Is the serum delta neutrophil index level different in gestational diabetic women?

Predictability of the Delta Neutrophil Index and Other Blood Parameters on Perinatal Outcomes in Pregnant Women With Systemic Lupus Erythematosus

PROBLEM

This study aimed to evaluate the predictive value of delta neutrophil index (DNI), a peripheral blood parameter, on perinatal outcomes in pregnant women with systemic lupus erythematosus (SLE).

METHOD OF STUDY

One hundred eighty-one participants, 78 pregnant women with SLE, and 103 healthy pregnant women were included in this retrospective study. Peripheral blood parameters including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and DNI taken in the first trimester were compared between groups.

RESULTS

NLR, PLR, and DNI were significantly higher in the SLE group (p = 0.027, p = 0.007, p = 0.0001, respectively). The same parameters were not found to be significant in determining disease activity in pregnant women with SLE (p > 0.05). When the predictive value of DNI for SGA in pregnancies with SLE was evaluated by receiver operating characteristic curve (ROC), the area under the ROC curve (AUC) was 0.666 (95% CI; 0.544-0.788, p = 0.018) with 84.6% sensitivity, 53.8% specificity, 56.0% PPV, and 78.1% NPV at a cut-off value of 0.16. The predictive value of DNI according to ROC for stillbirth in pregnancies with SLE was AUC 0.731 (95% CI: 0.539-0.923, p = 0.019) with a cut-off value of 0.17, sensitivity of 90%, specificity of 51.5%, PPV of 58.5%, and NPV of 87.2%.

CONCLUSIONS

Although DNI's prediction of SGA and stillbirth in pregnant women with SLE is encouraging, it needs more evidence from prospective studies with larger series.

In premature rupture of membranes, maternal serum delta neutrophil index may be a predictive factor for histological chorioamnionitis and affect fetal inflammatory markers: A retrospective cross-sectional study

PROBLEM

We aimed to investigate the predictive value of delta neutrophil index (DNI) for histological choriomanionitis (HCAM) and the effect of maternal inflammatory markers on neonatal outcomes and fetal inflammatory parameters.

METHOD OF STUDY

In this retrospective cross-sectional study, 68 pregnant women without HCAM (group 1) and 46 pregnant women diagnosed with HCAM (group 2) were divided into two groups. Demographic stories of the groups; maternal hematological parameters; maternal DNI and systemic inflammatory index (SII) values; outcomes of newborns; fetal inflammatory markers were recorded and compared between groups.

RESULTS

Maternal DNI, and SII levels were significantly higher in group 2 (p value < .05 for all). Admission to the neonatal unit (NICU) was higher in group 2 than in group 1 (p = .0001). We found that fetal inflammatory markers were significantly higher in group 2 (p values .001 for CRP, .0001 for DNI, and .002 for leukocyte). Maternal DNI was determined to be significantly diagnostic at a value of ≥1.3 in HCAM (p = .001). We observed that SII had a significant predictive value of 953036.6 (p = .019) for NICU admission. There is also a positive correlation between fetal inflammatory markers and maternal inflammatory markers.

CONCLUSIONS

We found that maternal inflammatory markers are high in HCAM, maternal DNI can predict patients who will develop HCAM, maternal SII value can predict NICU admission, fetal inflammatory markers are high in HCAM, and these markers are affected by maternal inflammatory markers.

Are serum delta neutrophil index and other inflammatory marker levels different in hyperemesis gravidarum?

AIM

Hyperemesis gravidarum (HEG) is a condition characterized by nausea and vomiting, fluid electrolyte and acid-base imbalance, dehydration, weight loss, and ketonuria in early pregnancy. The relationship of HEG with inflammation has been studied in many studies. This study aimed to investigate the role of serum delta neutrophil index (DNI), a new inflammatory marker, and other inflammatory markers in demonstrating the disease's presence and severity in HEG patients.

MATERIAL AND METHOD

This retrospective study was conducted by accessing the electronic data of 79 pregnant women diagnosed with HEG in a tertiary center between 2017 and 2022 and 100 healthy pregnant women. The demographic characteristics of the study and control groups, as well as the hematological parameters in the complete blood count and the levels of inflammatory markers, were recorded.

RESULTS

There was no significant difference between the groups regarding hematological parameters, DNI, platelet-lymphocyte ratio, monocyte-lymphocyte ratio, and systemic inflammation index (p > 0.05). Neutrophil count and neutrophil-lymphocyte ratio (NLR) were higher in the HEG group compared to the control group (p < 0.05).

