COVID-19感染孕妇入住重症监护室的特征及早产风险：聚类分析

IF 4.7 3区医学 Q1 INFECTIOUS DISEASES

Journal of Infection and Public Health Pub Date : 2024-10-28 DOI:10.1016/j.jiph.2024.102572

Antonio Sarria-Santamera , Nurly Kapashova , Radmir Sarsenov , Kymbat Mukhtarova , Aigerim Sipenova , Milan Terzic , Gauri Bapayeva , Asselzhan Sarbalina , Saule Zhumambayeva , Kamalzhan Nadyrov , Karina Tazhibayeva , Kulyash K. Jaxalykova , Aigul Myrzabekova , Zaituna Khamidullina

{"title":"COVID-19感染孕妇入住重症监护室的特征及早产风险：聚类分析","authors":"Antonio Sarria-Santamera , Nurly Kapashova , Radmir Sarsenov , Kymbat Mukhtarova , Aigerim Sipenova , Milan Terzic , Gauri Bapayeva , Asselzhan Sarbalina , Saule Zhumambayeva , Kamalzhan Nadyrov , Karina Tazhibayeva , Kulyash K. Jaxalykova , Aigul Myrzabekova , Zaituna Khamidullina","doi":"10.1016/j.jiph.2024.102572","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>The unique physiological changes during pregnancy present challenges in understanding the full scope and effects of COVID-19 on pregnant women, adding complexity to their medical management. Given the significant changes in the immune, circulatory, respiratory, and hormonal systems during the progression of the pregnancy, and the specific factors with higher risk of COVID-19, like metabolic, vascular, and endothelial factors, typically also associated with maternal and neonatal unfavorable outcomes, the full understanding of how COVID-19 affects pregnant women is not clarified yet.</div></div><div><h3>Methods</h3><div>In this study, anonymous data from medical records of pregnant women with lab-confirmed COVID‐19 in Astana, Kazakhstan from May 1, 2021, to July 14, 2021, were collected retrospectively. A multivariate regression model was built to identify factors associated with the risk of ICU admission. Cluster analysis was performed to identify distinct groups among women admitted to the ICU based on their blood parameters, coagulation profiles, and oxygenation saturation levels.</div></div><div><h3>Results</h3><div>10.7 % of pregnant women were admitted to ICU. Among them, 4.36 % were in the 2nd trimester and 13.58 % in the 3rd trimester. No women in the 1st trimester were admitted to ICU. A multivariate regression model demonstrates that gestational diabetes, leukocytes, CRP, and saturation were the factors significantly associated with a higher risk of ICU admission. Three clusters of pregnant women were segmented, and preterm birth was frequent in clusters 1 (serious systemic conditions affecting multiple organs) and 3 (women with hypertension and preeclampsia), whereas cluster 2 represents women who can also be characterized as suffering from infections with a possible autoimmune component. Neutrophil to lymphocyte ratio was frequent in clusters 1 and 3.</div></div><div><h3>Conclusion</h3><div>In this study, multivariable analysis identified factors with a risk of ICU admission, and clustering analysis helped to identify groups of COVID-19-infected pregnant women admitted to ICU with similar risk profiles. Differences in clusters can help to explain discrepancies in COVID-19 outcomes and suggest biochemical and molecular mechanisms involved in COVID-19 and outline a more personalized approach to understanding, diagnosing, and treating women.</div></div>","PeriodicalId":16087,"journal":{"name":"Journal of Infection and Public Health","volume":"17 12","pages":"Article 102572"},"PeriodicalIF":4.7000,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Characterization of COVID-19 infected pregnant women with ICU admission and the risk of preterm: A cluster analysis\",\"authors\":\"Antonio Sarria-Santamera , Nurly Kapashova , Radmir Sarsenov , Kymbat Mukhtarova , Aigerim Sipenova , Milan Terzic , Gauri Bapayeva , Asselzhan Sarbalina , Saule Zhumambayeva , Kamalzhan Nadyrov , Karina Tazhibayeva , Kulyash K. Jaxalykova , Aigul Myrzabekova , Zaituna Khamidullina\",\"doi\":\"10.1016/j.jiph.2024.102572\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>The unique physiological changes during pregnancy present challenges in understanding the full scope and effects of COVID-19 on pregnant women, adding complexity to their medical management. Given the significant changes in the immune, circulatory, respiratory, and hormonal systems during the progression of the pregnancy, and the specific factors with higher risk of COVID-19, like metabolic, vascular, and endothelial factors, typically also associated with maternal and neonatal unfavorable outcomes, the full understanding of how COVID-19 affects pregnant women is not clarified yet.</div></div><div><h3>Methods</h3><div>In this study, anonymous data from medical records of pregnant women with lab-confirmed COVID‐19 in Astana, Kazakhstan from May 1, 2021, to July 14, 2021, were collected retrospectively. A multivariate regression model was built to identify factors associated with the risk of ICU admission. Cluster analysis was performed to identify distinct groups among women admitted to the ICU based on their blood parameters, coagulation profiles, and oxygenation saturation levels.</div></div><div><h3>Results</h3><div>10.7 % of pregnant women were admitted to ICU. Among them, 4.36 % were in the 2nd trimester and 13.58 % in the 3rd trimester. No women in the 1st trimester were admitted to ICU. A multivariate regression model demonstrates that gestational diabetes, leukocytes, CRP, and saturation were the factors significantly associated with a higher risk of ICU admission. Three clusters of pregnant women were segmented, and preterm birth was frequent in clusters 1 (serious systemic conditions affecting multiple organs) and 3 (women with hypertension and preeclampsia), whereas cluster 2 represents women who can also be characterized as suffering from infections with a possible autoimmune component. Neutrophil to lymphocyte ratio was frequent in clusters 1 and 3.</div></div><div><h3>Conclusion</h3><div>In this study, multivariable analysis identified factors with a risk of ICU admission, and clustering analysis helped to identify groups of COVID-19-infected pregnant women admitted to ICU with similar risk profiles. Differences in clusters can help to explain discrepancies in COVID-19 outcomes and suggest biochemical and molecular mechanisms involved in COVID-19 and outline a more personalized approach to understanding, diagnosing, and treating women.</div></div>\",\"PeriodicalId\":16087,\"journal\":{\"name\":\"Journal of Infection and Public Health\",\"volume\":\"17 12\",\"pages\":\"Article 102572\"},\"PeriodicalIF\":4.7000,\"publicationDate\":\"2024-10-28\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Infection and Public Health\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S187603412400306X\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"INFECTIOUS DISEASES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Infection and Public Health","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S187603412400306X","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}

