Is neutrophil/lymphocyte ratio a useful marker to predict the severity of pre-eclampsia?

The Predictive Significance of Platelet-to-Lymphocyte Ratio for Miscarriage: A Systematic Review and Meta-Analysis

BACKGROUND

Miscarriage is a common complication of pregnancy, and its underlying pathophysiologic mechanisms remains unclear. The platelet-to-lymphocyte ratio (PLR), a prothrombotic and inflammatory marker, has been controversially discussed as a potential predictor of miscarriage. This systematic review and meta-analysis aimed to assess the predictive significance of the PLR in women with miscarriage compared to healthy pregnancies.

MATERIAL AND METHODS

Relevant studies were systematically searched in PubMed, Embase, Web of Sciencey, and Cochrane Library up to December 31, 2023. A systematic review and meta-analysis following PRISMA guidelines was conducted. Articles were identified, screened, and evaluated for quality to determine the predictive value of PLR for miscarriage.

RESULTS

Fourteen eligible articles, comprising a total of 3745 patients, were included in the meta-analysis. The pooled analysis found comparable PLR levels between miscarriage and non-miscarriage groups (SMD = 0.25; 95% Confidence Interval (CI): -0.05 to 0.54). Subgroup analysis revealed significant differences in PLR levels in the missed miscarriage group (SMD = 0.29; 95% CI: 0.01-0.56). and in studies with sample sizes smaller than 200 (SMD = 0.31; 95% CI: 0.05-0.56). Other subgroups did not exhibit significant differences. Subgroup analysis of PLR levels and miscarriage risk demonstrated no significant differences across all subgroups.

CONCLUSION

PLR is not a reliable predictor of miscarriage in general. However, for missed miscarriage cases, elevated PLR levels may serve as a practical and cost-effective marker for prediction.

The Correlation Between Neutrophil Elastase and Neutrophil-Lymphocyte Ratio in Endothelial Dysfunction of Preeclampsia

BACKGROUND

Preeclampsia (PE) is a serious inflammatory process that is unique to pregnancy, occurring at or after the 20th week of pregnancy, and leading to maternal and neonatal illness and systemic disruptions. Placental hypoxia leads to increased levels of cytokines and inflammatory syncytiotrophoblast microvillus membrane microparticles (STBM) which activates neutrophils leading to oxidative stress and endothelial dysfunction in preeclampsia. The mechanisms that cause PE in people remain unknown. To understand the pathophysiology of PE, numerous theories have been given. There is currently no proven treatment or early detecting marker for PE available so far.

METHODS

The present study includes 40 patients (20 controls and 20 PE patients) aged 20-45 years hospitalized at the Department of Obstetrics and Gynecology, Hamdard Institute of Medical Sciences and Research (HIMSR) and Hakeem Abdul Hameed Centenary (HAHC) Hospital, Jamia Hamdard, New Delhi. Nitric oxide (NO), neutrophil elastase (NE), and the neutrophil-to-lymphocyte ratio were measured. The blood and biochemical parameters in PE patients were also analyzed.

RESULTS

The neutrophil-to-lymphocyte ratio (NLR) was significantly increased in PE patients as compared to healthy pregnant. All the biochemical and hemodynamic parameters were assessed. The serum NO concentrations were lower in PE patients and endothelial dysfunction markers (NE and von Willebrand factor {vWF}) were markedly increased in PE patients. The difference was statistically significant with a p-value <0.05.

CONCLUSIONS

NLR is greatly increased in PE patients. An increase in NLR in PE patients occurs due to an increase in inflammatory markers and endothelial damage. Hence, the NLR could act as a novel diagnostic biomarker for depicting PE progression.

Predictive value of the HALP score for pre-eclampsia with severe features

INTRODUCTION

Predictive tests are needed to ensure the development and subsequent follow-up of pre-eclampsia, which is responsible for significant rates of morbidity and mortality during pregnancy. This study aimed to evaluate the predictive value of the Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) score for the severity of preeclampsia.

METHODS

We retrospectively analyzed the data of women diagnosed with pre-eclampsia at our clinic from January 2019 to January 2023. The control group consisted of normotensive, healthy pregnant women. Women diagnosed with preeclampsia were further evaluated in two groups: those with severe features and those without severe features. The clinical and demographic data of the cases were evaluated. The HALP score was calculated using the first trimester blood parameters of the cases and compared between groups.

RESULTS

The study included 229 patients with preeclampsia and 142 normotensive healthy controls. Of the patients with preeclampsia, 104 (28.1%) had severe features of the disease. The HALP score was significantly higher in the preeclampsia group with severe features than in the control group (6.18 ± 2.66 vs. 3.75 ± 1.86; p = 0.006). In multivariate logistic regression analysis, the HALP score (odds ratio: 2.02, 95% confidence interval: 1.10-3.32, p = 0.017) was found to be an independent indicator for preeclampsia with severe features. A HALP score of > 4.61 predicted the development of preeclampsia with severe features with a sensitivity of 74.5% and a specificity of 81.3%.

CONCLUSION

We found a significant correlation between the HALP score and preeclampsia with severe features. The HALP score may be useful in predicting the severity of preeclampsia.

The role of first trimester serum inflammatory indexes (NLR, PLR, MLR, SII, SIRI, and PIV) and the β-hCG to PAPP-A ratio in predicting preeclampsia

OBJECTIVE

The aim of this study was to investigate the predictive value of inflammation parameters and indices measured in the first trimester for the detection of preeclampsia.

MATERIALS AND METHODS

In this retrospective analysis, we examined the medical records of 276 eligible pregnancies at a tertiary referral center from 2022 to 2023. The cases were categorized into the Control group (n = 171), the Mild Preeclampsia group (n = 63), and the Severe Preeclampsia group (n = 42). We examined the demographic characteristics and perinatal outcomes of all participants. Additionally, we analyzed laboratory parameters, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune inflammation index (SII) (neutrophil*platelet/lymphocyte), systemic inflammation response index (SIRI) (neutrophil*monocyte/lymphocyte), pan-immune inflammation value (PIV) (neutrophil*platelet*monocyte/lymphocyte), and the β-hCG to PAPP-A ratio in the first trimester. Receiver operating characteristic curve (ROC) analysis was conducted to identify the optimal cut-off levels for inflammatory markers in predicting preeclampsia.

RESULTS

SIRI and PIV exhibited statistical significance in differentiating between the preeclampsia and control groups for predicting preeclampsia. The determined cut-off value for SIRI was 1.5, providing a sensitivity of 56.2% and a specificity of 55.6% (p = 0.012). Likewise, the cut-off value for PIV was 394.4, with a sensitivity of 55.2% and a specificity of 55% (p = 0.013). NLR, PLR, MLR, SII, and β-hCG to PAPP-A ratio could not predict preeclampsia.

CONCLUSIONS

This study suggests that SIRI and PIV hold promise as potential tools for predicting the risk of preeclampsia during the first trimester.