CONCLUSION

This is the first study to determine the relationship between HEG and serum DNI, a new inflammatory marker. We found that serum DNI values in HEG patients were not different from normal pregnancies and did not reflect the presence and severity of the disease. We also found that inflammatory markers other than the NLR were not different from normal pregnancies in HEG patients.

Immunological Changes in Pregnancy and Prospects of Therapeutic Pla-Xosomes in Adverse Pregnancy Outcomes

Stringent balance of the immune system is a key regulatory factor in defining successful implantation, fetal development, and timely parturition. Interference in these primary regulatory mechanisms, either at adolescence or prenatal state led to adverse pregnancy outcomes. Fertility restoration with the help of injectable gonadotrophins/progesterone, ovulation-inducing drugs, immunomodulatory drugs (corticosteroids), and reproductive surgeries provides inadequate responses, which manifest its own side effects. The development of a potential diagnostic biomarker and an effectual treatment for adverse pregnancy outcomes is a prerequisite to maternal and child health. Parent cell originated bi-layered-intraluminal nano-vesicles (30-150 nm) also known as exosomes are detected in all types of bodily fluids like blood, saliva, breast milk, urine, etc. Exosomes being the most biological residual structures with the least cytotoxicity are loaded with cargo in the form of RNAs (miRNAs), proteins (cytokines), hormones (estrogen, progesterone, etc.), cDNAs, and metabolites making them chief molecules of cell-cell communication. Their keen involvement in the regulation of biological processes has portrayed them as the power shots of cues to understand the disease's pathophysiology and progression. Recent studies have demonstrated the role of immunexosomes (immunomodulating exosomes) in maintaining unwavering immune homeostasis between the mother and developing fetus for a healthy pregnancy. Moreover, the concentration and size of the exosomes are extensively studied in adverse pregnancies like preeclampsia, gestational diabetes mellitus (GDM), and preterm premature rupture of membrane (pPROMs) as an early diagnostic marker, thus giving in-depth information about their pathophysiology. Exosomes have also been engineered physically as well as genetically to enhance their encapsulation efficiency and specificity in therapy for cancer and adverse pregnancies. Successful bench to bedside discoveries and interventions in cancer has motivated developmental biologists to investigate the role of immunexosomes and their active components. Our review summarizes the pre-clinical studies for the use of these power-shots as therapeutic agents. We envisage that these studies will pave the path for the use of immunexosomes in clinical settings for reproductive problems that arise due to immune perturbance in homeostasis either at adolescence or prenatal state.

Can the delta neutrophil ındex be used as a preliminary biomarker ın the evaluation of periodontal disease: a pilot study

OBJECTIVE

Tissue destruction in periodontal diseases is related to inflammatory mediators in the host. However, it is unknown whether a relationship between delta neutrophil index (DNI) and neutrophil-lymphocyte ratio (NLR) in Stage 3 Grade A patients occurs. This cross-sectional study aimed to investigate the relationship between periodontal disease and DNI and NLR.

METHODOLOGY

The study included 74 systemically healthy, non-smoking adults separated into 3 groups. Group 1: 26 subjects with good periodontal health, Group 2: 26 subjects with gingivitis, and Group 3: 22 subjects with Stage 3 Grade A periodontitis. After determining which group the patient will be included in, a clinical periodontal examination was made of each patient and pocket depth (PD), clinical attachment level (CAL), gingival index (GI), bleeding on probing (BOP) and plaque index (PI) parameters were measured. Venous blood samples were taken and examined with an automatic hematology analyzer for DNI, immature granulocytes (IG), NLR, C-reactive protein (CRP), procalcitonin, neutrophil count and lymphocyte count.

RESULTS

DNI, IG, CRP, and neutrophil count were observed to be highest in Group 3, followed by Group 2, and the difference between the groups in these parameters was determined to be statistically significant (p<0.001, p<0.001, p=0.046, p=0.016). DNI, IG, CRP and neutrophil count were observed to be positively correlated with periodontal parameters.

CONCLUSION

The findings of this study support the role of DNI as a new biomarker for periodontal diseases. DNI may better reflect the systemic level of stage 3 grade A periodontitis than traditional inflammatory markers.

Association of maternal neutrophil count in early pregnancy with the development of gestational diabetes mellitus: a prospective cohort study in China

OBJECTIVE

We evaluated the potential role of maternal serum levels of neutrophils in the first trimester of pregnancy in the prediction of gestational diabetes mellitus (GDM).

METHODS

This prospective cohort study enrolled singleton pregnant women before gestational weeks 16 and evaluated them until delivery. Among the 1467 pregnant women who performed prenatal care before 14 weeks of gestation in the cohort, a total of 731 were eligible for the final analysis. The associations between neutrophil counts, white blood cell count, neutrophil to lymphocyte ratio, and GDM (assessed by a 75-g oral glucose tolerance test between 24 and 28 weeks) were evaluated by multivariate logistic regression.