引用次数: 0

摘要

背景：妊娠期独特的生理变化给全面了解 COVID-19 对孕妇的影响带来了挑战，增加了医疗管理的复杂性。考虑到妊娠过程中免疫、循环、呼吸和激素系统的重大变化，以及 COVID-19 风险较高的特定因素，如代谢、血管和内皮因素，这些因素通常也与孕产妇和新生儿的不良结局有关，因此目前尚未完全弄清 COVID-19 对孕妇的影响：本研究回顾性收集了哈萨克斯坦阿斯塔纳市 2021 年 5 月 1 日至 2021 年 7 月 14 日期间实验室确诊 COVID-19 孕妇的匿名病历数据。建立了一个多变量回归模型，以确定与入住重症监护室风险相关的因素。根据血液参数、凝血状况和血氧饱和度水平，对入住重症监护室的妇女进行了聚类分析，以确定不同的群体：10.7%的孕妇住进了重症监护室。结果显示：10.7%的孕妇住进了重症监护室，其中4.36%的孕妇在怀孕第二个三个月，13.58%的孕妇在怀孕第三个三个月。没有妊娠头三个月的孕妇住进重症监护室。多变量回归模型显示，妊娠糖尿病、白细胞、CRP 和饱和度是与入住重症监护室风险较高明显相关的因素。孕妇分为三组，早产多见于第 1 组（影响多个器官的严重系统性疾病）和第 3 组（患有高血压和子痫前期的妇女），而第 2 组则代表那些可能患有自身免疫性感染的妇女。中性粒细胞与淋巴细胞的比率在第 1 组和第 3 组中较为常见：在这项研究中，多变量分析确定了入住 ICU 的风险因素，而聚类分析则有助于确定入住 ICU 的 COVID-19 感染孕妇中具有相似风险特征的群体。聚类的差异有助于解释COVID-19结果的差异，并提示了COVID-19的生化和分子机制，为理解、诊断和治疗妇女勾勒出了更个性化的方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Characterization of COVID-19 infected pregnant women with ICU admission and the risk of preterm: A cluster analysis

