Inflammatory markers in expectant COVID-19 positive patients: A relationship with clinical severity in a tertiary care referral facility.

Background: SARS-Co-V2 infection which was declared as a pandemic by the WHO has caused significant impact on morbidity and mortality to the mother and the fetus, especially the delta variant of the COVID-19. Hence it is important to identify the subgroup of women who are prone to adverse complications and prevent maternal and perinatal mortality. Inflammatory biomarker is one such tool to identify the high-risk expectant mothers. Methods and results: A total of 158 patients were identified in this retrospective study and they were classified based on the clinical signs and symptoms as per the society of maternal fetal medicine. 96.2% belonged to the non-severe group and 3.8% belonged to the severe infection group. Cough and fever were the most common symptoms. Inflammatory markers which were done on admission were correlated with the clinical disease severity. The difference in mean values of CRP, LDH and ferritin between the severe and non-severe group was significant statistically. The markers IL-6 and d-dimer were raised but did not correlate with disease severity. Neutrophil lymphocyte ratio (NLR) calculated from the blood counts was abnormal in all the patients in the severe group and statistically significant. Overall, the maternal outcome was good and maternal mortality rate was 1.89% (3/158). Neonatal outcome was good with stillbirth rate of 3.16% which was higher when compared to non-covid stillbirth rates (0.5%). Conclusion: inflammatory biomarkers like CRP and LDH are sensitive in predicting the adverse maternal fetal outcome. NLR is a simple ratio that has a good positive predictive value in identifying the need for more vigilant monitoring in expectant COVID-19 positive patients.