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Li P, Chen H, Zhang X, Wang J, Li Y, Wang Y, Wang F, Man D. Potential Predictive Value of Platelet Parameters in Preeclampsia. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2024; 5:453-460. [PMID: 39206020 PMCID: PMC11347876 DOI: 10.1089/whr.2023.0162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/19/2024] [Indexed: 09/04/2024]
Abstract
Objective Preeclampsia is a serious pregnancy complication that jeopardizes the health of both the mother and the fetus. Platelet parameters are closely linked to the severity of preeclampsia. This study aimed to assess the diagnostic potential of platelet parameters in the early second trimester for the detection of preeclampsia. Methods A total of 840 participants from the Affiliated Hospital of Jining Medical College were included in the study, consisting of 327 healthy pregnant women, 209 with mild preeclampsia, and 304 with severe preeclampsia. General clinical data and platelet parameters for these three groups of pregnant women were collected, and differences among them were compared. In addition, univariate analysis and logistic regression were used to identify preeclampsia risk factors, and receiver operating characteristic curve analysis was conducted to assess the predictive value of platelet parameters. Results Platelet count was not found to significantly differ between the healthy and preeclampsia groups. However, mean platelet volume, platelet distribution width (PDW), and platelet-large cell ratios (P-LCR) were observed to be significantly higher in the preeclampsia group than the healthy group. After adjusting for confounding factors (such as age, gestational week at blood sampling, systolic and diastolic blood pressure, and body mass index during the second trimester), it was determined that PDW and P-LCR could be considered effective predictors of preeclampsia. Conclusion In clinical practice, P-LCR and PDW hold potential predictive value for preeclampsia.
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Affiliation(s)
- Peng Li
- College of Clinical Medicine, Jining Medical University, Jining, Republic of China
- Department of Obstetrics, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Republic of China
| | - Hui Chen
- Department of Obstetrics, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Republic of China
| | - Xiaoyun Zhang
- Department of Obstetrics, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Republic of China
| | - Jishui Wang
- Department of Obstetrics, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Republic of China
| | - Yuting Li
- College of Clinical Medicine, Jining Medical University, Jining, Republic of China
- Department of Obstetrics, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Republic of China
| | - Yanping Wang
- Department of Obstetrics, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Republic of China
| | - Fengge Wang
- College of Clinical Medicine, Jining Medical University, Jining, Republic of China
- Department of Obstetrics, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Republic of China
| | - Dongmei Man
- Department of Obstetrics, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Republic of China
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Dionisio LM, Favero GM. Platelet indices and angiogenesis markers in hypertensive disorders of pregnancy. Int J Lab Hematol 2024; 46:259-265. [PMID: 37953406 DOI: 10.1111/ijlh.14202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/20/2023] [Indexed: 11/14/2023]
Abstract
INTRODUCTION Activated platelets exert a key role in the pathogenesis of preeclampsia (PE). There is evidence of distinctive patterns of platelet indices in PE in comparison to healthy pregnancies, therefore these indices can be potential tools for PE detection, risk stratification, and management. Considering the vascular aspects of its pathophysiology, PE is characterized by the increased levels of soluble FMS-like tyrosine kinase-1 (sFlt-1) an antiangiogenic factor, and reduced placental growth factor (PlGF), a proangiogenic factor. This study aimed to assess the platelet indices in hypertensive disorders of pregnancy (HDP) and its correlation with angiogenesis-related biomarkers. METHODS The groups for the study were: control (n = 114); gestational hypertension; (n = 112), and PE (n = 42). The platelet indices included were platelet counts (PLT-I and PLT-F), mean platelet volume (MPV), platelet distribution width (PDW), plateletcrit (PCT), platelet large cell ratio (P-LCR), and immature platelet fraction (IPF# and IPF%). Serum levels of sFlt-1 and PlGF were assessed. RESULTS PLT-I, PLT-F, and PCT% were lower in PE, while MPV, PDW, P-LCR, IPF%, and IPF# were increased. The parameter MPV presented the best performance for the discrimination of PE. There was a moderate positive correlation between sFlt-1 levels and MPV, PDW, and P-LCR. CONCLUSION Platelet indices can be potentially applied as additional tools for the diagnosis and management of HDP. Activated platelets may act as an extra source of sFlt-1 in PE.
