Nadire Elif ERGÜN, Saime SÜRMEN, Saide ERTÜRK, Derya BÜYÜKAYHAN, Mustafa Gani SÜRMEN

The Potential Role of Hematological and Biochemical Parameters in Pregnant Women with Viral Infection

Objective: Pregnancy is a process in which not only physical changes occur, but also immune responses are modulated. Therefore, pregnant women are more susceptible to viral infections due to these changes during the pregnancy. The present study aimed to evaluate the hematological and biochemical parameters of pregnant women diagnosed with viral infection. Materials and Methods: The study groups consisted of pregnant women diagnosed with cytomegalovirus (CMV), hepatitis B virus (HBV), influenza, Covid-19 and healthy pregnant women as control group. The data of a total of 522 pregnant women were analyzed retrospectively. SPSS 22.0 statistics package program was used for data analysis. Results: Significant differences were found in aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels, and neutrophil counts between CMV and control groups. There were also significant differences in AST, ALT, red blood cell distribution width (RDW), neutrophil lymphocyte ratio (NLR), white blood cell (WBC), platelet (PLT), neutrophil and lymphocyte values between hepatitis B surface antigen (HBsAg) positive and HBsAg negative pregnant groups. NLR and basophil (BASO) % of pregnant women with influenza infection were significantly higher than the control group. In Covid-19 positive pregnant women, AST, ALT, WBC, BASO values and BASO% were found to be significantly different from the control group. In addition, WBC and NLR values in Covid-19 positive pregnant women were found to be significantly lower than the influenza group. Conclusion: All these results suggest that especially the NLR value may have diagnostic and prognostic significance for viral infections in pregnant women. However, studies with larger samples and prospective analyses are needed for stronger evidence.

Keywords:

