kathryn J. Lindley
- Cardiovascular Division, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Deirdre J. Mattina
- Division of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Brandon McBay
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Odayme Quesada
- Women’s Heart Center, The Christ Hospital Heart and Vascular Institute, Cincinnati, Ohio, USA
- The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, Ohio, USA
| | - Nandita S. Scott
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - American College of Cardiology Cardiovascular Disease in Women Committee and Cardio-obstetrics Work Group
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Cardiovascular diseases, Mayo Clinic, Rochester, Minnesota, USA
- Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois, USA
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Brigham and Women’s Hospital, Boston, Massachusetts, USA
- University of California, Irvine, Orange, California, USA
- Baim Institute for Clinical Research, Boston, Massachusetts, USA
- Cardiovascular Division, Washington University in St. Louis, St. Louis, Missouri, USA
- Division of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
- Women’s Heart Center, The Christ Hospital Heart and Vascular Institute, Cincinnati, Ohio, USA
- The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, Ohio, USA
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10
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Guo X, Semerci N, De Assis V, Kayisli UA, Schatz F, Steffensen TS, Guzeloglu-Kayisli O, Lockwood CJ. Regulation of Proinflammatory Molecules and Tissue Factor by SARS-CoV-2 Spike Protein in Human Placental Cells: Implications for SARS-CoV-2 Pathogenesis in Pregnant Women. Front Immunol 2022; 13:876555. [PMID: 35464466 PMCID: PMC9022221 DOI: 10.3389/fimmu.2022.876555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/17/2022] [Indexed: 12/24/2022] Open
Abstract
SARS-CoV-2 infects cells via binding to ACE2 and TMPRSS2, which allows the virus to fuse with host cells. The viral RNA is detected in the placenta of SARS-CoV-2-infected pregnant women and infection is associated with adverse pregnancy complications. Therefore, we hypothesize that SARS-CoV-2 infection of placental cells induces pro-inflammatory cytokine release to contribute to placental dysfunction and impaired pregnancy outcomes. First, expression of ACE2 and TMPRSS2 was measured by qPCR in human primary cultured term cytotrophoblasts (CTBs), syncytiotrophoblast (STBs), term and first trimester decidual cells (TDCs and FTDCs, respectively), endometrial stromal cells (HESCs) as well as trophoblast cell lines HTR8, JEG3, placental microvascular endothelial cells (PMVECs) and endometrial endothelial cells (HEECs). Later, cultured HTR8, JEG3, PMVECs and HEECs were treated with 10, 100, 1000 ng/ml of recombinant (rh-) SARS-CoV-2 S-protein ± 10 ng/ml rh-IFNγ. Pro-inflammatory cytokines IL-1β, 6 and 8, chemokines CCL2, CCL5, CXCL9 and CXCL10 as well as tissue factor (F3), the primary initiator of the extrinsic coagulation cascade, were measured by qPCR as well as secreted IL-6 and IL-8 levels were measured by ELISA. Immunohistochemical staining for SARS-CoV-2 spike protein was performed in placental specimens from SARS-CoV-2–positive and normal pregnancies. ACE2 levels were significantly higher in CTBs and STBs vs. TDCs, FTDCs and HESCs, while TMPRSS2 levels were not detected in TDCs, FTDCs and HESCs. HTR8 and JEG3 express ACE2 and TMPRSS2, while PMVECs and HEECs express only ACE2, but not TMPRSS2. rh-S-protein increased proinflammatory cytokines and chemokines levels in both trophoblast and endothelial cells, whereas rh-S-protein only elevated F3 levels in endothelial cells. rh-IFNγ ± rh-S-protein augments expression of cytokines and chemokines in trophoblast and endothelial cells. Elevated F3 expression by rh-IFNγ ± S-protein was observed only in PMVECs. In placental specimens from SARS-CoV-2-infected mothers, endothelial cells displayed higher immunoreactivity against spike protein. These findings indicated that SARS-CoV-2 infection in placental cells: 1) induces pro-inflammatory cytokine and chemokine release, which may contribute to the cytokine storm observed in severely infected pregnant women and related placental dysfunction; and 2) elevates F3 expression that may trigger systemic or placental thrombosis.
