{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T04:28:43Z","timestamp":1792297723499,"version":"4.4.0"},"reference-count":24,"publisher":"Georg Thieme Verlag KG","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:p>\n            Objective\u2003This study aimed to determine if laboratory inflammatory markers can predict critical disease in symptomatic COVID-19 pregnant women.<\/jats:p><jats:p>\n            Study Design\u2003Multicenter, retrospective cohort study of all pregnant women presenting to New York City Health\u2009+\u2009Hospitals emergency departments from March 1 to May 30, 2020. We assessed all symptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive pregnant women with room air oxygen saturation &lt;95% on presentation. Logistic regression modeled the relationship of inflammatory markers to outcomes. Area under receiver operating characteristic (ROC) curve and maximum Youden index determined prognostic ability and optimal predictive cut-off values.<\/jats:p><jats:p>\n            Results\u2003A total of 498 of 5,002 pregnant women were SARS-CoV-2 RT-PCR positive of which 77 presented with hypoxemia. The absolute lymphocyte count (ALC) and neutrophil to lymphocyte ratio (NLR) were highly sensitive for progression to severe illness. ROC curve analysis identified predictive cutoffs: ALC\u2009&lt;\u20091.49\u2009\u00d7\u2009109\/L (96% sensitivity, 52% specificity, area under the receiver operating characteristic curve [AUC]\u2009=\u20090.80 (95% confidence interval [CI]: 0.70\u20130.90) and NLR &gt;8.1 (100% sensitivity, 70% specificity, AUC\u2009=\u20090.86 (95% CI: [0.76\u20130.96]).<\/jats:p><jats:p>\n            Conclusion\u2003ALC and NLR on presentation are sensitive markers of progression to critical COVID-19 disease in symptomatic pregnant women. This finding provides a practical, rapid method for assessment and can assist clinicians with decision-making regarding triage, level of care, and patient management.<\/jats:p><jats:p>\n            Key Points\n          <\/jats:p>","DOI":"10.1055\/s-0041-1732421","type":"journal-article","created":{"date-parts":[[2021,8,16]],"date-time":"2021-08-16T06:30:53Z","timestamp":1629095453000},"page":"1236-1243","source":"Crossref","is-referenced-by-count":9,"title":["Severity of COVID-19 Respiratory Complications during Pregnancy are Associated with Degree of Lymphopenia and Neutrophil to Lymphocyte Ratio on Presentation: A Multicenter Cohort Study"],"prefix":"10.1055","volume":"38","author":[{"given":"Daniel M.","family":"Lasser","sequence":"additional","affiliation":[{"name":"Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, NYCH\u2009+\u2009H\/Coney Island, New York City, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith","family":"Chervenak","sequence":"additional","affiliation":[{"name":"Department of Obstetrics & Gynecology, NYCH\u2009+\u2009H\/Bellevue, New York City, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert M.","family":"Moore","sequence":"additional","affiliation":[{"name":"Division of Maternal Fetal Medicine, Obstetrics & Gynecology, NYCH\u2009+\u2009H\/Jacobi, New York City, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tianying","family":"Li","sequence":"additional","affiliation":[{"name":"NYCH\u2009+\u2009H\/Office of Quality and Safety, New York City, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1176-4351","authenticated-orcid":false,"given":"Clementine","family":"Knight","sequence":"additional","affiliation":[{"name":"Albert Einstein College of Medicine, Bronx, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hugo O.","family":"Teo","sequence":"additional","affiliation":[{"name":"NYCH\u2009+\u2009H\/Office of Quality and Safety, New York City, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8565-0587","authenticated-orcid":false,"given":"Yogangi","family":"Malhotra","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, NYCH\u2009+\u2009H\/Jacobi, New York City, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the New York City Health\u2009+\u2009Hospitals Perinatal