Viral infection, neutrophil lymphocyte ratio, pregnancy, retrospective,

PDF

___

1. Vojtek I, Dieussaert I, Doherty TM, Franck V, Hanssens L, Miller J, et al. Maternal immunization: where are we now and how to move forward? Ann Med 2018; 50(3): 193-208. google scholar
2. Davis NL, King CC, Kourtis AP. Cytomegalovirus infection in pregnancy. Birth Defects Res 2017; 109(5): 336-46. google scholar
3. Borgia G, Carleo MA, Gaeta GB, Gentile I. Hepatitis B in pregnancy. World J Gastroenterol 2012; 18(34): 4677-83. google scholar
4. Memoli MJ, Harvey H, Morens DM, Taubenberger JK. Influenza in pregnancy. Influenza Other Respir Viruses 2013; 7(6): 1033-9. google scholar
5. Osman M, Klopfenstein T, Belfeki N, Gendrin V, Zayet S. A comparative systematic review of COVID-19 and influenza. Viruses 2021; 13(3): 452. google scholar
6. Üstündağ Y, Kazancı EG, Sevgican E, Erdem C, Huysal K. Hematological parameters in pregnant women with COVID-19: a systematic review. J Clin Chem Lab Med 2021; 4(2): 1000163. google scholar
7. Benedict CA, Angulo A, Patterson G, Ha S, Huang H, Messerle M, et al. Neutrality of the canonical NF-kappa B-dependent pathway for human and murine cytomegalovirus transcription and replication in vitro. J Virol 2004; 78(2): 741-50. google scholar
8. Ye B, Zhao H. Early abnormal liver enzyme levels may increase the prevalence of human cytomegalovirus antigenaemia after hematopoietic stem cell transplantation. J Int Med Res 2017; 45(2): 673-9. google scholar
9. Nigro G, Anceschi MM, Cosmi EV. Congenital cytomegalic disease collaborating group. Clinical manifestations and abnormal laboratory findings in pregnant women with primary cytomegalovirus infection. BJOG 2003; 110(6): 572-7. google scholar
10. Chang JJ, Lewin SR. Immunopathogenesis of hepatitis B virus infection. Immunol Cell Biol 2007; 85(1): 16-23. google scholar
11. Wang J, Huang R, Yan X, Li M, Chen Y, Xia J, et al. Red blood cell distribution width: A promising index for evaluating the severity and long-term prognosis of hepatitis B virus-related diseases. Dig Liver Dis 2020; 52(4): 440-6. google scholar
12. Huang R, Yang C, Wu K, Cao S, Liu Y, Su R, et al. Red cell distribution width as a potential index to assess the severity of hepatitis B virus-related liver diseases. Hepatol Res 2014; 44(14): E464-70. google scholar
13. Zhang X, Wang D, Chen Z, Guo N, Wang W, Xiong C, et al. Red cell distribution width-to-lymphocyte ratio: A novel predictor for HBV-related liver cirrhosis. Medicine (Baltimore) 2020; 99(23): e20638. google scholar
14. Gao P, Xiao P, Yang YL, Chen QF, Mao XR, Zhao ZB, et al. Effects and clinical significance of virus load on red blood cell parameters in different stage of hepatitis B. Beijing Da Xue Bao Yi Xue Ban 2014; 46(6): 941-4. google scholar
15. Atay K. Relationship between neutrophil-to-lymphocyte ratio, mean platelet volume, and fibrosis level in patients with chronic hepatitis B. Turkish J Academic Gastroenterol 2019; 18(1): 7-11. google scholar
16. Ahmad AE, Bakari AG, Musa BOP, Mustapha SK, Nasir AI, Tahir MI, et al. Haematological and immunological parameters in patients with chronic hepatitis b infection in Zaria, Nigeria. Sokoto J Med Lab Sci 2018; 3(4): 84-88. google scholar
17. Cai J, Wang K, Han T, Jiang H. Evaluation of prognostic values of inflammation-based makers in patients with HBV-related acute-on-chronic liver failure. Medicine (Baltimore) 2018; 97(46): e13324. google scholar
18. Chen L, Lou Y, Chen Y, Yang J. Prognostic value of the neutrophil-to-lymphocyte ratio in patients with acute-on-chronic liver failure. Int J Clin Pract 2014; 68(8): 1034-40. google scholar
19. Burn GL, Foti A, Marsman G, Patel DF, Zychlinsky A. The neutrophil. Immunity 2021; 54(7): 1377-91. google scholar
20. Vakili S, Savardashtaki A, Jamalnia S, Tabrizi R, Nematollahi MH, Jafarinia M, et al. Laboratory findings of COVID-19 infection are conflicting in different age groups and pregnant women: A literature review. Arch Med Res 2020; 51(7): 603-7. google scholar
21. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of Coronavirus Disease 2019 in China. N Engl J Med 2020; 382(18): 1708-20. google scholar
22. Yang AP, Liu JP, Tao WQ, Li HM. The diagnostic and predictive role of NLR, d-NLR and PLR in COVID-19 patients. Int Immunopharmacol 2020; 84: 106504. google scholar
23. Kong M, Zhang H, Cao X, Mao X, Lu Z. Higher level of neutrophil-to-lymphocyte is associated with severe COVID-19. Epidemiol Infect 2020; 148: e139. google scholar
24. Chan AS, Rout A. Use of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in COVID-19. J Clin Med Res 2020; 12(7): 448-53. google scholar
25. Erdogan A, Can FE, Gönüllü H. Evaluation of the prognostic role of NLR, LMR, PLR, and LCR ratio in COVID-19 patients. J Med Virol 2021; 93(9): 5555-9. google scholar
26. Kazancioglu S, Bastug A, Ozbay BO, Kemirtlek N, Bodur H. The role of haematological parameters in patients with COVID-19 and influenza virus infection. Epidemiol Infect 2020; 148: e272. google scholar
27. Nalbant A, Kaya T, Varim C, Yaylaci S, Tamer A, Cinemre H. Can the neutrophil/lymphocyte ratio (NLR) have a role in the diagnosis of coronavirus 2019 disease (COVID-19)? Rev Assoc Med Bras (1992) 2020; 66: 746-51. google scholar
28. Yılmaz Z, Güvey H, Çelik S, Çalışkan CS. Effect of complete blood count parameters on the clinical course of COVID-19 in pregnant women. Exp Clin Med 2022; 39(2): 409-13. google scholar
29. Arslan B, Bicer IG, Sahin T, Vay M, Dilek O, Destegul E. Clinical characteristics and hematological parameters associated with disease severity in COVID-19 positive pregnant women undergoing cesarean section:Asingle-centerexperience.JObstet Gynaecol Res 2022; 48(2): 402-10. google scholar
30. Hershko Klement A, Hadi E, Asali A, Shavit T, Wiser A, Haikin E, et al. Neutrophils to lymphocytes ratio and platelets to lymphocytes ratio in pregnancy: A population study. PLoS One 2018; 13(5): e0196706. google scholar
31. Deniz M, Tezer H, Tapisiz A. Yenidoğan ve gebelerde yeni coronavirüs hastalığı 2019 (Covid 19). Turkish J Pediatr Dis 2020; 14(3): 274-8. google scholar
32. Prozan L, Shusterman E, Ablin J, Mitelpunkt A, Weiss-Meilik A, Adler A, et al. Prognostic value of neutrophil-to-lymphocyte ratio in COVID-19 compared with Influenza and respiratory syncytial virus infection. Sci Rep 2021; 11(1): 21519. google scholar
33. Gibbs BF, Streatfield C, Falcone FH. Basophils as critical orchestrators of Th2-type immune responses. Expert Rev Clin Immunol 2009; 5(6): 725-34. google scholar
34. Murdaca G, Di Gioacchino M, Greco M, Borro M, Paladin F, Petrarca C, et al. Basophils and mast cells in COVID-19 pathogenesis. Cells 2021; 10(10): 2754. google scholar