Role of neutrophil / lymphocyte ratio, uric acid / albumin ratio and uric acid / creatinine ratio as predictors to severity of preeclampsia

BACKGROUND

Pre-eclampsia (PE) is an intractable obstetric disorder with high mortality and morbidity, affecting 6-8% of pregnancies worldwide. As its etiology and pathogenesis remain unclear, there are no specific prevention or treatment options. This study aimed to determine the association between neutrophil to lymphocyte ratio (NLR), uric acid to albumin ratio (UAR) and uric acid to creatinine ratio (UA/Cr) and severity of pre-eclampsia.

METHODS

A cross-sectional hospital-based study was conducted among pre-eclamptic women in Kosti Maternity Hospital from September to December 2022. Forty-five pre-eclamptic women were enrolled in this study and were classified according to the WHO classification of PE into mild PE (23 PE patients) and severe PE (22 PE patients). Data were collected using a semi-structured questionnaire covering medical history and clinical assessment. A blood sample was taken from each participant for measurements of the complete blood count (CBC), liver functions test (LFT) with enzymes, renal functions test (RFT) with electrolytes, and uric acid by standard techniques.

RESULTS

NLR was found to be statistically significantly higher in mothers with severe PE (6.3-9.9) than in those with mild PE (2.2-1.5) (p-value 0.048). Alanine aminotransferase (ALT) was significantly higher in women with severe PE than in those with mild PE (p-value = 0.02). The total means of platelet-lymphocyte ratio (PLR), UA/Cr, and UAR were insignificantly higher in women with severe PE compared with those with mild PE (p-values 0.666, 0.427, and 0.525, respectively). The means of uric acid and serum creatinine showed insignificant statistical elevation in women with severe PE compared with mild PE (p-values of 0.27 and 0.44, respectively). Serum albumin was found to be insignificantly lower in mothers with severe PE (3.3 ± 0.6 g/dl) than in those with mild PE (3.6 ± 0.6 g/dl); p-value = 0.21.

CONCLUSIONS

PE showed a significant statistical increase in WBC, neutrophils, alanine transaminase (ALT), and NLR in severe PE compared to mild PE and a significant statistical decrease in lymphocyte count in severe PE compared to mild PE. The measurement of NLR may be a useful laboratory marker for predicting the severity of PE.

Is the First-Trimester Systemic Immune-Inflammation Index Associated With Preeclampsia?

OBJECTIVE

Preeclampsia (PE) is a serious and common pregnancy issue. There is a systemic inflammation in PE and it is accompanied by increased oxidative stress, but the clear etiology has not been revealed. We aimed to predict PE with the systemic immune-inflammation index (SII) value calculated in the first trimester.

MATERIAL AND METHODS

 This is a retrospective study. One hundred fifty-seven pregnant women were included in the study. Twenty-seven pregnant women were excluded from the study. Age, gravida, parity, and hemogram values were recorded in the patients' first visit file records. The time and mode of delivery, birth weight, and APGAR scores were obtained from the file records of the patients. SII was created using the formula (neutrophil x platelet/lymphocyte).  Result: The study group included 30 pregnant women who had been diagnosed with PE. The control group consisted of the remaining 100 pregnant women. There was a statistically significant difference between PE and control groups in terms of SII (p=0.03). The SII level cut-off value for predicting PE was determined to be 836.83. This value's area was found to be 0.635 (0.519-0.752). Furthermore, the selectivity is 0.60 and the sensitivity is 0.40 for these values.  Conclusion: SII was found to be significantly higher in people with PE in the study. We showed that the SII value measured in the first trimester can be used to predict PE. It might make sense to combine this marker with the patient's history and other risk factors due to its low selectivity and sensitivity.

Evaluation of Midkine levels in pregnant women with preterm premature rupture of membranes: A cohort study from a tertiary hospital

OBJECTIVE

To assess midkine (MK) levels in pregnant women with preterm premature rupture of membranes (PPROM) and compare them to healthy pregnant women. We also assessed the performance of the maternal serum MK level in predicting neonatal intensive care unit (NICU) requirement in the PPROM group.

METHODS

Forty pregnant women who presented to our clinic at 24-37 gestational weeks and were diagnosed with PPROM were included in the study group. During the same period, 40 healthy pregnant women at similar gestational weeks were randomly selected as the control group. Clinical characteristics, inflammatory markers, and serum MK levels were compared between the groups. The same parameters were then compared between the PPROM cases with and without NICU requirement. Finally, the receiver operating characteristic (ROC) analysis was performed to assess the predictive value of MK for NICU requirement.

RESULTS

The PPROM and control groups were similar in terms of demographics. The MK level of the pregnant woman with PPROM was significantly higher than that of the controls. No statistically significant difference was found between the MK levels of the cases with and without NICU requirement in the PPROM group. In the ROC analysis, the optimal cut-off value of was found to be 0.287, at which it had 63 % sensitivity and 65 % specificity (area under the curve(AUC): 0.78, 95 % confidence interval(CI): 0.683-0.881, p < 0.001) for the prediction of NICU requirement in cases with PPROM. In the same analysis performed for the prediction of PPROM, when the optimal cut-off value was taken as 0.298, MK had 56 % sensitivity and 60 % specificity (AUC: 0.65, 95 % CI: 0.522-0.770, p = 0.037).

CONCLUSION

Serum MK seems to be associated with complicated inflammatory processes leading to PPROM, and this novel marker has the potential to predict NICU requirement in PPROM cases.

Effect of intraoperative blood transfusion on inflammatory response in parturients with placenta previa undergoing cesarean section: A prospective observational study

Background

The neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and red cell distribution width (RDW) have been reported as useful biomarkers for evaluating inflammation and a predictor of surgical prognosis. Although there have been recent reports that transfusion may affect inflammatory responses, studies on the post-transfusion inflammatory response in parturients are rare. Therefore, this study aimed to observe changes in inflammatory response after transfusion during cesarean section (C-sec) through NLR, PLR, and RDW.

Methods

Parturients aged 20-50 years who underwent C-sec under general anesthesia due to placenta previa totalis from March 4, 2021, to June 10, 2021 were participated in this prospective observational study. We compared postoperative NLR, PLR, and RDW between the transfusion and non-transfusion groups.

Results

A total of 53 parturients were included in this study, of which 31 parturients received intraoperative transfusions during C-sec. There were no significant difference in preoperative NLR (3.6 vs. 3.4, p = 0.780), PLR (132.8 vs. 111.3, p = 0.108), and RDW (14.2 vs. 13.6, p = 0.062) between the two groups. However, postoperative NLR was significantly higher in the transfusion group than in the non-transfusion group (12.2 vs. 6.8, p < 0.001). Postoperative RDW was significantly higher in the transfusion group than in the non-transfusion group (14.6 vs. 13.9, p = 0.002) whereas postoperative PLR was not significantly different between the two groups (108.0 vs. 117.4, p = 0.885).

Conclusions

Postoperative NLR and RDW, the inflammatory biomarkers, were significantly higher in the transfused C-sec parturients. These results suggest a significant association between postoperative inflammatory response and transfusion in obstetric practice.

