Tohoku J. Exp. Med., 2019 August, 248(4)

Anemia and Low Albumin Levels Are Associated with Severe Community-Acquired Pneumonia in Pregnancy: A Case-Control Study

YANJUN HE,¹ MIAOGEN LI,² CAIYUAN MAI,³ LUJING CHEN,⁴ XIAOMAN ZHANG,⁵ JIANYONG ZHOU,⁶ ZHIGUO YANG,⁷ JIA NI,⁸ YONGXING CHEN,⁹ MIAN CAI,¹⁰ QINGLIAN QI¹ and ZAIDONG YANG¹

¹Department of Intensive Care Unit, Foshan Women and Children Hospital Affiliated to Southern Medical University, Foshan, Guangdong, China
²Department of Internal Medicine, Foshan Women and Children Hospital Affiliated to Southern Medical University, Foshan, Guangdong, China
³Department of Obstetrics, Guangdong Women and Children Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
⁴Department of Obstetrics and Gynecology, Dongguan Women and Children Hospital, Dongguan, Guangdong, China
⁵Department of Obstetrics and Gynecology, Zhuhai Hospital of Ji'nan University, Zhuhai, Guangdong, China
⁶Department of Intensive Care Unit, The First People's Hospital of Zhaoqing, Zhaoqing, Guangdong, China
⁷Department of Intensive Care Unit, Second Hospital of Lanzhou University, Lanzhou, Gansu, China
⁸Department of Intensive Care Unit, Guizhou Provincial Maternity and Child Care Center, Guizhou, China
⁹Department of Intensive Care Unit, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, Jiangmen, Guangdong, China
¹⁰Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, China

Community-acquired pneumonia (CAP) is the most common form of pneumonia in pregnancy and may lead to severe adverse maternal and fetal outcomes. Severe CAP (SCAP) is defined as the need for invasive mechanical ventilation and with septic shock with the need for vasopressors. This study aimed to analyze the clinical characteristics and factors associated with SCAP in pregnancy. The present study was a case-control study of pregnant women hospitalized between September 2012 and September 2017 at nine tertiary hospitals in China. Among 358,424 pregnant women, we found 35 SCAP cases and 393 common CAP cases. The 35 SCAP cases were matched 1:4 with common CAP cases (n = 140), based on patient age and gestational weeks. Infection indicators, hemoglobin, platelets, coagulation function, liver, and kidney function markers, myocardial enzyme, arterial oxygen pressure/fraction inspired oxygen (PO₂/FiO₂), and partial echocardiographic results were different between the two groups at admission (all P < 0.05). The univariable analyses indicated significant differences for hemoglobin, BMI, irregular obstetric examination, albumin, and white blood cells (all P < 0.05) between the common CAP and SCAP groups. The multivariable logistic regression analysis showed that hemoglobin (OR = 0.87, 95% CI: 0.77-0.97, P = 0.01), BMI (OR = 0.42, 95% CI: 0.22-0.81, P = 0.01), and serum albumin (OR = 0.37, 95% CI: 0.19-0.69, P = 0.002) were independently associated with SCAP. Anemia and low serum albumin are possibly associated with SCAP in pregnancy. The results indicate that anemia and albumin levels should be examined and properly treated in pregnant women with CAP.

keywords —— anemia; albumin levels; community-acquired pneumonia; pregnancy; severe

© 2019 Tohoku University Medical Press

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Tohoku J. Exp. Med., 2019, 248, 297-305

Correspondence: Zaidong Yang, Department of Intensive Care Unit, Foshan Women and Children Hospital Affiliated to Southern Medical University, No. 11 Renminxi Road, Chancheng District, Foshan, Guangdong 528000, China.

e-mail: yangzd1963@sina.com