COVID-19 Research Subcommittee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2021,7,16]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"m3320","DOI":"10.1136\/bmj.m3320","article-title":"Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis","volume":"370","author":"J Allotey","year":"2020","journal-title":"BMJ"},{"issue":"10","key":"ref2","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1055\/s-0040-1712164","article-title":"The relationship between status at presentation and outcomes among pregnant women with COVID-19","volume":"37","author":"V London","year":"2020","journal-title":"Am J Perinatol"},{"issue":"01","key":"ref6","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1186\/s12967-020-02374-0","article-title":"Neutrophil-to-lymphocyte ratio predicts critical illness patients with 2019 coronavirus disease in the early stage","volume":"18","author":"J Liu","year":"2020","journal-title":"J Transl Med"},{"issue":"01","key":"ref7","doi-asserted-by":"crossref","first-page":"e6","DOI":"10.1016\/j.jinf.2020.04.002","article-title":"Neutrophil-to-lymphocyte ratio as an independent risk factor for mortality in hospitalized patients with COVID-19","volume":"81","author":"Y Liu","year":"2020","journal-title":"J Infect"},{"issue":"08","key":"ref8","doi-asserted-by":"crossref","first-page":"1081","DOI":"10.1001\/jamainternmed.2020.2033","article-title":"Development and validation of a clinical risk score to predict the occurrence of critical illness in hospitalized patients with COVID-19","volume":"180","author":"W Liang","year":"2020","journal-title":"JAMA Intern Med"},{"issue":"01","key":"ref9","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1186\/s13054-020-03374-8","article-title":"Predictive values of neutrophil-to-lymphocyte ratio on disease severity and mortality in COVID-19 patients: a systematic review and meta-analysis","volume":"24","author":"X Li","year":"2020","journal-title":"Crit Care"},{"issue":"01","key":"ref10","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1038\/s41598-020-79431-7","article-title":"Neutrophil-to-lymphocyte ratio and mortality in the United States general population","volume":"11","author":"M Song","year":"2021","journal-title":"Sci Rep"},{"issue":"11","key":"ref11","doi-asserted-by":"crossref","first-page":"771","DOI":"10.3390\/brainsci10110771","article-title":"Neutrophil-to-lymphocyte ratio and symptomatic hemorrhagic transformation in ischemic stroke patients undergoing revascularization","volume":"10","author":"M \u015awito\u0144ska","year":"2020","journal-title":"Brain Sci"},{"issue":"34","key":"ref12","doi-asserted-by":"crossref","first-page":"57489","DOI":"10.18632\/oncotarget.15423","article-title":"Neutrophil-to-lymphocyte ratio and neurological deterioration following acute cerebral hemorrhage","volume":"8","author":"S Lattanzi","year":"2017","journal-title":"Oncotarget"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1016\/j.clinbiochem.2017.11.008","article-title":"Neutrophil to lymphocyte ratio predict mortality and major adverse cardiac events in acute coronary syndrome: a systematic review and meta-analysis","volume":"52","author":"C H Dong","year":"2018","journal-title":"Clin Biochem"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"1","DOI":"10.21037\/jlpm.2019.10.03","article-title":"The clinical utility of neutrophil to lymphocyte ratio in pregnancy related complications: a mini-review","volume":"5","author":"H Ling","year":"2020","journal-title":"J Lab Precis Med"},{"issue":"44","key":"ref15","doi-asserted-by":"crossref","first-page":"1641","DOI":"10.15585\/mmwr.mm6944e3","article-title":"Update: characteristics of symptomatic women of reproductive age with laboratory-confirmed SARS-CoV-2 infection by pregnancy status - United States, January 22-October 3, 2020","volume":"69","author":"L D Zambrano","year":"2020","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"03","key":"ref16","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1016\/S0889-8545(05)70217-5","article-title":"Pneumonia in