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?:abstract
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Background There are specific physiologic features regarding the immunity and coagulation among pregnant women, which may play important roles in the illness development of COVID-19 Objective To determine the key factors associated with the deterioration of patients with COVID-19 and the differentiating clinical characteristics of pregnant women with COVID-19, to interfere with the progression of COVID-19 Study Design A retrospective study of 539 Chinese Han adult patients with COVID-19 was conducted, of which 36 cases were pregnant women 36 pregnant women without COVID-19 were recruited as the control The characteristics of severe and critical illness which were differentiated from mild and moderate illness in patients with COVID-19 were analyzed using a machine learning algorithm Additionally, major differences between pregnant women with COVID-19 and age-matched non-pregnant women with severe/critical COVID-19, paired with pregnant women without COVID-19, were explored to identify specific physiological features of pregnant women with COVID-19 Results For the total patient population, the lymphocyte, CD3+, CD4+, CD8+, CD19+ and CD16+56+ cell counts were significantly lower, and white blood cell (WBC), neutrophil and neutrophil-to-lymphocyte ratio (NLR) were higher in those with severe/critical illness than those with mild/moderate illness (P<0 001) The plasma levels of IL-6, IL-10 and IL-6 to IL-10 ratio (IL-6/10) were significantly increased in critical patients, compared to mild, moderate and severe patients (P<0 001) The above immunological co-clusters achieved an AUC of 0 801 (95% CI: 0 764-0 838);and its combined model with the coagulation and fibrinolysis index (prothrombin time, d-dimer) achieved an AUC of 0 815 (95% CI: 0 779-0 851) using the random Forest regression model to predict severe or critical illness For the pregnant women with COVID-19, none had pre-existing diseases They displayed increased WBC, neutrophil count, NLR, and levels of D-dimer and fibrinogen, along with decreased lymphocyte and IL-4 level (P<0 05), compared with non-pregnant women with mild/moderate COVID-19 Although they presented similar changes of immunological markers of lymphocyte, WBC, NLR, CD3+, CD4+, CD8+, CD16+56+ cell count and IL-6/10 compared with non-pregnant women with severe/critical COVID-19, none of the pregnant women with COVID-19 deteriorated into severe or critical illness There were no significant differences in comparison to WBC, lymphocyte, neutrophil, NLR, immunological markers or coagulation fibrinolysis markers between pregnant women with COVID-19 and pregnant women without COVID-19 As for the discrepancy of pathophysiological features between pregnant women with COVID-19 and non-pregnant women with severe/critical COVID-19, the immunological markers achieved an AUC of 0 875 (95% CI: 0 773-0 977);and its combined model with coagulation and fibrinolysis index achieved an AUC of 0 931 (95% CI: 0 850-1 000) Conclusions Immune dysregulation was identified as a crucial feature of COVID-19 patients which developed severe or critical illness, and pregnant women with COVID-19 presented with similar immune responses but rarer incidences of severe or critical illness Immune dysregulation is related to the risks of deterioration into severe or critical illness The specific coagulation/fibrinolysis system of pregnancy may reduce pregnant women with COVID-19 without pre-existing disease from the development of severe illness
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