Ferritin, fibrinojen ve prokalsitonin düzeyleri gebelerde COVID-19 klinik seyrini nasıl etkiler?

Yıl 2021, , 940 - 946, 27.12.2021

Huri Güvey , Canan Soyer Çalışkan , Samettin Çelik , Merve Yılmaz , Zehra Yılmaz

https://doi.org/10.31832/smj.932304

Öz

Amaç: Coronavirus Disease 2019 (COVID-19) birçok insanı olduğu kadar gebeleri de etkileyen bir pandemidir. Çalışmamızın amacı inflamatuar belirteçlerin gebelerde COVID-19 seyrine etkisini araştırmaktır.
Gereç ve yöntem: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pozitif olan 125 ve negatif olan 40 gebenin dahil edildiği bu kesitsel tipe tanımlayıcı çalışmada, COVID-19 olan hastalar oksijen satürasyonu, akciğer tutulumu bulgularına göre hafif orta ve ağır olarak gruplandırılmıştır. Fibirnojen, ferritin ve prokalsitonin değerleri karşılaştırılmıştır.
Bulgular: SARS-CoV-2 durumuna göre gebelerin ferritin (p=0,241) ve prokalsitonin (p=0,579) değerleri arasında da anlamlı fark saptanmazken, testi pozitif gebelerin fibrinojen değerleri anlamlı olarak yüksek bulunmuştur (p<0,001). SARS-CoV-2 pozitif olan katılımcıları kendi içerisinde klinik durumuna hafif, orta ve ağır olarak gruplandırıp baktığımızda ise; fibrinojen (p<0,001) değerleri arasında anlamlı fark saptanmıştır. İkili karşılaştırmada klinik seyri hafif olan grupta fibrinojen değeri orta (p<0,001) ve ağır (p<0,001) olan gruptan, klinik seyri orta olan grubun fibrinojen değeri ise ağır olan gruptan anlamlı olarak düşük saptanmıştır (p=0,007)
Sonuç: Hastalığın ağırlığı arttıkça fibrinojen seviyelerinin de arttığını tespit ettik. Fibrinojen gebelerde COVID-19 klinik durumunun ağırlığı ile ilgili bir gösterge olabilir ancak bu bulguyu güçlendirmek için daha büyük örnekleme sahip prospektif, izleme dayalı çalışmalar gerekmektedir.

Anahtar Kelimeler

COVID-19, Gebelik, Ferritin, Fibrinojen, Prokalsitonin

How do levels of ferritin, fibrinogen and procalcitonin affect the clinical course of COVID-19 in pregnant women?

Öz

Objective: Coronavirus disease 2019 (COVID 19) is a pandemic affecting pregnant women as well as lots of people. The aim of our study is to investigate the effects of inflammatory markers on the course of COVID-19 in pregnant women.
Materials and methods: In this cross-sectional descriptive study, which included 125 pregnant women who were positive for Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and 40 women who were negative, patients with COVID-19 were grouped as mild, moderate, and severe according to oxygen saturation, lung involvement findings. Fibrinogen, ferritin, and procalcitonin values of the participants were compared.
Results: While there was no significant difference between the ferritin (p = 0,241) and procalcitonin (p = 0,579) values of pregnant women according to the SARS-CoV-2 status, the fibrinogen values of pregnant women with positive test were found to be significantly higher (p<0,001). When we categorize the participants who are positive for SARS-CoV-2 as mild, moderate, and severe; a significant difference was found between fibrinogen (p<0,001) values. In paired comparison, the fibrinogen value of the group with mild disease was found to be significantly lower than the group with moderate (p<0,001) and severe (p<0,001), and the group with a moderate disease compared to the group with severe (p = 0,007).
Conclusion: We found that as the severity of the disease increased, fibrinogen levels also increased. Fibrinogen may be an indicator of the severity of the COVID-19 clinical course in pregnant women, but prospective, follow-up studies with larger samples are required to reinforce this finding.

