Laboratory analysis of symptomatic and asymptomatic pregnant patients with SARS-CoV-2 infection

Abstract

Background : Inflammatory biomarkers have been utilized to portend disease severity in non-pregnant individuals with SARS-CoV-2 infection. However, currently limited data are available, and with mixed results, to elucidate which inflammatory biomarkers may be most associated with clinical phenotype in pregnant patients. Objective : We aimed to compare laboratory findings among pregnant patients with severe acute respiratory syndrome coronavirus (SARS-CoV-2) by symptom status and disease severity. Study Design : We retrospectively evaluated pregnant patients at an urban academic U.S. hospital with positive polymerase-chain reaction SARS-CoV-2 testing between March and October 2020, performed for reported symptoms or universal screening on admission. In our hospital, all patients with SARS-CoV-2 were recommended to have baseline laboratory testing, including leukocyte, neutrophil and lymphocyte counts; aspartate and alanine aminotransferase; high sensitivity C-reactive protein (hsCRP); procalcitonin (PCT); lactate dehydrogenase (LDH); D-dimer; and ferritin. We performed multivariable logistic regression to evaluate peak laboratory abnormalities significantly associated with symptomatic SARS-CoV-2 infection and disease severity with gestational age at diagnosis, maternal age, and obesity as covariates. The sensitivity and specificity of laboratory abnormalities to identify symptomatic versus asymptomatic infection, and severe to critical disease versus mild to moderate disease, were calculated. Results : We identified 175 pregnant patients with SARS-CoV-2, of whom 100 (57%) were symptomatic; 17 (17%) of those who were symptomatic had severe to critical disease. Laboratory data was available for 128 patients, of whom 67 (52%) were symptomatic. Compared to asymptomatic people, symptomatic people were more likely to exhibit elevated hsCRP after adjusting for gestational age (aOR 5.67, 95% CI 1.42-22.52, sensitivity 81%, specificity 43%). In symptomatic individuals, transaminitis (aOR 5.67, 95% CI 1.27-25.43), elevated PCT (aOR 16.60, 95% CI 2.61-105.46), and elevated LDH (aOR 17.55, 95% CI 2.51-122.78) were independently associated with severe to critical disease compared to mild to moderate disease after adjusting for maternal age and obesity. Sensitivity for transaminitis, PCT elevation and LDH elevation was 47%, 87% and 53%, while specificity was 89%, 63% and 90%, respectively, for differentiating disease severity. Conclusion : Inflammatory biomarkers in pregnant patients with SARS-CoV-2 exhibit vast heterogeneity, poor discriminative ability, and thereby limited clinical utility. Larger registry studies should evaluate which inflammatory biomarkers, accounting for pregnancy physiology, may be most useful for risk stratification and prognostication of pregnant patients with SARS-CoV-2 infection.

Liver damage profile in COVID-19 pregnant patients

“…In the pregnancy correlation between abnormal LFTs and disease deterioration is scarce and inconsistent. Fisher SA et al revealed that transaminitis, elevated PCT and elevated LDH were independently associated with severe to critical disease compared to mild to moderate [ 36 ]. In another work written by Choudhary et al SARS-CoV-2 the infected pregnant women with liver dysfunction manifested in higher serum levels of ALT, AST and TBIL have been documented to experience heightened inflammation, more severe disease, increased morbidity, and higher mortality rates compared to those without liver impairment [ 23 ].…”

Pregnancy Outcomes, Immunophenotyping and Immunohistochemical Findings in a Cohort of Pregnant Patients with COVID-19—A Prospective Study

“…As expected, the inflammatory syndrome associated with COVID-19 was also outlined in various studies on pregnant patients [ 37 , 38 , 39 ]. Moreover, it was demonstrated that elevated serum levels of procalcitonin and ferritin were associated with severe forms of disease [ 40 , 41 ].…”

A Review of Cardiovascular Complications among Pregnant Patients with COVID-19

“…Symptomatic pregnant patients, compared to non-pregnant patients with COVID-19, are at increased risk of more severe illness due to COVID-19 including preeclampsia, preterm delivery, and maternal mortality [ 4 ]. Compared with non-pregnant age-matched women with COVID-19, parturients with severe COVID-19 in pregnancy are more likely to be admitted to the intensive care unit, require mechanical ventilation, or necessitate advanced respiratory and hemodynamic support, including extracorporeal membrane oxygenation (ECMO) [ 5 , 6 , 7 , 8 , 9 ]. Pregnant and postpartum patients who are Black or Hispanic, of advanced maternal age, or those with comorbidities including obesity, diabetes, hypertension and lung disease may be at even higher risk for severe COVID-19 infection, maternal death, and adverse perinatal outcomes including increased cesarean delivery and hypertensive disorders of pregnancy (HDP) [ 10 , 11 , 12 , 13 ].…”