DefinePK

Abstract

Background: Parturients with COVID-19 infection requiring Intensive Care Unit (ICU) admission are at increased risk of a poorer prognosis. Significance and predictive value of inflammatory biomarkers in these parturient remains unclear due to the ongoing physiological adaptations. This study evaluates the association between biomarkers and maternal mortality in parturients with COVID-19 infection in the ICU.
Methodology: In this retrospective study, 64 pregnant and postpartum patients with COVID-19 admitted to the ICU of Hospital Sultanah Bahiyah, Kedah, Malaysia, from January 2021 to June 2022 were reviewed.
Parturients were categorized into maternal mortality versus survival group, and records were analyzed to include information on maternal outcomes and laboratory variables.
Results: Of the 64 parturients (86% antepartum, mean age 31.7± 5.9 years old), 10 (15.6%) resulted in maternal mortality. The maternal mortality group showed significantly increased mean levels of C-reactive protein (CRP) and ferritin, with decreased mean levels of PaO2/FiO2 (P/F) ratio on ICU admission. For biomarker analysis via ROC curve analysis, CRP, ferritin, and D-dimer showed moderately good diagnostic performances (AUC: 0.7-0.8, P < 0.05). Based on univariate logistic regression analysis, CRP and D-dimer showed significant independent interactions with maternal mortality. Notably, COV of CRP (COV: 89.21 mg/L) and D-dimer (COV: 2.19 ug/mL) indicated an increased risk of maternal mortality for 10-fold and 4-fold, respectively. Non-laboratory parameters significantly associated with maternal mortality include invasive and prone ventilation with increased length of stay in the ICU.
Conclusion: Elevated levels of CRP and D-dimer were significantly associated with maternal mortality in pregnant and postpartum women with COVID-19 in ICU.