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Affiliation(s)
- Laura Mattana Dionisio
- Department of Clinical Analysis and Toxicology, State University of Ponta Grossa, Ponta Grossa, Parana, Brazil
- Department of General Biology, State University of Ponta Grossa, Ponta Grossa, Parana, Brazil
| | - Giovani Marino Favero
- Department of Clinical Analysis and Toxicology, State University of Ponta Grossa, Ponta Grossa, Parana, Brazil
- Department of General Biology, State University of Ponta Grossa, Ponta Grossa, Parana, Brazil
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Kassahun W, Kidanewold A, Koira G, Biresaw G, Shiferaw M. Hematological predictors of preeclampsia among pregnant women attending ante-natal clinic at Arba Minch General Hospital, South Ethiopia: A comparative cross-sectional study. Pract Lab Med 2024; 39:e00362. [PMID: 38318431 PMCID: PMC10840323 DOI: 10.1016/j.plabm.2024.e00362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/01/2024] [Accepted: 01/18/2024] [Indexed: 02/07/2024] Open
Abstract
Background Preeclampsia is a kind of pregnancy-related hypertension that affects 5.47 % of pregnancies in Ethiopia and 18.25 % of pregnant women who visit Arba Minch public health facilities for antenatal care. This study sought to identify hematological preeclampsia markers in pregnant women who received prenatal care at Arba Minch General Hospital. Methodology An institution-based comparative cross-sectional study was done from July 22 to October 30, 2021 at Arba Minch General Hospital. A total of 136 pregnant women were included in the study (46 with preeclampsia and 90 without preeclampsia). Epidata version 4.4. was used to enter data, and SPSS version 25.0 and Stata version17 were used for analysis. An independent sample t-test was used to examine the hematological parameter differences between study groups. Potential hematological markers were determined using receiver operating characteristic (ROC) analysis of the area under the curve (AUC). Statistical significance was defined if P value less than 0.05. Results A total of 136 pregnant women were studied. The complete blood count analysis showed that there were means differences in Red Cell Distribution (RDW) (p < 0.036), neutrophil-to-lymphocyte ratio (NLR) (p < 0.016) and relative lymphocyte count (Lymp%) (p < 0.047). The ROC analysis of the AUC for RDW, NLR and Lymp% resulted in 0.607, 0.609, 0.600 respectively. Conclusion RDW, NLR and Lymphocyte count could be potential candidate tools for the diagnosis and screening of preeclampsia. However, the robustness of the markers should be tested with prospective studies assessing changes present in each trimester.
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Affiliation(s)
| | - Aschalew Kidanewold
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Arba Minch University, Ethiopia
| | - Getahun Koira
- Department of Gynecology and Obstetrics, School of Medicine, College of Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Gelila Biresaw
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Arba Minch University, Ethiopia
| | - Mulu Shiferaw
- Biomedical Team, School of Medicine, College of Health Sciences, Woldia University, Woldia, Ethiopia
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Ye D, Li S, Ding Y, Ma Z, He R. Clinical value of mean platelet volume in predicting and diagnosing pre-eclampsia: a systematic review and meta-analysis. Front Cardiovasc Med 2023; 10:1251304. [PMID: 37868773 PMCID: PMC10587588 DOI: 10.3389/fcvm.2023.1251304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 09/20/2023] [Indexed: 10/24/2023] Open
Abstract
Background Pre-eclampsia (PE) is a severe pregnancy complication. Thrombocytopenia and platelet dysfunction are common hematology disorders in PE. Previous studies considered mean platelet volume (MPV), a functional marker of platelets, as a potentially useful predictor for the diagnosis of PE. Methods PubMed, China Biomedical Literature Database, Chinese National Knowledge Infrastructure, Embase, Wanfang, VIP, and Cochrane Library databases were searched to gather diagnostic trials evaluating the diagnosis of PE using MPV, from their inception to 13 March 2023. We also searched Google Scholar and Baidu. Results A total of 22 studies from 20 articles were found. The pooled diagnostic accuracy of the MPV for PE recognition was as follows: sensitivity (SEN) 0.676 [95% confidence interval (CI) (0.658-0.694)], specificity (SPE) 0.710 [95% CI (0.703-0.717)], and diagnostic odds ratio (DOR) 7.012 [95% CI (4.226-11.636)], and the SROC-AUC and Q* indices were 0.7889 and 0.7262, respectively. The pooled SEN, SPE, and DOR of the diagnostic accuracy of MPV for PE before 16 weeks of gestation were 0.707 [95% CI (0.670-0.743)], 0.639 [95% CI (0.611-0.667)], and 4.026 [95% CI (2.727-5.943)], and the SROC-AUC and Q* indices were 0.7278 and 0.6753, respectively. For the interval of truncation values between 9 and 10 fl, the SROC-AUC and Q* indices for MPV were 0.8856 and 0.8162, respectively. Conclusions Available evidence suggests that MPV has a moderate predictive and diagnostic value for PE, particularly in diagnosing after 20 weeks of gestation. The diagnostic accuracy is higher when the MPV cut-off falls between 9 and 10 fl. The sensitivity of MPV alone in diagnosing PE is not high, and the combination of other markers for predictive diagnosis may better differentiate PE. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023425154, identifier: CRD42023425154.
