Overview of Neutrophil-to-lymphocyte Ratio and Procalcitonin Level in Preeclampsia and Non-preeclampsia Patients with Confirmed COVID-19

Abstract

Introduction: Coronavirus disease-2019 (COVID-19) is an infectious disease that is currently a pandemic. Pregnant women are one of the populations that are susceptible to this infection because of physiological changes during pregnancy. In a meta-analysis study, it was shown that preeclampsia significantly occurred in pregnant patients infected with COVID-19 compared to the group without COVID-19 infection. Inflammatory markers that play an important role in these two diseases are neutrophil-to-lymphocyte ratio (NLR) and procalcitonin. Materials and methods: This research is a descriptive study using total sampling, including all pregnant women with COVID-19 infection at RSUP Prof. Dr. I.G.N.G. Ngoerah Hospital, Denpasar, Bali, from April 2020 to June 2021 with a diagnosis of preeclampsia and without preeclampsia. Results: A total of 152 patients were found, of which 16 patients were diagnosed with preeclampsia and 136 patients were without preeclampsia. Most cases of COVID-19 with preeclampsia and non-preeclampsia occurred in the maternal age range of 20–35 years. The majority of pregnant patients with COVID-19 are asymptomatic in both preeclampsia and non-preeclampsia. COVID-19 patients with preeclampsia each had 1 case with comorbid anemia, chronic hepatitis B, and heart failure. Meanwhile, non-preeclampsia had the most comorbid anemia, followed by asthma, HIV, and obesity. Pneumonia on chest X-ray is more common in non-preeclampsia patients. Proportionally, 78.95% were in the high NLR category, while for procalcitonin 26.32% were in the high category, 15.79% were in the low category and the rest were not examined. The NLR levels in preeclampsia and non-preeclampsia in both low and high categories are almost the same. Procalcitonin levels tended to be the same between the preeclampsia and non-preeclampsia groups. Conclusion: The median NLR and procalcitonin were almost uniform in the preeclampsia and non-preeclampsia groups, but proportionally most of them had high NLR and procalcitonin levels. The increase in NLR and procalcitonin in the preeclampsia group may be explained by one of the underlying pathophysiologies of preeclampsia inflammation.