Neutrophil-to-lymphocyte ratio (NLR) as a predictive index for liver and coagulation dysfunction in preeclampsia patients

BACKGROUND

Pre-eclampsia (PE) is a pregnancy disorder that is related to an enhanced immune response. Immune cell characteristics such as neutrophil or monocyte to lymphocyte ratios (NLR, MLR) are known to be related to kidney and liver dysfunction in hypertensive patients. Here, we aimed to analyze the correlations between NLR, MLR and platelet to lymphocyte ratio (PLR) and liver, renal and coagulation functional parameters and the impacts of these immune cell profiles to the prognostic significance in PE patients.

METHODS

Pre-delivery hematological and biochemical parameters of 320 first-time pregnant women registered at the Obstetrics Department of Yanbian University Hospital from 2016 to 2019 were analyzed retrospectively. Patients were divided into normal pregnancy (normal, n = 161), mild PE (mPE, n = 28) and severe PE (sPE, n = 131) groups according to diagnostic criteria. Pearson correlation analysis were performed and area under the curve (AUC) were conducted for the diagnostic values of NLR, MLR and PLR. Results were validated with data from the Department of Obstetrics and Gynecology of Seoul National University Hospital (SNUH).

RESULTS

Kidney functional indexes were adversative in mPE and sPE and liver and coagulation indexes were worse in sPE compared to normal groups. Among immune cells, lymphocytes were increased in mPE and sPE patients, resulted in reduced NLR, MLR and PLR in PE groups, more significant difference were shown in sPE. NLR and PLR were associated with CREA and/or BUN negatively and positive associations were observed with total protein (TP) and albumin (ALB) in sPE. Only NLR showed positive associations with coagulation indexes (PT and APTT) in sPE. AUC analysis for NLR, MLR and PLR were 0.700, 0.656, 0.643, respectively, and NLR < 3.7 predicted hypertension (95% CI in all participants: 0.647-0.749, p < 0.001). Blood pressure, liver, kidney and coagulation indexes were worse at cut off value (NLR < 3.7), and this was validated with the data from SNUH.

CONCLUSION

NLR could be used as an independent predictor of liver and coagulation dysfunction in PE patients. Our results may provide non-invasive and efficient way of the risk assessment among PE patients.

Childhood adversity, prenatal depression, and maternal inflammation across pregnancy

Background

To examine whether change in neutrophil-lymphocyte ratio, a marker of systemic inflammation, differs by childhood adversity and prenatal depression.

Methods

Prenatal complete blood count data were used to calculate neutrophil-lymphocyte ratio in first and third trimesters. The Adverse Childhood Experiences scale measured childhood adversity, and the Patient Health Questionnaire-9 measured depression. This is a secondary analysis of a study of predictors of risk for sleep-disordered breathing.

Results

Participants were 98 pregnant women, mean age 30 years (SD = 5), mean body mass index of 35 kg/m² (SD = 7), 61% identified as white, and 28% identified as Hispanic. Women who reported childhood sexual abuse history displayed greater increase in neutrophil-lymphocyte ratio over pregnancy relative to women without childhood sexual abuse. Change in neutrophil-lymphocyte ratio across pregnancy did not differ by prenatal depression.

Conclusion

Experiences of sexual abuse in childhood may impact markers of systemic inflammation in pregnancy.

Predictive values of combined platelet count, neutrophil-lymphocyte ratio, and platelet-lymphocyte ratio in preeclampsia

We aimed to determine predictive values of the platelet count (PC), Neutrophil lymphocyte ratio (NLR), and platelet lymphocyte ratio (PLR) in preeclampsia independently and in combination. One hundred and eighty pregnant women (96 normal pregnancies, 84 preeclampsia) were included in this study. ROC evaluated the predictive value of PC, NLR, and PLR. AUC, Youden's index, and optimal cut-off thresholds were calculated independently and in combination. The PC significantly decreased in preeclampsia (p < .0001, 95% CI -60.6437 to -24.5963) with cut-off level ≤250.3, whereas NLR was significantly increased in preeclampsia (5.28 ± 4.77, p = .0001, 95% CI 0.9813-2.9187) with cut-off level >4.47. In preeclampsia, PLR significantly decreased (94.32 ± 30.81, p = .0001, 95% CI 58.2583 to -29.6817) with cut-off level ≤100.48. Combined indices of PC, NLR, and PLR were significantly more predictive of preeclampsia when compared to independent indices (AUC 0.86, p < .001, 95% CI 0.801-0.907, sensitivity 75.0, and specificity 81.2) compared to independent indices.IMPACT STATEMENTWhat is already known on this subject? Many studies have tried to find out a simple screening test that would predict the risk of developing preeclampsia. Platelet count, Neutrophil lymphocyte ratio, and platelet lymphocyte ratio have been investigated independently to predict preeclampsia. These parameters are simple, cheap, and are usually available for all patients. Unfortunately, there are no universal cut-off levels accepted.What do the results of this study add? The use of a combination of platelet count, neutrophil-lymphocyte ratio, and platelet lymphocyte ratio is a simple and effective test to predict preeclampsia. The use of a scoring system involving cut-off levels of platelet count, neutrophil-lymphocyte ratio, and platelet lymphocyte ratio is a highly predictive index for developing preeclampsia.What are the implications of these findings for clinical practice and/or further research? In this study, we aimed to highlight the importance of using a combination of platelet count, neutrophil-lymphocyte ratio, and platelet lymphocyte ratio as a scoring index instead of using these parameters independently. More studies are needed to reach a universal cut-off level for each parameter.

Could fibrinogen to albumin ratio be a predictive marker for recurrent pregnancy loss

AIMS

Recurrent pregnancy loss (RPL) is usually defined by two or more consecutive clinical miscarriages, which causes psychological trauma for couples. In this study, we aimed to investigate the predictive role of fibrinogen to albumin ratio (FAR) in patients with RPL.

METHODS

Pregnant women in their first trimester of pregnancy were included in the study and divided into two groups as RPL patients (n: 44) and patients with no previous recurrent miscarriage (n: 60) as control group. Demographical parameters and routine blood parameters (fibrinogen, D-dimer, FAR, neutrophil to lymphocyte ratio [NLR], platelet count, main platelet volume [MPV], and red cell distribution width [RDW] values) were compared between the RPL group and the control group.

RESULTS

The groups were determined to be statistically different in regard to gravidity and parity (P < .001). The difference between the groups was statistically different in regard to fibrinogen (mg/dL), albumin (g/dL), FAR (%), NLR (%), RDW-coefficient of variation (%), RDW-standard deviation (fl), and platelet counts (10^-3 /μL). However, MPV (fl) and D-dimer (μg/L) levels were similar in both groups. The receiver operating characteristic curve analysis revealed that the NLR levels were 84.1% sensitive and 75% specific with a cut-off value of 4.27 and the FAR levels were 79.5% sensitive and 88.3% specific with a cut-off value of 105.69 for predicting RPL.