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Affiliation(s)
- Dan Ye
- The Second Clinical Medical College, Lanzhou University, Lanzhou, China
| | - Shuwen Li
- Department of Obstetrics, Lanzhou University Second Hospital, Lanzhou, China
| | - Yi Ding
- The Second Clinical Medical College, Lanzhou University, Lanzhou, China
| | - Zhenqin Ma
- The Second Clinical Medical College, Lanzhou University, Lanzhou, China
| | - Rongxia He
- Department of Obstetrics, Lanzhou University Second Hospital, Lanzhou, China
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Woldeamanuel GG, Tlaye KG, Wu L, Poon LC, Wang CC. Platelet count in preeclampsia: a systematic review and meta-analysis. Am J Obstet Gynecol MFM 2023; 5:100979. [PMID: 37098392 DOI: 10.1016/j.ajogmf.2023.100979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/13/2023] [Accepted: 04/18/2023] [Indexed: 04/27/2023]
Abstract
OBJECTIVE Many studies have reported the association between platelets and preeclampsia. However, sample sizes were small, and their findings were inconsistent. We conducted a systematic review and meta-analysis to evaluate the association in pooled samples and in detail. DATA SOURCES A systematic literature search was performed using Medline, Embase, ScienceDirect, Web of Science, Cochrane Library, NICHD-DASH, LILACS, and Scopus from inception to April 22, 2022. STUDY ELIGIBILITY CRITERIA Observational studies comparing platelet count between women with preeclampsia and normotensive pregnant women were included. METHODS The mean differences with 95% confidence interval in platelet count were calculated. Heterogeneity was assessed using I2 statistics. Sensitivity and subgroup analyses were conducted. Statistical analysis was performed using RevMan 5.3 and ProMeta 3 software. RESULTS A total of 56 studies comprising 4892 preeclamptic and 9947 normotensive pregnant women were included. Meta-analysis showed that platelet count was significantly lower in women with preeclampsia than in normotensive controls (overall: mean difference, -32.83; 95% confidence interval, -40.13 to -25.52; P<.00001; I2=92%; mild preeclampsia: mean difference, -18.65; 95% confidence interval, -27.17 to -10.14; P<.00001; I2=84%; severe preeclampsia: mean difference, -42.61; 95% confidence interval, -57.53 to -27.68; P<.00001; I2=94%). Significantly lower platelet count was also observed in the second trimester (mean difference, -28.84; 95% confidence interval, -44.59 to -13.08; P=.0003; I2=93%), third trimester (mean difference, -40.67; 95% confidence interval, -52.14 to -29.20; P<.00001; I2=92%), and before the diagnosis of preeclampsia (mean difference, -18.81; 95% confidence interval, -29.98 to -7.64; P=.009; I2=87%), but not in the first trimester (mean difference, -15.14; 95% confidence interval, -37.71 to 7.43; P=.19; I2=71%). Overall, the pooled sensitivity and specificity of platelet count were 0.71 and 0.77, respectively. The area under the curve was 0.80. CONCLUSION This meta-analysis confirmed that platelet count was significantly lower in preeclamptic women, irrespective of severity and presence or absence of associated complications, even before the onset of preeclampsia and in the second trimester of pregnancy. Our findings suggest that platelet count may be a potential marker to identify and predict preeclampsia.
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Affiliation(s)
- Gashaw Garedew Woldeamanuel
- Department of Obstetrics and Gynaecology, Li Ka Shing Institute of Health Sciences, School of Biomedical Sciences, Shenzhen Research Institute, The Chinese University of Hong Kong, Hong Kong SAR
| | - Kenean Getaneh Tlaye
- Department of Obstetrics and Gynaecology, Li Ka Shing Institute of Health Sciences, School of Biomedical Sciences, Shenzhen Research Institute, The Chinese University of Hong Kong, Hong Kong SAR
| | - Ling Wu
- Department of Obstetrics and Gynaecology, Li Ka Shing Institute of Health Sciences, School of Biomedical Sciences, Shenzhen Research Institute, The Chinese University of Hong Kong, Hong Kong SAR
| | - Liona C Poon
- Department of Obstetrics and Gynaecology, Li Ka Shing Institute of Health Sciences, School of Biomedical Sciences, Shenzhen Research Institute, The Chinese University of Hong Kong, Hong Kong SAR
| | - Chi Chiu Wang
- Department of Obstetrics and Gynaecology, Li Ka Shing Institute of Health Sciences, School of Biomedical Sciences, Shenzhen Research Institute, The Chinese University of Hong Kong, Hong Kong SAR.
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Patxot M, Stojanov M, Ojavee SE, Gobert RP, Kutalik Z, Gavillet M, Baud D, Robinson MR. Haematological changes from conception to childbirth: An indicator of major pregnancy complications. Eur J Haematol 2022; 109:566-575. [PMID: 36059200 PMCID: PMC9825915 DOI: 10.1111/ejh.13844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/26/2022] [Accepted: 07/29/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND About 800 women die every day worldwide from pregnancy-related complications, including excessive blood loss, infections and high-blood pressure (World Health Organization, 2019). To improve screening for high-risk pregnancies, we set out to identify patterns of maternal hematological changes associated with future pregnancy complications. METHODS Using mixed effects models, we established changes in 14 complete blood count (CBC) parameters for 1710 healthy pregnancies and compared them to measurements from 98 pregnancy-induced hypertension, 106 gestational diabetes and 339 postpartum hemorrhage cases. RESULTS Results show interindividual variations, but good individual repeatability in CBC values during physiological pregnancies, allowing the identification of specific alterations in women with obstetric complications. For example, in women with uncomplicated pregnancies, haemoglobin count decreases of 0.12 g/L (95% CI -0.16, -0.09) significantly per gestation week (p value <.001). Interestingly, this decrease is three times more pronounced in women who will develop pregnancy-induced hypertension, with an additional decrease of 0.39 g/L (95% CI -0.51, -0.26). We also confirm that obstetric complications and white CBC predict the likelihood of giving birth earlier during pregnancy. CONCLUSION We provide a comprehensive description of the associations between haematological changes through pregnancy and three major obstetric complications to support strategies for prevention, early-diagnosis and maternal care.