Background

The unique physiological changes during pregnancy present challenges in understanding the full scope and effects of COVID-19 on pregnant women, adding complexity to their medical management. Given the significant changes in the immune, circulatory, respiratory, and hormonal systems during the progression of the pregnancy, and the specific factors with higher risk of COVID-19, like metabolic, vascular, and endothelial factors, typically also associated with maternal and neonatal unfavorable outcomes, the full understanding of how COVID-19 affects pregnant women is not clarified yet.

Methods

In this study, anonymous data from medical records of pregnant women with lab-confirmed COVID‐19 in Astana, Kazakhstan from May 1, 2021, to July 14, 2021, were collected retrospectively. A multivariate regression model was built to identify factors associated with the risk of ICU admission. Cluster analysis was performed to identify distinct groups among women admitted to the ICU based on their blood parameters, coagulation profiles, and oxygenation saturation levels.

Results

10.7 % of pregnant women were admitted to ICU. Among them, 4.36 % were in the 2nd trimester and 13.58 % in the 3rd trimester. No women in the 1st trimester were admitted to ICU. A multivariate regression model demonstrates that gestational diabetes, leukocytes, CRP, and saturation were the factors significantly associated with a higher risk of ICU admission. Three clusters of pregnant women were segmented, and preterm birth was frequent in clusters 1 (serious systemic conditions affecting multiple organs) and 3 (women with hypertension and preeclampsia), whereas cluster 2 represents women who can also be characterized as suffering from infections with a possible autoimmune component. Neutrophil to lymphocyte ratio was frequent in clusters 1 and 3.

Conclusion

In this study, multivariable analysis identified factors with a risk of ICU admission, and clustering analysis helped to identify groups of COVID-19-infected pregnant women admitted to ICU with similar risk profiles. Differences in clusters can help to explain discrepancies in COVID-19 outcomes and suggest biochemical and molecular mechanisms involved in COVID-19 and outline a more personalized approach to understanding, diagnosing, and treating women.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊

Journal of Infection and Public Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH -INFECTIOUS DISEASES

CiteScore

13.10

自引率

1.50%

发文量

203

审稿时长

96 days

期刊介绍： The Journal of Infection and Public Health, first official journal of the Saudi Arabian Ministry of National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences and the Saudi Association for Public Health, aims to be the foremost scientific, peer-reviewed journal encompassing infection prevention and control, microbiology, infectious diseases, public health and the application of healthcare epidemiology to the evaluation of health outcomes. The point of view of the journal is that infection and public health are closely intertwined and that advances in one area will have positive consequences on the other. The journal will be useful to all health professionals who are partners in the management of patients with communicable diseases, keeping them up to date. The journal is proud to have an international and diverse editorial board that will assist and facilitate the publication of articles that reflect a global view on infection control and public health, as well as emphasizing our focus on supporting the needs of public health practitioners. It is our aim to improve healthcare by reducing risk of infection and related adverse outcomes by critical review, selection, and dissemination of new and relevant information in the field of infection control, public health and infectious diseases in all healthcare settings and the community.