Description of Neutrophil-to-lymphocyte Ratio, C-reactive Protein, and Procalcitonin Levels in Pregnancy with COVID-19 at Sanglah General Hospital Period of April 2020–April 2021

ABSTRACT

Background: Theoretically, pregnant women are more susceptible to infection of coronavirus disease 2019 (COVID-19) and severe pneumonia due to presentation of physiological changes adaptation and immunosuppression during pregnancy. Based on the immune clock theory, if pregnant women had COVID-19 in the first and third it can appearance of cytokine storm due to hyperinflammation state, and lead to poor maternal and neonatal outcomes. Hyperinflammation state is characterized by an increase in inflammatory biomarkers in the serum, including the neutrophil-to-lymphocyte ratio (NLR), C-reactive protein (CRP), and procalcitonin levels. This study aims to determine the characteristic of NLR, CRP, and procalcitonin in pregnancy with COVID-19 at Sanglah General Hospital, Denpasar, Bali, Indonesia. Methods: This study is a cross-sectional descriptive study using secondary data from patient’s medical records and is conducted in the delivery room and medical record department at Sanglah General Hospital, Denpasar from April 2020 to April 2021. Result: Pregnancy cases with COVID-19 in this study were in the 26–30-year age group, as much as 26 cases (37.14%) with most common comorbidities found were preeclampsia and electrolyte imbalance, as much as nine cases each (12.86%). Most of the neonates born at term, with birth weight 2,500 gm, and vigorous baby. The highest median NLR value was found in pregnant women with COVID-19 in comorbid with obesity, 6.79 (2.88–9.14). In this study, the cases with a length of stay more than or 10 days had a median NLR value of 6.93 (2.57–20.69), CRP 59.83 (1.60–151.56), and procalcitonin 0.145 (0.03–2.56), which are all higher than those whose length of stay was less than 10 days. Conclusion: NLR, CRP, and procalcitonin values are affected by the trimester of pregnancy, the maternal comorbidities, the commonly found chest X-ray features, the length of hospital stay, the prognostic value to be determined to find the disease severity, the needs of oxygen supplementation, and the intensive care treatment, and also they could be the predictors for neonatal outcome in pregnancy with COVID-19.