CONCLUSION

Our results indicate that the FAR and NLR levels seem to be effective parameters for predicting RPL with high sensitivity and specificity.

Association Between Neutrophil-Lymphocyte Ratio and Gestational Diabetes-A Systematic Review and Meta-Analysis

A growing body of evidence shows that the neutrophil-lymphocyte ratio (NLR) is a surrogate index of systemic inflammation in several chronic diseases. Conflicting associations between NLR and gestational diabetes mellitus (GDM) have been reported in individual studies. This meta-analysis sought to investigate the association between NLR and GDM. The PubMed, EMBASE, and Google Scholar databases were searched to identify relevant articles. The pooled standardized mean difference with 95% CI was calculated using a random-effects model. Subgroup and meta-regression analysis were carried out to control for the effects of GDM diagnostic criteria, ethnicity, body mass index (BMI), and age. Eleven eligible articles were included, containing 1271 participants with GDM and 1504 controls. Pooled outcomes indicated a higher NLR in GDM pregnancies than in normoglycemic controls (SMD = 0.584; 95% CI, 0.339-0.830; P < .001), although extensive heterogeneity between studies was noted. Subgroup analysis revealed that the higher pooled estimate in GDM was not affected by diagnostic criteria, ethnicity, or BMI, although matching for BMI reduced heterogeneity between studies. This meta-analysis supports the higher NLR in GDM described by some individual studies.

Neutrophil to Lymphocyte Ratio in Maternal Blood: A Clue to Suspect Amnionitis

There is no information about whether maternal neutrophil to lymphocyte ratios (NLRs) progressively increase with respect to the progression of acute histologic chorioamnionitis (acute-HCA) and increased maternal NLR is a risk factor for amnionitis, known as advanced acute-HCA, in pregnant women at risk for spontaneous preterm birth (PTB). The objective of the current study is to examine this issue. The study population included 132 singleton PTB (<34 weeks) due to either preterm labor or preterm-PROM with both placental pathology and maternal CBC results within 48 h before delivery. We examined maternal NLRs according to the progression of acute-HCA in extra-placental membranes (EPM) (i.e., group-0, inflammation-free EPM; group-1, inflammation restricted to decidua; group-2, inflammation restricted to the membranous trophoblast of chorion and the decidua; group-3, inflammation in the connective tissue of chorion but not amnion; group-4, amnionitis). Maternal NLRs significantly and progressively increased with the progression of acute-HCA (Spearman’s rank correlation test, γ = 0.363, p = 0.000019). Moreover, the increased maternal NLR (≥7.75) (Odds-ratio 5.56, 95% confidence-interval 1.26-24.62, p < 0.05) was a significant independent risk factor for amnionitis even after the correction for potential confounders. In conclusion, maternal NLRs significantly and progressively increased according to the progression of acute-HCA and the increased maternal NLR (≥7.75) was an independent risk factor for amnionitis in spontaneous PTB. The evaluation of the performance of NLR should clearly require a prospective description of this parameter in a cohort of patients with either threatened PTL or preterm-PROM.

Can complete blood count parameters that change according to trimester in pregnancy be used to predict severe preeclampsia?

We aimed to evaluate the effectiveness of changes over time in complete blood count (CBC) parameters to estimate the diagnosis of preeclampsia. Data on 161 severe preeclampsia patients and 161 healthy pregnant patients who met the study criteria of pregnant women whose CBC had been measured at 10-12, 22-24 and 28-30 weeks of pregnancy were compared. In the preeclampsia group, an increase in the mean platelet volume (MPV) value and a decrease in the number of platelets were statistically significant in the transition from the second to the third trimester. MPV and lymphocyte counts were more significant in the third trimester and neutrophil lymphocyte ratio (NLR) were more significant in the second trimester. We found that evaluation of the changes in lymphocyte, MPV and NLR values in three different trimesters of pregnancy rather than a single trimester was more meaningful to predict severe preeclampsia.Impact StatementWhat is already known on this subject? Studies have shown that MPV and NLR can predict preeclampsia. However, a clear cut off value could not be determined. The reasons for this may be that the gestational week during which the measurement is made is not standard and the patient groups are not homogeneous.What the results of this study add? In this study, CBC parameters at different stages of the preeclampsia process were compared in the severe preeclampsia group. According to our results, lymphocytes, NLR and MPV can be used to predict severe preeclampsia. In addition, NLR measurements in the second trimester and MPV and lymphocyte measurements in the third trimester were found to be more significant in predicting severe preeclampsia.What the implications are of these findings for clinical practice and/or further research? In order to predict severe preeclampsia, instead of a single measurement of CBC parameters, new calculations should be made that add change over time.

New indicators in evaluation of hemolysis, elevated liver enzymes, and low platelet syndrome: A case-control study

BACKGROUND

Indices such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), mean platelet volume (MPV), platelet distribution width (PDW), and red cell distribution width (RDW) are considered new markers of the systemic inflammatory response (SIR), and have been widely implemented for the diagnosis of patients with inflammatory diseases. These new indicators have also been widely investigated in preeclampsia (PE) but less analyzed in hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome.

AIM

To compare SIR markers among HELLP patients, PE only patients, and healthy gravidae.

METHODS

This retrospective case-control study enrolled 630 cases, including 210 patients with HELLP syndrome (HELLP group), 210 patients with only PE (PE group) and 210 healthy gravidae (control group). The three groups were matched by age, parity, status of assisted reproduction, and multiple pregnancies. Birthweight, gestational age at complete blood count collection, gestational age at delivery, mode of delivery, etc. were recorded. The main indices as NLR, PLR, MPV, PDW, and RDW among the groups were compared, as well as some secondary outcomes including neutrophil, platelets, and hemoglobin.

RESULTS

The NLR (6.4 vs 4.3 vs 3.5), MPV (11.9 vs 11.2 vs 10.7), PDW (16.4 vs 13.3 vs 14.2), leukocyte (12.4 × 10⁹/L vs 9.7 × 10⁹/L vs 8.7 × 10⁹/L) and neutrophil count (9.9 × 10⁹/L vs 7.3 × 10⁹/L vs 6.1 × 10⁹/L) were highest in the HELLP group, lower in the PE group, and lowest in the control group. Both the overall comparisons between the three groups (all ^bP < 0.01) and pairwise comparisons between every two groups elicited statistically significant differences (all ^dP < 0.01, except control vs PE: ^cP < 0.05 in PDW). The average lymphocyte counts were 1.4 (1.1, 2.0) × 10⁹/L in the HELLP group, 1.6 (1.3, 2.0) × 10⁹/L in the PE group and 1.7 (1.4, 2.0) × 10⁹/L in the control group. The overall comparison of lymphocyte count within the three groups had statistically significant differences (P = 0.000). The pairwise comparisons between every two groups demonstrated that the HELLP group had a lower lymphocyte count than both the PE (P = 0.019) and control groups (P = 0.000), but the difference between the PE and control groups was not statistically significant (P = 0.432). The overall comparisons on platelet counts and the PLR among these three groups also showed statistically significant differences (both P = 0.000), from low to high being those in the HELLP group (43.4 × 10⁹/L, 64.0), control group (180.5 × 10⁹/L, 103.6) and PE group (181.5 × 10⁹/L, 112.8). Pairwise comparisons of neither index displayed statistically significant differences between the PE and control groups (both P > 0.05), while the differences in the two indices between the HELLP group and the two other groups were still statistically significant (all P = 0.000). RDW values were highest in the HELLP group (14.5% [13.6, 15.3]), lower in the control group (14.1% [13.5, 14.8]) and lowest in the PE group (13.9% [13.4, 14.9]). The difference between the PE and control group did not show statistical significance (P = 1.000), while RDW values in the HELLP group were higher than those in the other two groups (^cP < 0.05 vs control, ^dP < 0.01 vs PE).

