COVID-19 infection in pregnancy: a single center experience with 75 cases.

OBJECTIVES: This study aimed to summarize the clinical features, maternal, fetal, and perinatal outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) proven infections of pregnancies. MATERIAL AND METHODS: This retrospective single center study was conducted on 75 pregnant patients diagnosed of coronavirus disease 2019 (COVID-19). Demographic characteristics, clinical courses, laboratory and radiological findings, and maternal and perinatal outcomes were analyzed using medical records. RESULTS: Of the 75 pregnant women infected with COVID-19, 49 had mild infections. The most common initial symptoms were myalgia (61.4%), cough (57.9%), headache (50.9%), and dyspnea (49.1%). More than half of the patients (57.3%) on admission were in their third trimester. Three patients had pre-existing chronic illnesses (hypothyroidism, asthma and rheumatoid arthritis) and three patients had gestational diabetes. There were two cases admitted to intensive care unit, one of whom was due to COVID-19 infection. No maternal mortality was recorded. The mode of delivery was a cesarean section in 20 cases among the 35 labors. Six gestations ended in a miscarriage and 11 women gave birth prematurely. One stillbirth occurred at the 38th week of gestation. Among 37 neonates, 14 necessitated admission to neonatal intensive care unit. Neonatal mortality, congenital malformation, and mother to child transmission were not seen in the newborns. CONCLUSIONS: The results of our study suggest that the clinical course of COVID-19 infection in pregnant women was mostly asymptomatic/mild. There was also no evidence of vertical transmission of COVID-19 infection.

Comparing the predictive values of procalcitonin/albumin ratio and other inflammatory markers in determining COVID-19 severity.

Objective: To examine the relationship between COVID-19 severity and procalcitonin/albumin ratio (PAR) and compare the PAR with oft-reported inflammatory markers, including procalcitonin, white blood cell (WBC), neutrophil/lymphocyte ratio (NLR) and C-reactive protein (CRP). Methods: In this retrospective research study conducted at Sanliurfa Training and Research Hospital during May to September 2020; total, 577 adult subjects diagnosed with COVID-19 were included and categorized into two groups based on place of hospitalization: the intensive care unit (ICU) group (n=151) and the general ward (GW) group (n=426). Laboratory test results and demographic characteristics of the subjects were recorded. Results: PAR, NLR, CRP, WBC, neutrophil and procalcitonin values were markedly higher in the ICU group than in the GW group. On the contrary, lymphocyte count and albumin level were markedly lower. PAR showed positive correlations with WBC, NLR, and CRP. Multivariate analysis showed that advanced age, presence of hypertension, elevated PAR, WBC, NLR, urea and lactate dehydrogenase levels were independent risk factors associated with the need for intensive care in COVID-19 subjects. Among them, the PAR showed the highest odds ratio (5.564) for ICU admission. Additionally, the area under the ROC curve of the PAR (0.888) was markedly greater than that of WBC (0.777), NLR (0.822), CRP (0.842) and procalcitonin (0.870). Conclusions: This study revealed that PAR was superior to procalcitonin, WBC, NLR and CRP in determining COVID-19 severity. PAR was an important predictor of ICU requirement in COVID-19 cases.

Thiol level and total oxidant/antioxidant status in patients with COVID-19 infection.

BACKGROUND: Accumulating evidence suggests that oxidative stress is closely related to the pathogenesis and severity of COVID-19 infection. Here, we attempted to compare thiol, total oxidant status (TOS), total antioxidant status (TAS), and oxidative stress index (OSI) levels between COVID-19 patients who need and do not need intensive care unit (ICU) support, and determine whether these markers could be used as predictors of ICU admission. METHODS: We recruited 86 patients with COVID-19 infection and classified them into two groups according to the level of care: ICU group (n = 40) and non-ICU group (n = 46). Thiol, TAS, TOS, and OSI levels were determined and compared between the two groups. RESULTS: The levels of thiol and TAS in serum were markedly lower in ICU patients than in the non-ICU patients. On the contrary, TOS and OSI levels were markedly higher. Inflammatory markers, including white blood cell, neutrophil, C-reactive protein, procalcitonin, and ferritin, were negatively correlated with the thiol and TAS, and positively correlated with the TOS and OSI. We determined that areas under the ROC curve for thiol, TAS, TOS, and OSI were 0.799, 0.778, 0.713, and 0.780, respectively. CONCLUSIONS: Our results revealed that the increase in oxidative stress and decrease in antioxidant levels in COVID-19-infected patients were associated with worsening of disease. Thiol, TAS, TOS, and OSI parameters can be used to distinguish between ICU patients and those who do not, among which thiol was the best predictor of ICU requirement.