Anahtar Kelimeler

COVID-19; pregnancy; fibrinogen; ferritin; procalcitonin

Kaynakça

• 1. World Health Organization. Director-General’s remarks at the media briefing on 2019-nCoV on 11 February 2020. https://www.who.int/dg/speeches/detail/who-director-general-s- remarks-at-the-media-briefing-on-2019-ncov-on-11-february-2020. 2020. p. 2020. (Erişim tarihi: 29.04.2021)
• 2. Ramanathan K, Antognini D, Combes A, Paden M, Zakhary B, Ogino M,, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395(10223):497–506.
• 3. Schwartz D. The Effects of Pregnancy on Women with COVID-19: Maternal and Infant Outcomes. Clin Infect Dis 2020;71(16):2042–2044.
• 4. Zaigham M, Andersson O. Maternal and perinatal outcomes with COVID-19: A systematic review of 108 pregnancies. Acta Obstet Gynecol Scand 2020;99(7):823–829.
• 5. Levi M, Toh CH, Thachil J, Watson HG. Guidelines for the diagnosis and management of disseminated intravascular coagulation. Br J Haematol 2009;145(1):24–33.
• 6. Di Micco P, Russo V, Carannante N, Imparato M, Cardillo G, Lodigiani C. Prognostic Value of Fibrinogen among COVID-19 Patients Admitted to an Emergency Department: An Italian Cohort Study. J Clin Med 2020;9(12):4134.
• 7. Lippi G, Cervellin G. Procalcitonin for diagnosing and monitoring bacterial infections : for or against ? Clin Chem Lab Med 2018;56(8):1193–1195.
• 8. Kell DB, Pretorius E. Serum ferritin is an important inflammatory disease marker, as it is mainly a leakage product from damaged cells. Metallomics 2014;6(4):748–773.
• 9. Ruddell RG, Hoang-Le D, Barwood J, Rutherford P, Piva T, Watters D, et al. Ferritin functions as a proinflammatory cytokine via iron- independent PKC-ζ/NFκB-regulated signalling in rat hepatic stellate cells. Hepatology 2010;49(3):887–900.
• 10. Dahan S, Segal G, Katz I, Hellou T, Tietel M, Bryk G, et al. Ferritin as a Marker of Severity in COVID-19 Patients: A Fatal Correlation. IMAJ 2020;22(8):494–500.
• 11. Delahoy M, Whitaker M, O’Halloran A, Chai SJ, Kirley PD, Alden N, et al. Characteristics and maternal and birth outcomes of hospitalized pregnant women with laboratory-confirmed COVID-19 — COVID-NET, 13 States, March 1–August 22, 2020. MMWR 2020;69(38):1347-1354. 12. Clinical spectrum of SARS-CoV-2 infection. https://www.covid19treatmentguidelines.nih.gov/overview/clinical-spectrum/ (Erişim tarihi 29.04.2021).
• 13. Bi X, Su Z, Yan H, Du J, Wang J, Chen L, et al. Prediction of severe illness due to COVID-19 based on an analysis of initial Fibrinogen to Albumin Ratio and Platelet count. Platelets [Internet] 2020;31(5):674–679.
• 14. Han H, Yang L, Liu R, Liu F, Liu F, Wu KL, et al. Prominent changes in blood coagulation of patients with SARS-CoV-2 infection. Clin Chem Lab Med 2020;58(7):1116–1120.
• 15. Minasyan H, Flachsbart F. Blood coagulation: a powerful bactericidal mechanism of human innate immunity. Int Rev Immunol [Internet] 2019;38(1):3–17.
• 16. Delvaeye M, Conway EM. Coagulation and innate immune responses: Can we view them separately? Blood [Internet]. 2009;114(12):2367–2374.
• 17. Xiang JZ, Cao DY, Yang YYY, Cezmi YY, Gao AAY. Clinical characteristics of 140 patients infected with SARS- CoV-2 in Wuhan , China. Allergy 2020;00:1–12.
• 18. Guan W, Ni Z, Hu Y, Liang W, Ou C, He J,et al. Clinical Characteristics of Coronavirus Disease 2019 in China. New 2020;382:1708–1720.
• 19. Lippi G, Plebani M. Procalcitonin in patients with severe coronavirus disease 2019 (COVID-19): A meta-analysis. Clin Chim Acta 2020;505:190–191.
• 20. Van Berkel M, Kox M, Frenzel T, Pickkers P, Schouten J, Van Berkel M, et al. Biomarkers for antimicrobial stewardship: A reappraisal in COVID-19 times? Crit Care 2020;24(1):1–4.
• 21. Liu W, Wang Q, Zhang Q, Chen L, Chen J, Zhang B, et al. Coronavirus disease 2019 (COVID-19) during pregnancy: a case series. Preprints 2020;2020020373.
• 22. Banchini F, Cattaneo GM, Capelli P. Serum ferritin levels in inflammation : a retrospective comparative analysis between COVID-19 and emergency surgical non- COVID-19 patients. World J Emerg Surg 2021;16:9.
• 23. Cheng L, Li H, Li L, Liu C, Chen H, Li Y. Ferritin in the coronavirus disease 2019 ( COVID-19 ): A systematic review and meta-analysis. J Clin Lab Anal 2020;34:e23618.
• 24. Colafrancesco S, Alessandri C, Conti F, Priori R. COVID-19 gone bad : A new character in the spectrum of the hyperferritinemic syndrome ? Autoimmun Rev 2020;19:102573.