CONCLUSION

SIR markers such as NLR, RDW, MPV, and PDW were increased and PLR was decreased in HELLP. These SIR markers may become new indicators in the evaluation of HELLP syndrome.

The clinical utility of D-dimer/platelet count ratio in pregnant women

OBJECTIVE

We performed a retrospective study to assess the clinical utility of a new index, D-dimer/platelet count (DD/PLT) ratio, in discriminating preeclampsia from normal pregnancy and gestational hypertension during third trimester, compared to the biomarkers currently used, such as D-dimer (DD), platelet (PLT), lymphocyte (LIN) and neutrophil (NEU) counts, fibrinogen (FIB), PLT/NEU, NEU/LIN and PLT/LIN ratios.

STUDY DESIGN

We retrospectively included 213 subjects. Of them, 163 and 50 were singleton pregnant and healthy non-pregnant women, respectively. Among pregnant women, 105 had normal pregnancy, 33 had gestational hypertension, and 25 had preeclampsia.

RESULTS

Using Receiver Operating Curve (ROC) analysis, DD/PLT ratio showed significant higher area under the curve (AUC) (0.90; 95% confidence interval (CI) 0.84-0.95) in discriminating preeclampsia from normal pregnancy compared to those of DD, NEU, FIB, LIN, PLT/NEU, NEU/LIN and PLT/LIN ratios (p < .03). In discriminating preeclampsia from gestational hypertension, the DD/PLT AUC (0.90; 95% CI 0.79-0.96) was significantly higher than those of DD, NEU, FIB, LIN, NEU/LIN and PLT/LIN ratios (p < .03), and not statistically different from those of PLT (p = .22) and PLT/NEU ratio (p = .46).

CONCLUSIONS

This study shows that DD/PLT ratio helps to discriminate preeclampsia from normal pregnancy and gestational hypertension. Large-scale studies are needed to verify its clinical usefulness, and to suggest more appropriate cutoff values for a widespread use.

Association between neutrophil to lymphocyte ratio and carotid artery wall thickness in healthy pregnant women

OBJECTIVE

Pregnancy may elicit a state of mild inflammation that might affect, either directly or indirectly, haematological parameters associated with systemic inflammation. In particular, both Neutrophil-to-lymphocyte ratio (NLR) and Red blood cells Distribution Width (RDW) have been found to be elevated in complicated pregnancy. However, data regarding the association of these haematological parameters with common carotid artery (CCA) intima-media thickness (IMT) in healthy pregnancy are scanty. Aim of this study was to evaluate possible changes in CCA-IMT during normal pregnancy and in the postpartum period, and to correlate these changes with NLR and RDW.

STUDY DESIGN

Between October 2019 and February 2020, a prospective study was carried out on 73 consecutive healthy pregnant women (32.8 ± 4.9 yrs/old). Women underwent obstetric assessment, complete blood cell counts with calculation of NLR and RDW, two-dimensional transthoracic echocardiography and carotid Doppler ultrasonography.

RESULTS

During normal pregnancy, both NLR and RDW progressively increased (p < 0.0001); likewise, parameters of carotid dimensions also significantly increased (p < 0.0001). Hematological and morphological changes all decreased in postpartum period. By univariable logistic regression, the variables which showed the greatest independent association with CCA-IMT (defined as CCA-IMT ≥0.55 mm) were: age (HR 1.33, 95% CI 1.15-1.53, p < 0.0001), pre-pregnant BMI (HR 2.75, 95% CI 1.72-4.41, p < 0.0001), third trimester E/e' ratio (HR 1.64, 95% CI 1.34-2.02, p < 0.0001), and third trimester NLR (HR 3.00, 95% CI 1.64-5.50, p < 0.0001). Multivariable logistic regression analysis demonstrated that third trimester NLR was the only variable that retained statistical significance (HR 2.49, 95% CI 1.35-4.59, p = 0.003). An NLR ≥ 2 reached 83% of sensitivity and 99% of specificity in identifying a CCA-IMT ≥0.55 mm (AUC = 0.95). A strong linear correlation of both third trimester NLR and RDW with CCA-IMT was observed (r = 0.89 and 0.83, respectively).

CONCLUSIONS

Pregnancy is a state of chronic mild inflammation and the progressive increase in NLR and RDW during normal pregnancy is significantly associated with CCA intimal-medial thickening.

Mechanisms of Key Innate Immune Cells in Early- and Late-Onset Preeclampsia

Preeclampsia is a complex cardiovascular disorder of pregnancy with underlying multifactorial pathogeneses; however, its etiology is not fully understood. It is characterized by the new onset of maternal hypertension after 20 weeks of gestation, accompanied by proteinuria, maternal organ damage, and/or uteroplacental dysfunction. Preeclampsia can be subdivided into early- and late-onset phenotypes (EOPE and LOPE), diagnosed before 34 weeks or from 34 weeks of gestation, respectively. Impaired placental development in early pregnancy and subsequent growth restriction is often associated with EOPE, while LOPE is associated with maternal endothelial dysfunction. The innate immune system plays an essential role in normal progression of physiological pregnancy and fetal development. However, inappropriate or excessive activation of this system can lead to placental dysfunction or poor maternal vascular adaptation and contribute to the development of preeclampsia. This review aims to comprehensively outline the mechanisms of key innate immune cells including macrophages, neutrophils, natural killer (NK) cells, and innate B1 cells, in normal physiological pregnancy, EOPE and LOPE. The roles of the complement system, syncytiotrophoblast extracellular vesicles and mesenchymal stem cells (MSCs) are also discussed in the context of innate immune system regulation and preeclampsia. The outlined molecular mechanisms, which represent potential therapeutic targets, and associated emerging treatments, are evaluated as treatments for preeclampsia. Therefore, by addressing the current understanding of innate immunity in the pathogenesis of EOPE and LOPE, this review will contribute to the body of research that could lead to the development of better diagnosis, prevention, and treatment strategies. Importantly, it will delineate the differences in the mechanisms of the innate immune system in two different types of preeclampsia, which is necessary for a more personalized approach to the monitoring and treatment of affected women.

Can Inflammatory Hematological Parameters be a Guide to Late-onset Fetal Growth Restriction?