RESULTS

Neutrophil count outperformed the neutrophil to lymphocyte ratio and white blood cell count in predicting GDM occurrence. We applied a smoothing function and found that neutrophil count was associated with both fasting blood glucose (FBG) (p=.0149) and 1-h postprandial blood glucose (PBG) (p=.0187) after adjustment pre-pregnancy body mass index, family history of diabetes, and age. Logistic regression analysis found that the highest neutrophil count level (6.28-14.73 × 10⁹/L) had a 1.85-fold (95% CI 1.10, 3.09) increased risk of GDM compared with that of the lowest tertile (1.47-4.82 × 10⁹/L).

CONCLUSIONS

The results indicated an association between higher neutrophil levels and GDM occurrence.

The diagnostic indicators of gestational diabetes mellitus from second trimester to birth: a systematic review

BACKGROUND

Gestational diabetes mellitus (GDM) is glucose intolerance first recognised during pregnancy. Both modalities and thresholds of the GDM diagnostic test, the Oral Glucose Tolerance Test (OGTT), have varied widely over time and among countries. Additionally, OGTT limitations include inconsistency, poor patient tolerability, and questionable diagnostic reliability. Many biological parameters have been reported to be modified by GDM and could potentially be used as diagnostic indicators. This study aimed to 1) systematically explore biomarkers reported in the literature as differentiating GDM from healthy pregnancies 2) screen those indicators assessed against OGTT to propose OGTT alternatives.

MAIN BODY

A systematic review of GDM diagnostic indicators was performed according to PRISMA guidelines (PROSPERO registration CRD42020145499). Inclusion criteria were full-text, comprehensible English-language articles published January 2009-January 2021, where a biomarker (from blood, ultrasound, amniotic fluid, placenta) was compared between GDM and normal glucose tolerance (NGT) women from the second trimester onward to immediately postpartum. GDM diagnostic method had to be clearly specified, and the number of patients per study higher than 30 in total or 15 per group. Results were synthesised by biomarkers.

RESULTS

Of 13,133 studies identified in initial screening, 174 studies (135,801 participants) were included. One hundred and twenty-nine studies described blood analytes, one amniotic fluid analytes, 27 ultrasound features, 17 post-natal features. Among the biomarkers evaluated in exploratory studies, Adiponectin, AFABP, Betatrophin, CRP, Cystatin-C, Delta-Neutrophil Index, GGT, TNF-A were those demonstrating statistically and clinically significant differences in substantial cohorts of patients (> 500). Regarding biomarkers assessed versus OGTT (i.e. potential OGTT alternatives) most promising were Leptin > 48.5 ng/ml, Ficolin3/adiponectin ratio ≥ 1.06, Chemerin/FABP > 0.71, and Ultrasound Gestational Diabetes Score > 4. These all demonstrated sensitivity and specificity > 80% in adequate sample sizes (> / = 100).

CONCLUSIONS

Numerous biomarkers may differentiate GDM from normoglycaemic pregnancy. Given the limitations of the OGTT and the lack of a gold standard for GDM diagnosis, advanced phase studies are needed to triangulate the most promising biomarkers. Further studies are also recommended to assess the sensitivity and specificity of promising biomarkers not yet assessed against OGTT.

TRIAL REGISTRATION

PROSPERO registration number CRD42020145499.

Increased serum delta neutrophil index levels are associated with intrahepatic cholestasis of pregnancy

OBJECTIVE

This study aims to compare the maternal serum delta neutrophil index (DNI) levels in intrahepatic cholestasis of pregnancy (ICP) and healthy pregnancies.

METHODS

This study consisted of a group of patients (n = 40) diagnosed with isolated ICP who gave birth in our hospital and a control group (n = 60) between December 1, 2015, and June 30, 2018. The diagnosis of ICP was made based on pruritus and elevated fasting serum bile acids and liver enzymes. Laboratory tests of both groups in the hospitalization process were retrospectively examined. Maternal and neonatal characteristics, pregnancy outcomes, and DNI values of the two groups were compared. Statistical analyses were performed using SPSS version 20.

RESULTS

Mean maternal serum DNI levels were significantly higher in women with ICP than in the control group (0.49 ± 4.8 vs -3.99 ± 3.02, p = <0.01). Receiver operating characteristic (ROC) curve analysis was used to define the DNI value where ICP can be best predicted.

CONCLUSION

DNI, a new inflammatory marker, was found to be higher in women with ICP than in normal pregnancies.

