Analysis of the COVID-19 Severity Based on NLR and the Mortality Rate of Pregnant Women with COVID-19 at Dr. Moewardi General Hospital, Surakarta, Central Java, Indonesia
Abstract
Background: Coronavirus Disease 2019 (COVID-19) is a disease of the human respiratory system. Pregnant women are more susceptible to respiratory infections due to physiological changes in the immune and cardiopulmonary systems. Routine laboratory biomarkers such as lymphocytes, neutrophils, and NLR are considered prognostic in COVID-19. This study aimed to analyzed the severity of COVID-19 based on NLR on the mortality of pregnant women with COVID-19 at Dr. Moewardi, Surakarta.
Subjects and Method: This study used analytic observational with a cross-sectional. The study subjects were 82 pregnant women with confirmed COVID-19, aged over 18 years, and being treated at RSUD Dr. Moewardi Surakarta between March 2020 to January 2022. The samples were taken using the consecutive sampling technique. The independent variable is the severity of COVID-19 based on clinical presentation. The dependent variable is the laboratory results in lymphocytes, neutrophils, and NLR. Data were collected from medical records and anlayzed using SPSS software.
Results: There was correlation between NLR on the severity of pregnant women with COVID-19 (Mean= 10.11; SD= 4.10; p= 0.026) and there was a significant correlation between NLR on the mortality rate of pregnant women with COVID-19 (Mean= 9.92; SD= 3.94; p<0.001).
Conclusion: NLR affected the severity and the mortality rate among pregnant women with COVID-19.
Keywords: COVID-19, pregnancy, lymphocytes, neutrophils, NLR, mortality
Correspondence: Dhea Fitria Rachma. Faculty of Medicine Universitas Sebelas Maret Surakarta. Jl. Ir. Sutami 36A, Surakarta 57126, Indonesia. Email: dheaf1020@student.uns.ac.id. Mobile: 085702594898.
Indonesian Journal of Medicine (2022), 07(04): 401-410
https://doi.org/10.26911/theijmed.2022.07.04.05
References
Arslan B, Bicer IG, Sahin T, Vay M, Dilek O, Destegul E (2022). Clinical characteristics and hematological parameters associated with disease severity in COVID19 positive pregnant women undergoing cesarean section: a singlecenter experience. J. Obstet. Gynaecol. 48(2): 402410. doi: 10.1111/jog.15108.
Cascella M, Rajnik M, Cuomo A, Dulebohn SC, Di Napoli R (2022). Features, evaluation and treatment coronavirus (COVID 19). Stat Pearls Publishing. Available at: https://www.ncbi.nlm.nih.gov/books/NBK554776/ (Accessed: 16 January 2022).
deKay JT, Emery IF, Rud J, Eldridge A, Lord C, Gagnon DJ, May TL, Herrera VLM, et al. (2021). DEspRhigh neutrophils are associated with critical illness in COVID19. Sci Rep. 11(1): 1–11. doi: 10.1038/s41598021019437.
Erol Koç EM, Flndlk RB, Akkaya H, Karadaǧ I, Tokalloǧlu EÖ, Tekin ÖM (2021). Comparison of hematological parameters and perinatal outcomes between COVID19 pregnancies and healthy pregnancy cohort. J. Perinat. Med. 49(2): 141–147. doi: 10.1515/jpm20200403.
Fuad M, Oehadian A, Prihatni D, Marthoenis M (2021). Neutrophil to lymphocyte ratio and covid19 symptombased severity at admission. Althea Med. J. 8(1): 1–6. doi: 10.15850/amj.v8n1.2255.
Gavriatopoulou M, Korompoki E, Fotiou D, NtanasisStathopoulos I, Psaltopoulou T, Kastritis E, Terpos E, Dimopoulos MA (2020). Organspecific manifestations of covid19 infection. Int. J. Clin. Exp. Med. 20(4: 493–506. doi: 10.1007/s1023802000648x.