PURPOSE

To compare the rates obtained from hematological parameters in cases of late-onset idiopathic fetal growth restriction (FGR) with healthy pregnancies and to evaluate the effect on neonatal outcomes.

METHODS

The study group consisted of 63 pregnant women with late-onset idiopathic FGR and the control group consisted of 91 healthy pregnant women. The determined rates were calculated from the control hemograms of patients at 28 weeks. Both groups were compared for neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and other parameters.

RESULTS

NLR, leukocyte and neutrophil levels were significantly higher in the FGR group (p<0.05). There was no significant difference in PLR, platelet and lymphocyte levels between the groups (p>0.05). To predict FGR, the best cut-off value of NLR was determined to be 4.11 with 56% sensitivity and 88% specificity values.

CONCLUSION

Neutrophil, lymphocyte and platelet interactions have an important role in FGR development. Inflammation can be involved in the etiopathogenesis in late-onset FGR.

The benefits of higher LMR for early threatened abortion: A retrospective cohort study

Problem

To investigate the relation of inflammation-related parameters and pregnancy outcome in women with the early threatened abortion.

Method of study

630 women with early threatened abortion were divided into two groups based on the pregnancy outcome. All of them had the blood routine examination before treating. The differences between two groups were analyzed by the Chi-squared test, Student T test, Mann-Whitney U test, Binary Logistic Regression, Marginal Structural Model and Threshold effect analysis.

Results

We found that there is no significant difference in the pregnancy outcome for NLR (OR:0.92, CI95%:0.72, 1.17) and PLR (OR:1.00, CI%:0.99, 1.01). However, a difference had a statistical significance in the pregnancy outcome when LMR less than 2.19 (OR:0.39, CI95%:0.19,0.82).

Conclusions

This study suggested that higher LMR was related to the lower risk of miscarriage in the women with early threatened abortion in a way.

Systemic inflammatory response markers in preeclampsia

PURPOSE

Neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), platelet distribution width (PDW), red cell distribution width (RDW), mean platelet volume (MPV), and plateletcrit (PCT) are known as systemic inflammatory response markers. In this study, we aimed to evaluate changes in NLR, PLR, PDW, RDW, MPV, and PCT in preeclampsia (PE) and their use in predicting its severity.

MATERIALS AND METHODS

This is a retrospective case-control study. The study comprised 64 control group (healthy pregnant females), 51 females with mild PE, and 13 with severe PE. These three groups were compared with demographic data and inflammation markers.

RESULTS

There were no statistically significant differences between healthy pregnant females and preeclaptic females in terms of median age, hemoglobin, lymphocyte, neutrophil, platelet, NLR, PLR, PDV, RDW, MPV, PCT (P > 0.05). The control group has a higher number of gravity and parity than the PE group (P < 0.001). MPV value is a lower PE group than the control group (P < 0.001). Both gravity and parity were significantly higher in the patients with mild PE than in the control group (P < 0.001). MPV value was statistically higher in the control group compared both mild and severe PE (P < 0.001), however, no statistical difference between mild and severe PE (P = 0.305).

CONCLUSIONS

MPV may be clinically useful markers in the prediction of PE. Further, prospective multicenter studies are needed to reveal the association between these markers and PE.

Correlation of biological parameters with placental parameters and pregnancy outcomes in pre-eclamptic women

INTRODUCTION

Pre-eclampsia is characterized by maternal vascular malperfusion and chronic inflammation in placenta. Our purpose was to investigate the potential correlation of biological parameters with placental parameters and pregnancy outcomes in pre-eclamptic women.

METHODS

Pre-eclamptic women were identified by interrogation of the Medical Registry Department in six French maternities between April 2013 and June 2018. Histological parameters in placentas (weight, macroscopic and microscopic lesions), baseline maternal characteristics and pregnancy outcomes (course of pregnancy, newborns' characteristics) were collected. Biological parameters were blood cell ratios (Platelet-to-Lymphocyte Ratio (PLR), Neutrophil-to-Lymphocyte Ratio (NLR)) collected at delivery and Placental growth factor (PlGF) measured in women with an available first trimester serum sample. Correlations of blood cell ratios and PlGF levels with placental parameters and pregnancy outcomes were assessed by Pearson's correlation test for quantitative parameters and by logistic regression analysis for qualitative parameters.

RESULTS

202 pregnancies were included, among which 68 had a first trimester PlGF quantification. No correlation was found between biological parameters and placental lesions. Low PLR was correlated with low placental weight (r = 0.156, p = 0.036) and with low birth weight (r = 0.179, p = 0.015). Low PlGF was correlated with long time from pre-eclampsia diagnosis to delivery (r = -0.250, p = 0.048).

CONCLUSIONS

There is no correlation between biological parameters and placental lesions in pre-eclamptic women. Yet, low PLR at delivery is correlated with low placental and birth weights. Moreover, low first trimester PlGF is correlated with long time from pre-eclampsia diagnosis to delivery.

First trimester neutrophil to lymphocyte ratio (NLR) and pregnancy outcome

In early pregnancy, miscarriage is the most common complication. The early identification of women at high risk for miscarriage could improve pregnancy outcomes. We investigated whether the first trimester neutrophil to lymphocyte ratio (NLR) could be used as a prognostic marker for miscarriage, in pregnancies after spontaneous conception. We retrospectively identified 129 pregnant women who had a first trimester full blood count available and known pregnancy outcome. First trimester NLR was calculated for each woman and mean NLR values were compared between women with live births (group 1) with those with miscarriage (group 2). Mean NLR values were not significantly different between the two groups (2.5 ± 1.0 vs. 2.9 ± 1.5, p = .167) and were not associated with pregnancy outcomes. However, NLR values >5.8 were exclusively observed in the miscarriage group (p = .028).IMPACT STATEMENTWhat is already known on this subject? As a marker of inflammation, NLR has been found to be elevated in various diseases and complications that affect pregnancy outcome. Pregnancy complications, such as preeclampsia and gestational diabetes have been associated with an increased NLR, but little is known on their direct causal relationship. So far, there has been no evaluation of maternal NLR in regards to miscarriage in otherwise healthy women.What do the results of the study add? We found that NLR does not differ significantly between pregnant women with live birth and those whose pregnancy ended in miscarriage . However, NLR values >5.8 were solely found in the miscarriage group- an observation that was statistically significant.What are the implications of these findings for clinical practice and/or further research? The above finding supports high NLR values as a potential marker for the identification of the subset of miscarriages in otherwise healthy pregnant women. This may allow personalised approaches to prevent pregnancy loss.

Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, and Routine Complete Blood Count Components in HELLP Syndrome: A Matched Case Control Study

Background and objective: Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are new readily available inflammatory markers that have been analyzed in pregnancy-induced hypertensive disorders such as preeclampsia. Studies on the NLR/PLR ratio in hemolysis, elevated liver enzymes, low-platelet count (HELLP) syndrome are limited in the current literature. We compared NLR/PLR and other complete blood count (CBC) components between women with HELLP syndrome and women with healthy pregnancies. Methods: We conducted a retrospective matched case–control study at a tertiary care hospital in NY (USA) in the time frame between January 2016 and December 2018. The study compared pregnant women with HELLP syndrome (cases) to women with healthy pregnancies in the third trimester (controls), matched by age, body mass index (BMI), parity, and race. Patient with preeclampsia, infection, and fever were excluded. Venous blood samples were obtained as part of the routine work-up at admission for delivery, which included a CBC. The main outcomes were NLR and PLR. The secondary outcomes were hemoglobin, red cell distribution width (RDW), platelet count, mean platelet volume (MPV), neutrophils, lymphocytes. Results: There were 14 patients in each group. They were matched by age, race, BMI, and parity. NLR (5.8 vs. 3.6, p-value = 0.002) and neutrophil count (10.7 vs. 6.8, p-value = 0.001) were higher in women with HELLP compared to controls. PLR (34 vs. 130.2, p-value < 0.001) and platelet count (71 vs. 223, p-value < 0.001) were lower in the study group compared to controls. Conclusions: NLR was higher, and PLR was lower in women with HELLP syndrome. These inflammatory markers can be incorporated into the diagnostic algorithm for HELLP syndrome. Future studies are needed to evaluate their ability to predict HELLP syndrome.

[Maternal neutrophil-to-lymphocyte ratio as a prognostic biomarker for placental inflammatory response in late pregnancy]

OBJECTIVE

To investigate the association between maternal serum neutrophil-lymphocyte ratio (NLR) and placental inflammatory response (PIR) in late pregnancy.

METHODS

We retrospectively analyzed the clinical and follow-up data of 478 pregnant women undergoing routine prenatal examination and delivery in our hospital in the year 2016. According to the placental pathological results, the women were divided into PIR group (238 cases) and control group (240 cases). The levels of serum inflammatory makers including leukocytes, neutrophils, lymphocytes, C-reactive protein (CRP) and NLR were compared between the two groups to analyze the association of these markers with PIR. Multivariate analysis was performed to identify the independent risk factors of PIR. Logistic regression model was established and the area under the receiver operating characteristic curve (ROC) was used for analyzing the prognostic value of these makers in late pregnancy.

RESULTS

The areas under the curve (AUC) of leukocytes, neutrophils, lymphocytes, CRP and NLR were 0.698 (95%CI: 0.485-0.766), 0.716 (95%CI: 0.453-0.783), 0.329 (95%CI: 0.228-0.431), 0.725 (95%CI: 0.677-0.765) and 0.801 (95%CI: 0.742-0.856), respectively. After adjusting the confounders, multivariate logistic regression analysis showed that preterm labor (OR=2.446, 95%CI: 1.003-4.590), premature rupture of membranes (OR=2.304, 95%CI: 1.049-4.161), NLR &gt; 7 (OR=3.268, 95%CI: 2.071-6.920), and CRP &gt; 15 mg/L (OR=2.137, 95%CI: 1.412-8.236) were independent risk factors for PIR.

CONCLUSIONS

An increased NLR in late pregnancy can serve as an effective indicator for predicting the risk of PIR.

Neutrophil-to-lymphocyte ratio and platelet indices in pre-eclampsia

OBJECTIVE

To compare the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and platelet indices between women with pre-eclampsia and normotensive pregnant women.

METHODS

A cross-sectional study conducted from January to July 2017 at a tertiary care hospital in Delhi, India. The study compared pregnant women aged 18-40 years with pre-eclampsia diagnosed at term with healthy pregnant women matched for gestational age. Venous blood samples were drawn and complete blood count was analyzed. The parameters recorded were hemoglobin, red cell distribution width (RDW), platelet count, mean platelet volume (MPV), plateletcrit, and platelet distribution width.

RESULTS

There were 67 women included in each group. NLR was higher in women with pre-eclampsia compared with the control group (6.8 ± 7.6 vs 3.0 ± 0.98; P=0.001). Both PLR (14.18 ± 14.4 vs 9.54 ± 3.6; P=0.012) and MPV (9.45 ± 1.19 vs 9.02 ± 1.1; P=0.029) were higher in the study group compared with the control group. Platelet count was lower in pre-eclamptic women compared with the control group (188 ± 89.7 vs 200.1 ± 62.36; P=0.014). RDW was also higher in the study group (P=0.025).

CONCLUSIONS

The present study found that the inflammatory markers NLR, PLR, RDW, and MPV were higher in women with pre-eclampsia. Measuring NLR and PLR may be useful in predicting pre-eclampsia among women at high risk during prenatal follow-up.

Neutrophils to lymphocytes ratio and platelets to lymphocytes ratio in pregnancy: A population study

BACKGROUND

Neutrophils to lymphocytes ratio (NLR) and platelets to lymphocytes ratio (PLR) are both inflammatory ratios that can be easily calculated from a simple blood count. They are frequently reported and tested as prognostic factors in several medical disciplines. Pregnancy involves special reference values for laboratory assays.

OBJECTIVE

The aim of this study was to define pregnancy-related reference values for NLR and PLR according to trimester, background morbidity and according to the patient's age.

STUDY DESIGN

A retrospective analysis of a large cohort undergoing community-based pregnancy surveillance between the years 2011-2016. Data were analyzed according to high-risk patient versus normal-risk patient.

RESULTS

A total of 11,415 patients were included. Mean PLR and NLR values were 136.3±44.3, 2.6±1, respectively during the first trimester, 144.6±47.1, 4.0±1.4 respectively during the second trimester and 118.1±42.0, 3.5±1.2 respectively during the third trimester. No difference was detected between the high-risk and the normal population (P-values 0.3, 0.5 and 0.4 for PLR in each trimester respectively and 0.3, 0.4, 0.6 for NLR in each trimester, respectively). No differences were detected among parity categories. The correlation between patient's age and either PLR and NLR was a weak positive correlation (though statistically significant). Both PLR and NLR reached a maximum value during the second trimester. The differences between mean NLR and PLR between trimesters were significant (P <0.01 for all differences tested). PLR rises in the presence of anemia, reaching statistical significance (P-value for PLR in each trimester was <0.01). NLR showed an opposite trend (P-values for NLR were 0.4, 0.005 and 0.06 in each trimester, respectively).

CONCLUSIONS

In our cohort, there were generally no differences between the high-risk and the normal population, excluding patients with a fibroid uterus or inflammatory bowel disease who presented a significantly elevated PLR through all trimesters. Both PLR and NLR reached a maximum value during the second trimester and were positively correlated with age. We anticipate that the population-based data will assist in providing accurate reference values for future research testing NLR and PLR measures during pregnancy.

Oxidative stress and endothelial function in normal pregnancy versus pre-eclampsia, a combined longitudinal and case control study

Background

Pre-eclampsia (PE) is related to an impaired endothelial function. Endothelial dysfunction accounts for altered vascular reactivity, activation of the coagulation cascade and loss of vascular integrity. Impaired endothelial function originates from production of inflammatory and cytotoxic factors by the ischemic placenta and results in systemic oxidative stress (OS) and an altered bioavailability of nitric oxide (•NO). The free radical •NO, is an endogenous endothelium-derived relaxing factor influencing endothelial function. In placental circulation, endothelial release of •NO dilates the fetal placental vascular bed, ensuring feto-maternal exchange. The Endopreg study was designed to evaluate in vivo endothelial function and to quantify in vitro OS in normal and pre-eclamptic pregnancies.