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Affiliation(s)
- Marion Patxot
- Department of Computational BiologyUniversity of LausanneLausanneSwitzerland,Swiss Institute of BioinformaticsLausanneSwitzerland
| | - Miloš Stojanov
- Materno‐fetal and Obstetrics Research Unit, Department of Obstetrics and GynecologyCentre Hospitalier Universitaire VaudoisLausanneSwitzerland
| | - Sven Erik Ojavee
- Department of Computational BiologyUniversity of LausanneLausanneSwitzerland,Swiss Institute of BioinformaticsLausanneSwitzerland
| | | | - Zoltán Kutalik
- Department of Computational BiologyUniversity of LausanneLausanneSwitzerland,Swiss Institute of BioinformaticsLausanneSwitzerland,Statistical GeneticsUniversity Center for Primary Care and Public HealthLausanneSwitzerland
| | - Mathilde Gavillet
- Service and Central Laboratory of Haematology, Department of Oncology and Department of Laboratories and PathologyCentre Hospitalier Universitaire VaudoisLausanneSwitzerland
| | - David Baud
- Materno‐fetal and Obstetrics Research Unit, Department of Obstetrics and GynecologyCentre Hospitalier Universitaire VaudoisLausanneSwitzerland
| | - Matthew R. Robinson
- Medical GenomicsInstitute of Science and Technology AustriaKlosterneuburgAustria
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Wu J, Zhang J, Yang J, Zheng TQ, Chen YM. Association between platelet indices and risk of preeclampsia in pregnant women. J OBSTET GYNAECOL 2022; 42:2764-2770. [PMID: 35959779 DOI: 10.1080/01443615.2022.2109136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
We aimed to examine the association between the platelet indices and the risk of preeclampsia (PE) at different gestational weeks (GW) to explore the feasibility of early prediction of PE with these indices. About 7314 normotensive pregnant women and 396 PE patients were included and platelet indices, including platelet count (PC), plateletcrit (PCT), platelet distribution width (PDW), mean platelet volume (MPV) at different gestational weeks (1-12, 13-28, 29-32, 33-36 and 37-41 GW) were compared in two statistical methods. Patients with PE tended to have higher means of PC, PCT, PDW and MPV than normal pregnant women at early stage of pregnancy. The odds of PE were significantly increased with the increase of PC, PCT, PDW and MPV both at 13-28 GW and 29-32 GW, which indicated that increased values of PC, PCT, PDW and MPV at 13-32 GW were associated with greater subsequent risk of preeclampsia. Increased PC, PCT, PDW and MPV may have potential to predict preeclampsia before the disease onset.Impact StatementWhat is already known on this subject? Previous studies indicated that preeclampsia patients may have decreased platelet count (PC), plateletcrit (PCT) and increased platelet distribution width (PDW) and mean platelet volume (MPV). Increased PDW and MPV or decreased PC/MPV may have predictive values for PE.What do the results of this study add? The discrepancy with previous studies lay in the increased values of PC and PCT in PE patients at early stage of pregnancy. The study indicated that increased PC, PCT, PDW and MPV may have potential to predict preeclampsia far ahead of the disease onset. The results may reflect the abnormal turnover of platelets in PE patients.What are the implications of these findings for clinical practice and/or further research? These findings may help to guide early interventions before progress to overt preeclampsia by predicting onset of preeclampsia via easily available platelet indices in early weeks of gestation, which is especially valuable in areas lacking medical resources. The inconsistency with previous studies can facilitate researchers to further explore the coagulation mechanism beneath preeclampsia and pay more attention to the dynamic changes of platelet indices and other coagulation indices during pregnancy.
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Affiliation(s)
- Jinjuan Wu
- Department of Obstetrics and Gynecology, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Jing Zhang
- Department of Obstetrics and Gynecology, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Jinying Yang
- Department of Obstetrics and Gynecology, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Thomas Qintian Zheng
- Department of Obstetrics and Gynecology, Guangzhou Women and Children's Medical Center, Guangzhou, China.,Department of Obstetrics and Gynecology, Valleywise Health/District Medical Group, 2601 E. Roosevelt Road, Phoenix, AZ, USA.,Department of Obstetrics and Gynecology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Yu-Ming Chen
- School of Public Health, Sun Yat-sen University, Guangzhou, China
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Liu H, Pu Y, Ai S, Wang X, He S, Wang K, Dang Y. The Relationship Between Preeclampsia and Arsenic Concentration in the Peripheral Blood. Biol Trace Elem Res 2022; 200:3965-3974. [PMID: 34993909 DOI: 10.1007/s12011-021-02988-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 10/20/2021] [Indexed: 12/26/2022]
Abstract
Preeclampsia (PE) is a pregnancy-specific disorder, which is one of the leading causes of maternal, fetal, and neonatal death, particularly in developing countries. Arsenic (As), which is commonly found in soil and groundwater, has been associated with various complications of pregnancy, such as spontaneous abortion, hypertension, and stillbirth. Hence, the study was used to explore the relationship between PE and blood concentration of As in this study. Blood concentration of As during pregnancy was measured by inductively coupled plasma mass spectrometry (ICP-MS). The results shown that the mean blood concentration of As was gradually increased from the control group to the severe PE group (P < 0.0001). Elevated blood concentration of As was associated with the prevalence of PE (OR = 12.81, 95% CI: 2.43-67.39 and 27.55, 1.75-433.43 for middle and high vs. low). Furthermore, elevated blood concentration of As was associated with the severity of PE. Additionally, we observed that blood concentration of As was associated with the hypoproteinemia (P = 0.001, rs = 0.37). Blood concentration of As was negatively corelated with the mean corpuscular volume (MCV) (P = 0.040, rs = - 0.23) and positively corelated with the mean corpuscular hemoglobin concentration (MCHC) (P = 0.044, rs = 0.23). Overall, our results indicated that the blood concentration of As can significantly predict the occurrence of PE. Additionally, we provided evidence that blood concentration of As may affect the occurrence of hypoproteinemia. These findings may provide some ideas for the prevention of PE and pregnancy complications.