Inflammation-based Indices Predicting Mortality in COVID-19.

Efficiency of various inflammation-based indices, including neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), lymphocyte/monocyte ratio (LMR), C-reactive protein/lymphocyte ratio (CLR), albumin/globulin ratio (AGR), haemoglobin, albumin, lymphocyte, and platelet (HALP), systemic immune-inflammatory index (SII) and prognostic nutritional index (PNI), was examined in predicting mortality in COVID-19 patients. The study population consisted of 827 COVID-19 patients, including 733 survivors and 94 non-survivors. Compared with the survivor group, the NLR, PLR, CLR, and SII values of the non-survivor group were markedly higher; however, the LMR, PNI, HALP and AGR values were markedly lower. Multivariate analysis identified PNI, NLR, CLR, older age, male gender and dyslipidemia as independent factors for mortality in COVID-19 patients. PNI had the largest area under the curve to predict mortality, followed by CLR, NLR, and other indexes. This data revealed that PNI, NLR, and CLR are independent factors of mortality in COVID-19 patients among inflammation-based indexes. Key Words: COVID-19 mortality, Prognostic nutritional index, C-reactive protein/lymphocyte ratio, Neutrophil/lymphocyte ratio.

Role of NLR, PLR, ELR and CLR in differentiating COVID-19 patients with and without pneumonia.

OBJECTIVES: Neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), monocyte/lymphocyte ratio (MLR), eosinophil/lymphocyte ratio (ELR), and C-reactive protein (CRP)/lymphocyte ratio (CLR) are well-established inflammatory indices. This study aimed to examine whether NLR, PLR, MLR, ELR and CLR could differentiate coronavirus disease 2019 (COVID-19) patients with pneumonia from those of without. METHODS: We retrospectively examined the laboratory parameters including CRP, D-dimer, procalcitonin and complete blood count of 306 COVID-19 patients (pneumonic = 152 and non-pneumonic = 154). NLR, PLR, MLR, ELR and CLR values of each patient were calculated. The ability of these indices to distinguish COVID-19 patients with and without pneumonia was determined by receiver operating characteristic (ROC) analysis. RESULTS: NLR, PLR and CLR values were higher while ELR value was lower in pneumonic COVID-19 patients compared with patients with non-pneumonic COVID-19 infection. MLR value was similar in the two groups. NLR, PLR and CLR were positively correlated with CRP and procalcitonin. ELR was negatively correlated with CRP. The ROC analysis revealed that the optimal cut-off value of CLR for discriminating COVID-19 patients with pneumonia from those without pneumonia was 1.14 and the area under curve (AUC) for CLR was 0.731 (sensitivity = 81.5% and specificity = 55.6%), which was markedly higher than the AUCs of NLR (0.622), PLR (0.585) and ELR (0.613). However, no statistical differences were observed between AUC values of NLR, PLR and ELR (P > .05). CONCLUSION: Our findings showed that NLR, PLR, ELR and CLR indices can be used in differentiating COVID-19 patients with or without pneumonia. Among them, the CLR index was the best predictor of pneumonia in COVID-19 patients.

The value of C-reactive protein/albumin, fibrinogen/albumin, and neutrophil/lymphocyte ratios in predicting the severity of CoVID-19.

OBJECTIVE: This retrospective study aimed to determine the predictive values of the C-reactive protein (CRP)/albumin ratio (CAR), fibrinogen/albumin ratio (FAR), and neutrophil/lymphocyte ratio (NLR) parameters, which reflect the systemic inflammatory status, for the severity of COVID-19. METHODS: A total of 188 patients diagnosed with COVID-19 were enrolled in this study. Among them, 118 were in the severe group, and 70 were in the non-severe group. Levels of albumin, CRP, D-dimer, procalcitonin, fibrinogen, and hemoglobin; leukocyte, neutrophil, lymphocyte, and monocyte counts; and the FAR, CAR, and NLR were compared between the two groups. RESULTS: The CAR, FAR, and NLR values were significantly higher in the severe group compared to the non-severe group. CAR, FAR, and NLR were positively correlated with leukocyte and neutrophil counts and CRP, procalcitonin, and fibrinogen levels. On the other hand, they were inversely correlated with monocyte (except for NLR) and lymphocyte counts. Receiver operator characteristic analysis showed that the area under the curve (AUC) for CAR, FAR, and NLR was 0.841, 0.737, and 0.802, respectively. CONCLUSIONS: Our investigation revealed that the CAR, FAR, and NLR indices can be used to predict the severity of COVID-19, among which CAR was the best predictor of severe COVID-19.