Methods/design

The study is divided into two arms, a prospective longitudinal study and a matched case control study. In the longitudinal study, pregnant patients ≥18 years old with a singleton pregnancy will be followed throughout pregnancy and until 6 months post-partum. In the case control study, cases with PE will be compared to matched normotensive pregnant women. Maternal blood concentration of superoxide (O₂•) and placental concentration of •NO will be determined using EPR (electron paramagnetic resonance). Endothelial function and arterial stiffness will be evaluated using respectively Peripheral Arterial Tonometry (PAT), Flow-Mediated Dilatation (FMD) and applanation tonometry. Placental expression of eNOS (endothelial NOS) will be determined using immune-histochemical staining. Target recruitment will be 110 patients for the longitudinal study and 90 patients in the case-control study.

Discussion

The results of Endopreg will provide longitudinal information on in vivo endothelial function and in vitro OS during normal pregnancy and PE. Adoption of these vascular tests in clinical practice potentially predicts patients at risk to develop cardiovascular events later in life after PE pregnancies. •NO, O₂•⁻ and eNOS measurements provide further inside in the pathophysiology of PE.

Trial registration

This trial has been registered on clinicaltrials.gov. ClinicalTrials.gov Identifier: NCT02603913. Registered October 2015.

Are neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and/or mean platelet volume (MPV) clinically useful as predictive parameters for preeclampsia?

OBJECTIVE

Preeclampsia (PE) is a severe pregnancy complication with significant maternal and neonatal morbi-mortality resulting in high health care costs. Prevention, mainly based on the administration of acetylsalicylic acid, is only possible if timely identification of high-risk patients can be realized in an easy, nonexpensive, and widely available method. This paper explores the clinical usability of neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and/or mean platelet volume (MPV) in discriminating between women that will and those that will not develop PE.

STUDY DESIGN

Demographic data and laboratory results were retrospectively collected and compared in 2050 pregnant women (164 PE and 1886 controls) between 1 January 2014 and 31 January 2016.

RESULTS

In the PE group, gravidity, parity, gestational age, and birth weight were significantly lower compared to the control group. Before the 20th pregnancy week, MPV was significantly elevated in the PE group compared to the controls (p = .006), hence analysis revealed an optimal cut-off point of 8.15 (sensitivity 66.7%, specificity 56.3%) for predicting PE. At the end of pregnancy, NLR and MPV appeared to be higher and PLR lower in the PE group compared to the controls, which strengthens the current knowledge on the pathogenesis of PE.

CONCLUSIONS

MPV is significantly elevated in the first half of pregnancy in women who later develop PE and might therefore be implemented in combination with other parameters in a PE prediction model.

C-reactive protein is differentially modulated by co-existing infections, vitamin deficiencies and maternal factors in pregnant and lactating indigenous Panamanian women

Background

The usefulness of C-reactive protein (CRP) as a non-specific marker of inflammation during pregnancy and lactation is unclear in impoverished populations where co-existing infections and vitamin deficiencies are common.

Methods

This cross-sectional study in Panama recruited 120 pregnant and 99 lactating Ngäbe-Buglé women from 14 communities in rural Panama. Obstetric history, indoor wood smoke exposure, fieldwork, BMI, vitamins A, B₁₂, D, and folic acid, and inflammation markers (CRP, neutrophil/lymphocyte ratio (NLR), plateletcrit and cytokines) were measured. Multiple regressions explored both associations of CRP with other inflammatory markers and associations of CRP and elevated CRP based on trimester-specific cut-offs with maternal factors, infections and vitamin deficiencies.

Results

CRP was higher in pregnancy (51.4 ± 4.7 nmol/L) than lactation (27.8 ± 3.5 nmol/L) and was elevated above trimester specific cut-offs in 21% of pregnant and 30% of lactating women. Vitamin deficiencies were common (vitamin A 29.6%; vitamin D 68.5%; vitamin B₁₂ 68%; folic acid 25.5%) and over 50% of women had two or more concurrent deficiencies as well as multiple infections. Multiple regression models highlighted differences in variables associated with CRP between pregnancy and lactation. In pregnancy, CRP was positively associated with greater indoor wood smoke exposure, caries and hookworm and negatively associated with Ascaris and vaginal Lactobacillus and Bacteroides/Gardnerella scores. Consistent with this, greater wood smoke exposure, caries as well as higher diplococcal infection score increased the odds of trimester-elevated CRP concentrations whereas longer gestational age lowered the likelihood of a trimester-elevated CRP. During lactation, folic acid deficiency was associated with higher CRP whereas parity, number of eosinophils and Mobiluncus score were associated with lower CRP. Also, a higher BMI and Trichomonas vaginalis score increased the likelihood of an elevated CRP whereas higher parity and number of eosinophils were associated with lower likelihood of an elevated CRP.

Conclusions

Infections both raise and lower CRP concentrations in pregnant and lactating mothers. Only folic acid deficiency during lactation was associated with higher CRP concentrations. Caution is required when interpreting CRP concentrations in pregnant and lactating women who have co-existing nutrient deficiencies and multiple infections.

Electronic supplementary material

The online version of this article (doi:10.1186/s40249-017-0307-1) contains supplementary material, which is available to authorized users.

Neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, mean platelet volume, red cell distribution width and plateletcrit in preeclampsia

INTRODUCTION AND AIM

Neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), mean platelet volume (MPV), red cell distribution width (RDW) and plateletcrit (PCT) have all been recognized as systemic inflammatory response (SIR) markers. Our aim was to evaluate changes in NLR, PLR, RDW, MPV and PCT in preeclampsia and their use in predicting the severity of PE.

STUDY DESIGN

This retrospective cohort study included 219 patients. Of them, 27 had mild PE, 82 had severe PE, and 110 were healthy, normotensive pregnant patients.

RESULTS

There were no significant differences in NLR between the groups (p=0.423). Both PLR and PCT were lower in the patients with severe PE than in the control group, and these differences showed a statistical significance (p=0.007 and p<0.001). On the other hand, both RDW and MPV were statistically higher in the patients with severe PE compared to the control group (p=0.011 and p<0.001). ROC analyzes were used to examine the ability of markers to predict those with severe PE from those with mild PE. Areas under the curve for NLR, PLR and RDW were not statistically significant (p=0.636, 0.104 and 0.36, respectively). For MPV and PCT, the values of area under the curve were 0.641 and 0.712, respectively, and the p values for these parameters statistically differed (p=0.028, p=0.001).

CONCLUSION

MPV or PCT may be clinical useful markers in the prediction of severe PE. Further, prospective multicenter studies are warranted to better reveal the association between SIR markers and PE.