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Affiliation(s)
- Haixia Liu
- Institute of Maternal, Child and Adolescent Health, School of Public Health, Lanzhou University, Lanzhou, China
| | - Yudong Pu
- Songshan Lake Central Hospital of Dongguan City, Dongguan, China
| | - Shiwei Ai
- Institute of Maternal, Child and Adolescent Health, School of Public Health, Lanzhou University, Lanzhou, China
| | - Xiaoxue Wang
- Institute of Maternal, Child and Adolescent Health, School of Public Health, Lanzhou University, Lanzhou, China
| | - Shuzhen He
- Songshan Lake Central Hospital of Dongguan City, Dongguan, China
| | - Ke Wang
- Institute of Maternal, Child and Adolescent Health, School of Public Health, Lanzhou University, Lanzhou, China
| | - Yuhui Dang
- Institute of Maternal, Child and Adolescent Health, School of Public Health, Lanzhou University, Lanzhou, China.
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9
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Simultaneous use of Tumor Necrosis Factor, Lipid Profile, and β-hCG As Markers of Severity of Preeclampsia. J Obstet Gynaecol India 2022; 72:83-88. [PMID: 35928084 PMCID: PMC9343506 DOI: 10.1007/s13224-021-01556-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 08/19/2021] [Indexed: 10/20/2022] Open
Abstract
Objective Tumor necrosis factor, Lipid Profile, and β-hCG are markers that proved to be changed with preeclampsia. We aim to study their combined use as predictors of the severity of preeclampsia. Methods A case-control study was conducted in our University Hospitals on pregnant women complicated by mild or severe PE and healthy normal pregnant women as a control group. Samples of these markers were taken at a gestational age between 28 and 36 weeks. Results A total number of 90 pregnant women were selected. The first group was mild PE (17 cases), the second group was severe PE (28 cases), and the third group was normal pregnant women (control group 45 cases). There is a statistically significant positive correlation between β-hCG, triglycerides, Cholesterol, LDL, VLDL, and Tumor necrosis factor. These markers correlate with the severity of PE. HDL demonstrates a statistically significant negative correlation with TNF-α and β-hCG. Conclusions There is a strong correlation between the increase of TNF, β-hCG, triglycerides, LDL, and cholesterol in cases of PE. These markers are associated with the severity of PE. These markers can be incorporated into a predictive model for PE.
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Gelaw Y, Asrie F, Walle M, Getaneh Z. The value of eosinophil count in the diagnosis of preeclampsia among pregnant women attending the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2021. BMC Pregnancy Childbirth 2022; 22:557. [PMID: 35820860 PMCID: PMC9274180 DOI: 10.1186/s12884-022-04892-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 07/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Currently, studies showed that eosinophil count had clinical significance in the diagnosis and prognosis of diseases. But, the clinical significance of eosinophil count in pregnancy specifically in preeclampsia (PE) is not well studied. The main objective of the present study was to assess the diagnosis value of eosinophils counts among pregnant women with PE. METHODS A comparative cross-sectional study was conducted on a total of 126 pregnant women at the University of Gondar Comprehensive Specialized Hospital, using a convenient sampling technique. Socio-demographic and clinical data were collected by questionnaire and datasheet from patient's charts, respectively. A total of six ml of blood was collected from each study participant; three ml for complete cell count analysis using Sysmex XS-500i hematology analyzer and three ml for liver function tests using Humastar 200 chemistry analyzer. The data were entered into Epi-data and exported to SPSS 20 for analysis. The independent t-test was used for normally distributed data and, the Mann-Whitney U test was used for non-normally distributed data. Binary logistic regression and receiver operative curve analyses were also done to assess the diagnosis value of eosinophils count. P-value < 0.05 was considered statistically significant. RESULTS The eosinophils count of PE pregnant women were significantly lower than the normotensive (NT) pregnant women (median (IQR): 50 (10-200) vs. 120 (60 - 270); (p = 0.002). The eosinophil count ≤ 55 cells/µL had an AUC of 0.66 (95% CI; 0.56-0.75) for diagnosis of PE with a sensitivity of 50.8%, specificity of 77.8%, and positive and negative predictive value of 69.6% and 61.3%, respectively. The abnormal AST and ALT results were significantly higher among PE pregnant women compared to NT pregnant women (AOR: 14.86; 95% CI: 4.97-44.4 and Fischer exact test p-value = 0.001, respectively). CONCLUSION The eosinophil count ≤ 55cells/µl had a reasonable/acceptable AUC which may use in the diagnosis of PE. AST and ALT were also significantly higher in PE pregnant women compared to NT pregnant women. Multicenter longitudinal studies with a large sample size are recommended to verify the role of eosinophil count in the diagnosis of PE.