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Affiliation(s)
- Xiaofang Guo
- Department of Obstetrics and Gynecology, University of South Florida, Morsani College of Medicine, Tampa, FL, United States
| | - Nihan Semerci
- Department of Obstetrics and Gynecology, University of South Florida, Morsani College of Medicine, Tampa, FL, United States
| | - Viviana De Assis
- Department of Obstetrics and Gynecology, University of South Florida, Morsani College of Medicine, Tampa, FL, United States
| | - Umit A Kayisli
- Department of Obstetrics and Gynecology, University of South Florida, Morsani College of Medicine, Tampa, FL, United States
| | - Frederick Schatz
- Department of Obstetrics and Gynecology, University of South Florida, Morsani College of Medicine, Tampa, FL, United States
| | - Thora S Steffensen
- Department of Pathology, Tampa General Hospital, Tampa, FL, United States
| | - Ozlem Guzeloglu-Kayisli
- Department of Obstetrics and Gynecology, University of South Florida, Morsani College of Medicine, Tampa, FL, United States
| | - Charles J Lockwood
- Department of Obstetrics and Gynecology, University of South Florida, Morsani College of Medicine, Tampa, FL, United States
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11
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Sharma R, Verma R, Solanki HK, Seth S, Mishra N, Sharma R, Mishra P, Singh M. Impact of Severity of Maternal COVID-19 Infection on Perinatal Outcome and Vertical Transmission Risk: An Ambispective Study From North India. Cureus 2022; 14:e21820. [PMID: 35261838 PMCID: PMC8894681 DOI: 10.7759/cureus.21820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2022] [Indexed: 12/15/2022] Open
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12
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Arslan B, Bicer IG, Sahin T, Vay M, Dilek O, Destegul E. Clinical characteristics and hematological parameters associated with disease severity in COVID-19 positive pregnant women undergoing cesarean section: A single-center experience. J Obstet Gynaecol Res 2021; 48:402-410. [PMID: 34837446 PMCID: PMC9011896 DOI: 10.1111/jog.15108] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/11/2021] [Accepted: 11/17/2021] [Indexed: 12/11/2022]
Abstract
AIM The study aimed to describe clinical characteristics and outcomes of pregnant women with COVID-19 undergoing cesarean section, and evaluated the association of blood values at admission with severe COVID-19 disease in this group of patients. METHOD We retrospectively analyzed the clinical data of 110 patients infected with COVID-19 who underwent cesarean section at Adana City Education and Research Hospital in Turkey. The COVID-19 severity of the patients was classified as either severe or nonsevere disease according to World Health Organization of COVID-19 clinical management guidance. We compared blood values, clinical characteristics, and outcomes between severe and nonsevere patients. Receiver operating characteristics (ROC) curves analyses and area under the ROC curve (AUC) value was calculated to evaluate the predictive value of blood parameters on the COVID-19 severity. RESULTS Of the 110 women, 12 were severe cases. Severe patients had higher ferritin, neutrophil-to-lymphocyte ratio (NLR), lactate dehydrogenase (LDH), alanine transaminase (ALT), aspartate transaminase (AST), and procalcitonin levels on admission (p < 0.05). The ROC analysis demonstrated AUC of NLR, LDH, AST, ALT, ferritin, and procalcitonin was 0.757, 0.856, 0.840, 0.771, 0.821, and 0.698, respectively. The LDH had a maximum specificity (90.8%), with the cutoff value of 365. The O-blood group was more likely to have severe illness than the non-O-blood group (relative risk: 3.6; 95% confidence interval; 1.2-10.4). CONCLUSION This study shows that LDH values at admission are an early and powerful predictor of severe infection for pregnant women with COVID-19 who will undergo a cesarean section.
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Affiliation(s)
- Baris Arslan
- Department of Anesthesia and Intensive Care, Adana City Education and Research Hospital, Adana, Turkey
| | - Ilhan G Bicer
- Department of Anesthesia and Intensive Care, Adana City Education and Research Hospital, Adana, Turkey
| | - Tuna Sahin
- Department of Anesthesia and Intensive Care, Adana City Education and Research Hospital, Adana, Turkey
| | - Merve Vay
- Department of Obstetrics and Gynecology, Adana City Education and Research Hospital, Adana, Turkey
| | - Okan Dilek
- Department of Radiology, Adana City Education and Research Hospital, Adana, Turkey
| | - Emre Destegul
- Department of Obstetrics and Gynecology, Adana City Education and Research Hospital, Adana, Turkey
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