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Am J Perinatol 2021; 38(12): 1236-1243
DOI: 10.1055/s-0041-1732421
Original Article

Severity of COVID-19 Respiratory Complications during Pregnancy are Associated with Degree of Lymphopenia and Neutrophil to Lymphocyte Ratio on Presentation: A Multicenter Cohort Study

Daniel M. Lasser
1   Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, NYCH + H/Coney Island, New York City, New York
,
Judith Chervenak
2   Department of Obstetrics & Gynecology, NYCH + H/Bellevue, New York City, New York
,
Robert M. Moore
3   Division of Maternal Fetal Medicine, Obstetrics & Gynecology, NYCH + H/Jacobi, New York City, New York
,
Tianying Li
4   NYCH + H/Office of Quality and Safety, New York City, New York
,
Clementine Knight 
5   Albert Einstein College of Medicine, Bronx, New York
,
Hugo O. Teo
6   NYCH + H/Office of Quality and Safety, New York City, New York
,
Yogangi Malhotra 
7   Department of Pediatrics, NYCH + H/Jacobi, New York City, New York
,
on behalf of the New York City Health + Hospitals Perinatal COVID-19 Research Subcommittee › Author Affiliations Funding None.
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Abstract

Objective This study aimed to determine if laboratory inflammatory markers can predict critical disease in symptomatic COVID-19 pregnant women.

Study Design Multicenter, retrospective cohort study of all pregnant women presenting to New York City Health + Hospitals emergency departments from March 1 to May 30, 2020. We assessed all symptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive pregnant women with room air oxygen saturation <95% on presentation. Logistic regression modeled the relationship of inflammatory markers to outcomes. Area under receiver operating characteristic (ROC) curve and maximum Youden index determined prognostic ability and optimal predictive cut-off values.

Results A total of 498 of 5,002 pregnant women were SARS-CoV-2 RT-PCR positive of which 77 presented with hypoxemia. The absolute lymphocyte count (ALC) and neutrophil to lymphocyte ratio (NLR) were highly sensitive for progression to severe illness. ROC curve analysis identified predictive cutoffs: ALC < 1.49 × 109/L (96% sensitivity, 52% specificity, area under the receiver operating characteristic curve [AUC] = 0.80 (95% confidence interval [CI]: 0.70–0.90) and NLR >8.1 (100% sensitivity, 70% specificity, AUC = 0.86 (95% CI: [0.76–0.96]).

Conclusion ALC and NLR on presentation are sensitive markers of progression to critical COVID-19 disease in symptomatic pregnant women. This finding provides a practical, rapid method for assessment and can assist clinicians with decision-making regarding triage, level of care, and patient management.

Key Points

  • Few tools exist to gauge risk of severe COVID-19 disease in pregnancy.

  • ALC and NLR are sensitive predictive markers of disease progression in symptomatic women.

  • Cut-off values for ALC and NLR will help direct patient triage and management.

Keywords

COVID-19 - pregnancy - lymphopenia - neutrophil-lymphocyte ratio - hypoxemia - inflammatory markers


Publication History

Received: 31 December 2020

Accepted: 01 June 2021

Article published online:
16 July 2021

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