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Affiliation(s)
- Yemataw Gelaw
- College of Medicine and Health Sciences, School Biomedical and Laboratory Sciences, Department of Hematology and Immunohematology, University of Gondar, Gondar, Ethiopia.
| | - Fikir Asrie
- College of Medicine and Health Sciences, School Biomedical and Laboratory Sciences, Department of Hematology and Immunohematology, University of Gondar, Gondar, Ethiopia
| | - Muluken Walle
- College of Medicine and Health Sciences, Department of Medical Laboratory Science, Jigijiga University, Jigijiga, Ethiopia
| | - Zegeye Getaneh
- College of Medicine and Health Sciences, School Biomedical and Laboratory Sciences, Department of Hematology and Immunohematology, University of Gondar, Gondar, Ethiopia
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Bînă AM, Aburel OM, Avram VF, Lelcu T, Lința AV, Chiriac DV, Mocanu AG, Bernad E, Borza C, Craina ML, Popa ZL, Muntean DM, Crețu OM. Impairment of mitochondrial respiration in platelets and placentas: a pilot study in preeclamptic pregnancies. Mol Cell Biochem 2022; 477:1987-2000. [PMID: 35389182 PMCID: PMC9206634 DOI: 10.1007/s11010-022-04415-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/10/2022] [Indexed: 12/21/2022]
Abstract
Preeclampsia (PE) is a major complication of pregnancy with partially elucidated pathophysiology. Placental mitochondrial dysfunction has been increasingly studied as major pathomechanism in both early- and late-onset PE. Impairment of mitochondrial respiration in platelets has recently emerged as a peripheral biomarker that may mirror organ mitochondrial dysfunction in several acute and chronic pathologies. The present study was purported to assess mitochondrial respiratory dys/function in both platelets and placental mitochondria in PE pregnancies. To this aim, a high-resolution respirometry SUIT (Substrate-Uncoupler-Inhibitor-Titration) protocol was adapted to assess complex I (glutamate + malate)- and complex II (succinate)-supported respiration. A decrease in all respiratory parameters (basal, coupled, and maximal uncoupled respiration) in peripheral platelets was found in preeclamptic as compared to healthy pregnancies. At variance, placental mitochondria showed a dichotomous behavior in preeclampsia in relation to the fetal birth weight. PE pregnancies with fetal growth restriction were associated with decreased in coupled respiration (oxidative phosphorylation/OXPHOS capacity) and maximal uncoupled respiration (electron transfer/ET capacity). At variance, these respiratory parameters were increased for both complex I- and II-supported respiration in PE pregnancies with normal weight fetuses. Large randomized controlled clinical studies are needed in order to advance our understanding of mitochondrial adaptive vs. pathological changes in preeclampsia.
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Affiliation(s)
- Anca M Bînă
- Department III Functional Sciences - Pathophysiology, "Victor Babeş" University of Medicine and Pharmacy, Timişoara, Romania, Eftimie Murgu Sq. No. 2, Timişoara, Romania
- Center for Translational Research and Systems Medicine, "Victor Babeş" University of Medicine and Pharmacy, Timişoara, Romania, Eftimie Murgu Sq. No. 2, Timişoara, Romania
| | - Oana M Aburel
- Department III Functional Sciences - Pathophysiology, "Victor Babeş" University of Medicine and Pharmacy, Timişoara, Romania, Eftimie Murgu Sq. No. 2, Timişoara, Romania
- Center for Translational Research and Systems Medicine, "Victor Babeş" University of Medicine and Pharmacy, Timişoara, Romania, Eftimie Murgu Sq. No. 2, Timişoara, Romania
| | - Vlad F Avram
- Center for Translational Research and Systems Medicine, "Victor Babeş" University of Medicine and Pharmacy, Timişoara, Romania, Eftimie Murgu Sq. No. 2, Timişoara, Romania
- Department VII Internal Medicine II - Diabetes, Nutrition and Metabolic Diseases, "Victor Babeş" University of Medicine and Pharmacy, Timişoara, Romania, Eftimie Murgu Sq. No. 2, Timişoara, Romania
| | - Theia Lelcu
- Department III Functional Sciences - Pathophysiology, "Victor Babeş" University of Medicine and Pharmacy, Timişoara, Romania, Eftimie Murgu Sq. No. 2, Timişoara, Romania
- Center for Translational Research and Systems Medicine, "Victor Babeş" University of Medicine and Pharmacy, Timişoara, Romania, Eftimie Murgu Sq. No. 2, Timişoara, Romania
| | - Adina V Lința
- Department III Functional Sciences - Pathophysiology, "Victor Babeş" University of Medicine and Pharmacy, Timişoara, Romania, Eftimie Murgu Sq. No. 2, Timişoara, Romania
- Center for Translational Research and Systems Medicine, "Victor Babeş" University of Medicine and Pharmacy, Timişoara, Romania, Eftimie Murgu Sq. No. 2, Timişoara, Romania
| | - Daniela V Chiriac
- Department XII Obstetrics and Gynecology - Obstetrics and Gynecology I, "Victor Babeş" University of Medicine and Pharmacy, Timişoara, Romania, Eftimie Murgu Sq. No. 2, Timişoara, Romania
| | - Adelina G Mocanu
- Department XII Obstetrics and Gynecology - Obstetrics and Gynecology III, "Victor Babeş" University of Medicine and Pharmacy, Timişoara, Romania, Eftimie Murgu Sq. No. 2, Timişoara, Romania
| | - Elena Bernad
- Department XII Obstetrics and Gynecology - Obstetrics and Gynecology III, "Victor Babeş" University of Medicine and Pharmacy, Timişoara, Romania, Eftimie Murgu Sq. No. 2, Timişoara, Romania
| | - Claudia Borza
- Department III Functional Sciences - Pathophysiology, "Victor Babeş" University of Medicine and Pharmacy, Timişoara, Romania, Eftimie Murgu Sq. No. 2, Timişoara, Romania
- Center for Translational Research and Systems Medicine, "Victor Babeş" University of Medicine and Pharmacy, Timişoara, Romania, Eftimie Murgu Sq. No. 2, Timişoara, Romania
| | - Marius L Craina
- Department XII Obstetrics and Gynecology - Obstetrics and Gynecology III, "Victor Babeş" University of Medicine and Pharmacy, Timişoara, Romania, Eftimie Murgu Sq. No. 2, Timişoara, Romania
| | - Zoran L Popa
- Department XII Obstetrics and Gynecology - Obstetrics and Gynecology III, "Victor Babeş" University of Medicine and Pharmacy, Timişoara, Romania, Eftimie Murgu Sq. No. 2, Timişoara, Romania.
