Association of Pregnancy With Coronavirus Cytokine Storm: Systematic Review and Meta-analysis.

Autor: Muthuka J; Head Quaters, Kenya Medical Training College, Nairobi, Kenya., Kiptoo M; Department of Health Sciences, South Eastern University of Kenya, Kitui, Kenya., Oluoch K; Head Quaters, Kenya Medical Training College, Nairobi, Kenya., Nzioki JM; College of Health Sciences, Jumeira University, Dubai, United Arab Emirates., Nyamai EM; Department of Nursing, Faculty of Clinical Sciences, Kenya Medical Training College, Nairobi, Kenya.
Jazyk: angličtina
Zdroj: JMIR pediatrics and parenting [JMIR Pediatr Parent] 2022 Oct 04; Vol. 5 (4), pp. e31579. Date of Electronic Publication: 2022 Oct 04.
DOI: 10.2196/31579
Abstrakt: Background: COVID-19 was first identified in Wuhan, China, in December 2019, spreading to the rest of the globe, becoming a pandemic. Some studies have shown an association between pregnancy status and severe COVID-19 with a cytokine storm, whereas others have shown contrasting results.
Objective: The aim of this study was to examine the relationship between pregnancy status and the clinical COVID-19 severity characterized by the cytokine storm through a systematic review and meta-analysis.
Methods: We searched the Google Scholar, PubMed, Scopus, Web of Science, and Embase databases to identify clinical studies suitable for inclusion in this meta-analysis. Studies reporting pregnancy status and comparing the COVID-19 severity cytokine storm outcome were included. COVID-19 severity characterized by a cytokine storm was described using parameters such as intensive care unit admission, invasive mechanical ventilation, mechanical ventilation, hospital admission, pro- and anti-inflammatory cytokine levels, consolidation on chest computed tomography scan, pulmonary infiltration, extreme fevers as characteristic of a cytokine storm, syndromic severity, higher neutrophil count indicative of a cytokine storm, and severe COVID-19 presentation.
Results: A total of 17 articles including data for 840,332 women with COVID-19 were included. This meta-analysis revealed a correlation between positive pregnancy status and severe COVID-19 with a cytokine storm (random-effects model odds ratio [OR] 2.47, 95% CI 1.63-3.73; P<.001), with a cumulative incidence of 6432 (14.1%) and 24,352 (3.1%) among pregnant and nonpregnant women with COVID-19, respectively. The fixed-effects model also showed a correlation between pregnancy status and severe COVID-19 with a cytokine storm (OR 7.41, 95% CI 7.02-7.83; P<.001). Considerable heterogeneity was found among all pooled studies (I²=98%, P<.001). Furthermore, the updated analysis showed substantially low heterogeneity (I²=29 %, P=.19), and the funnel plot revealed no publication bias. The subanalysis between single-center and multicenter studies demonstrated similar heterogeneity (I 2 =72% and 98%, respectively). Sensitivity analysis on each subgroup revealed that pregnancy was significantly related to severe COVID-19 with a cytokine storm from single-center studies (fixed-effects model OR 3.97, 95% CI 2.26-6.95; P<.001) with very low heterogeneity (I²=2%, P=.42).
Conclusions: Being pregnant is clearly associated with experiencing a severe course of COVID-19 characterized by a cytokine storm. The COVID-19 pandemic should serve as an impetus for further research on pregnant women diagnosed with COVID-19 to map out the salient risk factors associated with its severity.
Trial Registration: PROSPERO CRD42021242011; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=242011.
(©John Muthuka, Michael Kiptoo, Kelly Oluoch, Japheth Mativo Nzioki, Everlyn Musangi Nyamai. Originally published in JMIR Pediatrics and Parenting (https://pediatrics.jmir.org), 04.10.2022.)
Databáze: MEDLINE
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