pregnancy","volume":"28","author":"P S Ramsey","year":"2001","journal-title":"Obstet Gynecol Clin North Am"},{"issue":"03","key":"ref17","first-page":"65","article-title":"Changes in maternal physiology during pregnancy","volume":"3","author":"B H Heidemann","year":"2003","journal-title":"Br J Anaesth"},{"issue":"03","key":"ref18","doi-asserted-by":"crossref","first-page":"100134","DOI":"10.1016\/j.ajogmf.2020.100134","article-title":"Clinical course of severe and critical coronavirus disease 2019 in hospitalized pregnancies: a United States cohort study","volume":"2","author":"R AM Pierce-Williams","year":"2020","journal-title":"Am J Obstet Gynecol MFM"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1186\/s40560-020-00453-4","article-title":"Lymphopenia in severe coronavirus disease. (COVID-19): systematic review and meta-analysis","volume":"8","author":"I Huang","year":"2020","journal-title":"J Intensive Care"},{"issue":"07","key":"ref21","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1111\/aogs.13867","article-title":"Maternal and perinatal outcomes with COVID-19: a systematic review of 108 pregnancies","volume":"99","author":"M Zaigham","year":"2020","journal-title":"Acta Obstet Gynecol Scand"},{"issue":"02","key":"ref22","first-page":"89","article-title":"Neutrophils to lymphocytes ratio and the prognosis of the COVID-19 patients","volume":"3","author":"M Taghavi-Farahabadi","year":"2020","journal-title":"Immunoregulation"},{"issue":"03","key":"ref23","doi-asserted-by":"crossref","first-page":"1589","DOI":"10.1002\/jmv.26505","article-title":"Apoptosis and immunophenotyping of peripheral blood lymphocytes in Iranian COVID-19 patients: clinical and laboratory characteristics","volume":"93","author":"S Taghiloo","year":"2021","journal-title":"J Med Virol"},{"issue":"05","key":"ref24","doi-asserted-by":"crossref","first-page":"2867","DOI":"10.1002\/jmv.26742","article-title":"Apoptosis-induced T-cell lymphopenia is related to COVID-19 severity","volume":"93","author":"A Cizmecioglu","year":"2021","journal-title":"J Med Virol"},{"issue":"05","key":"ref25","doi-asserted-by":"crossref","first-page":"1164","DOI":"10.1182\/bloodadvances.2020003568","article-title":"A neutrophil activation signature predicts critical illness and mortality in COVID-19","volume":"5","author":"M L Meizlish","year":"2021","journal-title":"Blood Adv"},{"issue":"12","key":"ref26","first-page":"1005","article-title":"A systematic review and meta-analysis of pregnancy and COVID-19: Signs and symptoms, laboratory tests, and perinatal outcomes","volume":"18","author":"S Hassanipour","year":"2020","journal-title":"Int J Reprod Biomed (Yazd)"},{"issue":"06","key":"ref27","doi-asserted-by":"crossref","first-page":"1326","DOI":"10.1097\/AOG.0b013e3181c2bde8","article-title":"Pregnancy and laboratory studies: a reference table for clinicians","volume":"114","author":"M Abbassi-Ghanavati","year":"2009","journal-title":"Obstet Gynecol"},{"issue":"04","key":"ref28","doi-asserted-by":"crossref","first-page":"262","DOI":"10.7326\/M20-1495","article-title":"Variation in false-negative rate of reverse transcriptase polymerase chain reaction-based SARS-CoV-2 tests by time since exposure","volume":"173","author":"L M Kucirka","year":"2020","journal-title":"Ann Intern Med"}],"container-title":["American Journal of Perinatology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0041-1732421.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,9,23]],"date-time":"2021-09-23T00:54:40Z","timestamp":1632358480000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0041-1732421"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,16]]},"references-count":24,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2021,9,22]]},"published-print":{"date-parts":[[2021,10]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0041-1732421","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0735-1631","1098-8785"],"issn-type":[{"value":"0735-1631","type":"print"},{"value":"1098-8785","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,7,16]]}}}