| | - Danina M Muntean
- Department III Functional Sciences - Pathophysiology, "Victor Babeş" University of Medicine and Pharmacy, Timişoara, Romania, Eftimie Murgu Sq. No. 2, Timişoara, Romania.
- Center for Translational Research and Systems Medicine, "Victor Babeş" University of Medicine and Pharmacy, Timişoara, Romania, Eftimie Murgu Sq. No. 2, Timişoara, Romania.
| | - Octavian M Crețu
- Department IX Surgery I - Surgical Semiotics I, "Victor Babeş" University of Medicine and Pharmacy, Timişoara, Romania, Eftimie Murgu Sq. No. 2, Timişoara, Romania
- Center for Hepato-Biliary and Pancreatic Surgery, "Victor Babeş" University of Medicine and Pharmacy, Timişoara, Romania, Eftimie Murgu Sq. No. 2, Timişoara, Romania
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Kılıç BŞ, Atakul N. Evaluation of Platelet Large Cell Ratio (PLCR) Results in Patients with Preeclampsia and HELLP. CYPRUS JOURNAL OF MEDICAL SCIENCES 2022. [DOI: 10.4274/cjms.2021.2021-140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Han Q, Zheng S, Chen R, Zhang H, Yan J. A New Model for the Predicting the Risk of Preeclampsia in Twin Pregnancy. Front Physiol 2022; 13:850149. [PMID: 35464090 PMCID: PMC9024216 DOI: 10.3389/fphys.2022.850149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 02/21/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveWe aimed to develop an effective nomogram model for predicting the risk of preeclampsia in twin pregnancies.MethodsThe study was a retrospective cohort study of women pregnant with twins who attended antenatal care and labored between January 2015 and December 2020 at the Fujian Maternity and Child Health Hospital, China. We extracted maternal demographic data and clinical characteristics. Then we performed the least absolute shrinkage and selection operator regression combined with clinical significance to screen variables. Thereafter, multivariate logistic regression was used to construct a nomogram that predicted the risk of preeclampsia in twin pregnancies. Finally, the nomogram was validated using C-statistics (C-index) and calibration curves.ResultsA total of 2,469 women with twin pregnancies were included, of whom 325 (13.16%) had preeclampsia. Multivariate logistic regression models revealed that serum creatinine, uric acid, mean platelet volume, high-density lipoprotein, lactate dehydrogenase, fibrinogen, primiparity, pre-pregnancy body mass index, and regular prenatal were independently associated with preeclampsia in twin pregnancies. The constructed predictive model exhibited a good discrimination and predictive ability for preeclampsia in twin pregnancies (concordance index 0.821).ConclusionThe model for the prediction of preeclampsia in twin pregnancies has high accuracy and specificity. It can be used to assess the risk of preeclampsia in twin pregnancies.
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Yakiştiran B, Tanaçan A, Altinboğa O, Erol A, Şenel S, Elbayiyev S, Yücel A. Role of derived neutrophil-to-lymphocyte ratio, uric acid-to-creatinine ratio and Delta neutrophil index for predicting neonatal outcomes in pregnancies with preeclampsia. J OBSTET GYNAECOL 2022; 42:1835-1840. [PMID: 35290156 DOI: 10.1080/01443615.2022.2040968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We aimed to compare the maternal and neonatal systemic inflammatory markers, platelet indices and new indices in biochemical parameters in women with preeclampsia and healthy controls. The secondary aim was to investigate whether there was a relationship between maternal hematological markers and neonatal outcomes. A retrospective case control study was conducted in a tertiary hospital. Maternal demographic and birth characteristics, complete blood count indices, derived neutrophil to lymphocyte ratio (dNLR), Delta neutrophil index (DNI), uric acid-to-creatinine (Cre) ratio and uric acid-to-alanine transaminase ratio, neonatal hematological parameters were compared between the preeclamptic group and control group. The study consisted of 170 cases (84 preeclampsia and 86 control). Neutrophil-to-lymphocyte ratio (NLR), dNLR, blood urea nitrogen (BUN), creatinine (Cre), uric acid, LDH, aspartate transaminase (AST) and alanine aminotransferase (ALT), uric acid-to-Cre ratio and uric acid-to-ALT ratio were higher and statistically significant in the preeclamptic group than in control ones (p: 0.000 - BUN, Cre, uric acid, LDH, p: 0.001 - AST, p: 0.004 - ALT, p: 0.000 - uric acid-to-Cre ratio, p: 0.009 - uric acid-to-ALT ratio, respectively). NLR and platelet-to-lymphocyte (PLR) ratio were significantly higher in newborns of preeclamptic mothers (p: 0.039; p: 0.004, respectively). A low-moderate correlation between maternal uric acid-to-Cre ratio and neonatal PLR was detected (r: 0.193; p: 0.013). Moreover, moderate negative correlations between maternal PLR (r:-0.231, p: 0.002), uric acid (r: 0.332, p:0.000) and adverse neonatal outcomes were found. Uric acid and PLR, which can be easily calculated clinically may predict adverse neonatal outcomes.IMPACT STATEMENTWhat is already known about this topic? Preeclampsia is known as a significant cause of maternal morbidity and mortality. Haematological indices have been evaluated for the prognosis of many kinds of disease.What do the results of this study add? This study has focussed on new combined haematological-biochemical indices and its relationship with neonatal outcomes. Both higher NLR, derived NLR, DNI and lower PLR were recorded as useful markers for preeclampsia.What are the implications of these findings for clinical practice and/or further research? Some indices that were calculated by assessing basic and simple blood parameters may help clinicians to predict clinical outcomes of preeclampsia.