Delta Neutrophil Index as a Promising Biomarker for Placental Implantation Disorders

OBJECTIVE

We aimed to investigate the value of maternal serum delta neutrophil index (DNI) levels in predicting placenta accreta spectrum in patients with placenta previa.

METHODS

The patients who were found to have placenta previa totalis were included in our study. Location of placental implantation and depth of myometrial invasion were defined by transabdominal and transvaginal 2D gray scale and Doppler sonography and confirmed during cesarean section and histopathological evaluation. Patients were subjected to complete blood counts, including prenatal hemoglobin level, total white blood cell count, differential leukocyte count, and platelet count. The following formula was used to calculate the DNI level: DNI (%)=(leukocyte subfraction analyzed by cytochemical reaction in the MPO channel) - (leukocyte subfraction analyzed using the nuclear lobularity channel with reflected light beam measurements).

RESULTS

Placenta previa was detected in 295 patients; 31 of them had PAS. As the control group, 189 patients were evaluated. In the group with PAS, the DNI value was significantly higher (p<0.05) than the other groups. DNI value in the group with previa only was also significantly higher (p<0.05) than the control group. In the univariate model, a significant (p<0.05) effect of DNI value and number of cesarean sections was observed in separating patients with previa only and PAS. In the multivariate model, a significant independent (p>0.05) effect of the DNI value was observed in separating patients with previa only and PAS. Significant efficiency of DNI value [area under the curve 0.899 (0.814-0.984)] was observed in differentiating patients with previa only and PAS. Significant efficacy of DNI 5 cut-off value [area under the curve 0.858 (0.770-0.946)] was observed in distinguishing patients with previa only and PAS (sensitivity 80.0%, positive predictive value 64.9%, specificity 91.6%, negative predictive value 95.9%) CONCLUSION: Maternal DNI values seem to be beneficial with respect to both previa and invasion prediction. Although more comprehensive studies are needed to test this proposition, prediction studies of this practical test should be done in different trimesters and its usability with respect to preventing maternal-fetal morbidity should be investigated.

Gestational diabetes mellitus and inflammatory biomarkers of neutrophil-lymphocyte ratio and platelet-lymphocyte ratio: a systematic review and meta-analysis

PURPOSE

To evaluate the association between two inflammatory biomarkers of neutrophil -lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) with gestational diabetes mellitus (GDM).

METHODS AND MATERIALS

Systematic search was performed up to June 2020 in databases such as PubMed, Embase, Scopus, Web of Science, and Google scholar. The random-effects model was utilised to combine the weighted mean differences (WMDs) and their 95% confidence intervals (CIs).

RESULTS

Out of a total of 849 articles, sixteen studies were eligible. Our findings indicated higher NLR (WMD = 0.48, 95% CI: 0.25, 0.71) and PLR (WMD = 8.22, 95% CI: -0.50, 16.94) values in pregnancies diagnosed with GDM compared with non-GDM control pregnancies. However, the difference in PLR value did not reach a statistically significant level (Z = 1.85, p = 0.065). In meta-regression analysis, we found no significant influence of total sample size [for NLR (B= -0.0, p = 0.13), for PLR (B= -0.02, p = 0.55)] and publication year [for NLR (B= -0.02, p = 0.61), for PLR (B = 0.89, p = 0.75)] on association between NLR and PLR with GDM.

CONCLUSION

The current meta-analysis is the first, to our knowledge, to show that NLR value is significantly associated with GDM. However, PLR showed no significant association with GDM.

Gestational Diabetes Mellitus and Maternal Immune Dysregulation: What We Know So Far

Gestational diabetes mellitus (GDM) is an obstetric complication that affects approximately 5-10% of all pregnancies worldwide. GDM is defined as any degree of glucose intolerance with onset or first recognition during pregnancy, and is characterized by exaggerated insulin resistance, a condition which is already pronounced in healthy pregnancies. Maternal hyperglycaemia ensues, instigating a 'glucose stress' response and concurrent systemic inflammation. Previous findings have proposed that both placental and visceral adipose tissue play a part in instigating and mediating this low-grade inflammatory response which involves altered infiltration, differentiation and activation of maternal innate and adaptive immune cells. The resulting maternal immune dysregulation is responsible for exacerbation of the condition and a further reduction in maternal insulin sensitivity. GDM pathology results in maternal and foetal adverse outcomes such as increased susceptibility to diabetes mellitus development and foetal neurological conditions. A clearer understanding of how these pathways originate and evolve will improve therapeutic targeting. In this review, we will explore the existing findings describing maternal immunological adaption in GDM in an attempt to highlight our current understanding of GDM-mediated immune dysregulation and identify areas where further research is required.