Predictive Performance of Hematological Parameters for Acute Respiratory Distress Syndrome in Hospitalized Pregnant and Postpartum Women With COVID-19

Introduction: Early identification of risk factors for acute respiratory distress syndrome (ARDS) in patients with coronavirus disease 2019 (COVID-19) is essential to guide preventive interventions. This study aimed to evaluate the predictive performance of hematological parameters measured at hospital admission for ARDS in pregnant and postpartum women with COVID-19. Materials and methods: This retrospective cohort study included all pregnant and postpartum women hospitalized with COVID-19 between March 2020 and October 2021. Demographic, clinical, and laboratory data were extracted from medical records. Total white blood cell (WBC), neutrophil, lymphocyte, and monocyte counts, as well as the neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte ratio (MLR), were evaluated using receiver operating characteristic curve analysis, and the area under the curve (AUC) was calculated to assess their predictive performance for ARDS in these groups. Results: A total of 126 patients were included, of whom 75.4% were aged 26-40 years. Overweight (37.8%) and obesity (45.9%) were the most frequent comorbidities. ARDS developed in 43.6% of patients, and 68.3% required invasive mechanical ventilation. Patients with ARDS had significantly higher WBC and neutrophil counts and lower lymphocyte counts (all p < 0.001). Both NLR and MLR were significantly associated with ARDS (p < 0.001). NLR showed the highest predictive performance for ARDS (AUC = 0.86) and a sensitivity of 81.5%. MLR demonstrated moderate predictive performance (AUC = 0.73) with a sensitivity of 63.0%. Conclusions: Hematological parameters, particularly the NLR and MLR, measured at hospital admission may be useful for assessing the risk of ARDS in pregnant and postpartum women with COVID-19. Further studies are needed to establish the predictive performance of these parameters for ARDS in this population.