Ish P, Malhotra N, Agrawal S Gupta N (2020). Relative lymphocytosis in COVID19 a ray of hope. Adv. Respir. Med. 88(3): 287–288. doi: 10.5603/ARM.a2020.0098.
Karimi L, Makvandi S, VahedianAzimi A, Sathyapalan T, Sahebkar A (2021). Effect of COVID19 on mortality of pregnant and postpartum women: a systematic review and metaanalysis. J. Pregnancy. doi: 10.1155/2021/8870129.
Kemenkes (2021). Keputusan Menteri Kesehatan Republik Indonesia No Hk.01.07/Menkes/5671/2021 tentang Manajemen Klinis Tata Laksana, 3, pp.: 1–106.
Kerboua KE (2021). NLR: A Costeffective nomogram to guide therapeutic interventions in COVID19. Immunol. Invest. 50(1): 92–100. doi: 10.1080/08820139.2020.1773850.
Koyasu S, Moro K (2012). Role of innate lymphocytes in infection and inammation. Front. Immunol. 3: 1–13. doi: 10.3389/fimmu.2012.00101.
Krishnan A, Hamilton JP, Alqahtani SA Woreta TA (2021). COVID19: An overview and a clinical update. World J. Clin. Cases. 9(1): 8–23. doi: 10.12998/wjcc.v9.i1.8.
LagunasRangel FA (2020). Neutrophiltolymphocyte ratio and lymphocytetocreactive protein ratio in patients with severe coronavirus disease 2019 (COVID19): A MetaAnalysis. J. Med. Virol. 92(10): 1733–1734. doi: 10.1002/jmv.25819.
Martha NT, Utama BI (2022). Absolute lymphocyte count and neutrophil lymphocyte ratio in pregnancy confirmed positive for SARSCoV2 at Dr. M. Djamil Hospital, Padang, 25, pp.: 49–53.
Phoswa WN, Khaliq OP (2020). Is pregnancy a risk factor of COVID19? Eur. J. Obstet Gynecol Reprod Biol. 252: 605–609.
Rosales C (2018). Neutrophil: a cell with many roles in inflammation or several cell types? Frontiers in Physiology. 9: 1–17. doi: 10.3389/fphys.2018.00113.
Rothan HA, Byrareddy SN (2020). A framework for five big v’s of big data and organizational culture in firms. J. Autoimmun. doi: 10.1016/j.jaut.2020.102433.
Sukrisman L, Sinto R, Priantono D (2021). Hematologic profiles and correlation between absolute lymphocyte count and neutrophil/ lymphocyte ratio with markers of inflammation of covid19 in an indonesian national referral hospital. Int. J. Gen. Med. 14(71): 6919–6924. doi: 10.2147/IJGM.S337440.
Villar J, Ariff S, Gunier RB, Thiruvengadam R, Rauch S, Kholin A, Roggero P, Prefumo F, et al. (2021). Maternal and neonatal morbidity and mortality among pregnant women with and without COVID19 infection: the intercovid multinational cohort study. JAMA Pediatr. 175(8): 817–826. doi: 10.1001/jamapediatrics.2021.1050.
World Health Organization (2020). Clinical management of COVID19: interim guidance geneva world health organization 2020.
Yang AP, Liu J, Tao W, Li H (2020). The diagnostic and predictive role of NLR, dNLR and PLR in COVID19 Patients. Int. Immunopharmacol. doi: 10.1016/j.intimp.2020.106504.
Zheng M, Gao Y, Wang G, Song G, Liu S, Sun D, Xu Y, Tian Z (2020). Functional exhaustion of antiviral lymphocytes in COVID19 patients. Cell. Mol. Immunol. 17(5): 533–535. doi: 10.1038/s4142302004022.
Zhang Z (2016). Univariate description and bivariate statistical inference: The first step delving into data. Ann. Transl. Med. 4(5). doi: 10.21037/atm.2016.02.11.