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Affiliation(s)
- Betül Yakiştiran
- Division of Perinatology, Department of Obstetrics and Gynecology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Atakan Tanaçan
- Division of Perinatology, Department of Obstetrics and Gynecology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Orhan Altinboğa
- Division of Perinatology, Department of Obstetrics and Gynecology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Ahmet Erol
- Division of Perinatology, Department of Obstetrics and Gynecology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Selvi Şenel
- Division of Perinatology, Department of Obstetrics and Gynecology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Sarkhan Elbayiyev
- Division of Neonatology, Department of Pediatrics, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Aykan Yücel
- Division of Perinatology, Department of Obstetrics and Gynecology, Ankara Bilkent City Hospital, Ankara, Turkey
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Walle M, Asrie F, Gelaw Y, Getaneh Z. The role of platelet parameters for the diagnosis of preeclampsia among pregnant women attending at the University of Gondar Comprehensive Specialized Hospital antenatal care unit, Gondar, Ethiopia. J Clin Lab Anal 2022; 36:e24305. [PMID: 35202493 PMCID: PMC8993625 DOI: 10.1002/jcla.24305] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 01/22/2022] [Accepted: 02/12/2022] [Indexed: 11/17/2022] Open
Abstract
Background Preeclampsia (PE) is a pregnancy‐related illness characterized by high blood pressure (BP) and proteinuria after the 20th gestational week (GW). Platelet (PLT) parameter changes are the common hematological abnormalities observed in PE patients. The main aim of this study was to assess the role of PLT parameters for PE diagnosis among pregnant women. Methods A comparative cross‐sectional study was conducted at the University of Gondar Specialized Hospital. A total of 126 pregnant women (63 normotensive [NT] and 63 PE) were recruited using a convenient sampling method. Three milliliter blood was collected from each participant, and PLT parameters were determined using Sysmex XS‐500i analyzer. An independent t‐test supplemented with receiver‐operating characteristics (ROC) were used for comparisons and diagnostic value of PLT parameters between the study groups. Results Platelet count (PC) was significantly lower in the PE group compared to that in the NT group, whereas mean platelet volume (MPV), platelet large cell ratio (P‐LCR), and platelet distribution width (PDW) were significantly higher in PE. MPV had the largest area under the curve (AUC) [0.91: 95% CI; 0.85–0.96] followed by PC [0.79: 95% CI; 0.72–0.87]. MPV can differentiate PE patients from NT pregnant women at cut‐off value ≥12.10 fl (84.1% sensitivity and 87.3% specificity) while PC can indicate PE at a cut‐off value ≤176.5 × 109/L (65.1% sensitivity and 87.3% specificity). Conclusion A decreased PC and an increased MPV, P‐LCR, and PDW can be used as a simple, cost‐effective, quick, and reliable method of PE screening. Of them, MPV is the best indicator of PE.
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Affiliation(s)
- Muluken Walle
- Department of Medical laboratory science, College of Medicine and Health Sciences, Jigjiga University, Jigjiga, Ethiopia
| | - Fikir Asrie
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yemataw Gelaw
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Zegeye Getaneh
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Elmaradny E, Alneel G, Alkhattaf N, AlGadri T, Albriakan N. Predictive values of combined platelet count, neutrophil-lymphocyte ratio, and platelet-lymphocyte ratio in preeclampsia. J OBSTET GYNAECOL 2021; 42:1011-1017. [PMID: 34927550 DOI: 10.1080/01443615.2021.1986476] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
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.
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Affiliation(s)
- Emad Elmaradny
- Department of Obstetrics and Gynecology, Al Yamamah Maternity Hospital, Riyadh, Saudi Arabia
| | - Ghadeer Alneel
- Department of Obstetrics and Gynecology, Al Yamamah Maternity Hospital, Riyadh, Saudi Arabia
| | - Nouf Alkhattaf
- Department of Obstetrics and Gynecology, Al Yamamah Maternity Hospital, Riyadh, Saudi Arabia
| | - Tariq AlGadri
- Department of Obstetrics and Gynecology, Al Yamamah Maternity Hospital, Riyadh, Saudi Arabia
| | - Nawal Albriakan
- Department of Obstetrics and Gynecology, Al Yamamah Maternity Hospital, Riyadh, Saudi Arabia
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