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Bayram F, Ozgen G, Karasın SS, Ozgen L. The predictive value of HALP score and systemic immune inflammation (SII) index in hyperemesis gravidarum. J Obstet Gynaecol Res 2023. [PMID: 37211347 DOI: 10.1111/jog.15666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 04/24/2023] [Indexed: 05/23/2023]
Abstract
AIM Hyperemesis gravidarum (HG) is one of the most common serious diseases in early pregnancy. This study aimed to investigate the clinical significance of hemoglobin, albumin, lymphocyte, and platelet (HALP) score and systemic immune inflammation (SII) index in the presence and severity of HG. METHODS This retrospective case-control study was conducted in a training and educational university hospital between January 2019 and July 2022. A total of 521 pregnant women, of whom 360 were diagnosed with HG at 6-14 weeks of gestation and 161 were low-risk pregnancies, were included in the study. Patients' demographic characteristics and laboratory parameters were recorded. Patients with HG were divided into three categories: mild (n = 160), moderate (n = 116), and severe (n = 84), according to disease severity. The modified PUQE scoring was used to determine the severity of HG. RESULTS The mean age of the patients was 27.6 (16-40) years. We divided the pregnant women into the control group and HG group. The HALP score was significantly lower in the HG group (average, 2.8 ± 1.3), whereas the SII index was found to be significantly higher (average, 895.8 ± 458.1). A negative correlation was found between the increase in the severity of HG and HALP score. The HALP score was the lower in severe HG (mean, 2.16 ± 0.81) and was significantly different from other HG categories (p < 0.01). Moreover, a positive correlation was noted between increased HG severity and SII index levels. The SII index was higher in the severe HG group and was significantly different from the others (1001.2 ± 437.2) (p < 0.01). CONCLUSIONS The HALP score and SII index can be useful, cost-effective, and easily accessible objective biomarkers to predict the presence and severity of HG.
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Affiliation(s)
- Feyza Bayram
- Department of Obstetrics and Gynecology, Bursa Yuksek Ihtisas Educational and Research Hospital, Bursa, Turkey
| | - Gulten Ozgen
- Department of Obstetrics and Gynecology, Bursa Yuksek Ihtisas Educational and Research Hospital, Bursa, Turkey
| | - Süleyman Serkan Karasın
- Department of Obstetrics and Gynecology, Bursa Yuksek Ihtisas Educational and Research Hospital, Bursa, Turkey
| | - Levent Ozgen
- Department of Obstetrics and Gynecology, Uludag University, Bursa, Turkey
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Dal Y, Akkuş F, Karagün Ş, Çolak H, Coşkun A. Are serum delta neutrophil index and other inflammatory marker levels different in hyperemesis gravidarum? J Obstet Gynaecol Res 2023; 49:828-834. [PMID: 36627732 DOI: 10.1111/jog.15542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 12/26/2022] [Indexed: 01/12/2023]
Abstract
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.
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Affiliation(s)
- Yusuf Dal
- Department of Obstetrics and Gynecology, Perinatology Department, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Fatih Akkuş
- Department of Obstetrics and Gynecology, Perinatology Department, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - Şebnem Karagün
- Department of Obstetrics and Gynecology, Perinatology Department, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Hatun Çolak
- Department of Obstetrics and Gynecology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Ayhan Coşkun
- Department of Obstetrics and Gynecology, Perinatology Department, Mersin University Faculty of Medicine, Mersin, Turkey
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BESER DMENEKSE, OLUKLU D, HENDEM DUYAN, AYHAN SGONCU, SAHİN D. The Role Of Systemic Immune-Inflammation Index In The Severity Of Hyperemesis Gravidarum. J Gynecol Obstet Hum Reprod 2023; 52:102583. [PMID: 36977460 DOI: 10.1016/j.jogoh.2023.102583] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/23/2023] [Accepted: 03/25/2023] [Indexed: 03/28/2023]
Abstract
BACKGROUND Hyperemesis gravidarum(HEG) is one of the severe health problems in early pregnancy. Obstetricians should be aware of systemic inflammation in HEG patients to provide better preventive strategies. AIM Hyperemesis gravidarum(HEG) is one of the most common causes of hospitalization in early pregnancy. Complete blood count parameters can be used as inflammatory markers in patients with HEG. We aimed to investigate the Systemic Immune-Inflammation Index (SII)in predicting the severity of HEG. METHODS This cross-sectional study was performed with 469 pregnant women diagnosed and hospitalized with HEG. The study parameters were calculated from complete blood count tests and urine analysis. Demographic characteristics, the Pregnancy Unique Quantification of Emesis (PUQE) scale values, and ketonuria levels at hospital admission were recorded. The neutrophil‑to‑lymphocyte ratio (NLR), platelet‑to‑lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and SII, calculated by the formula (neutrophil × platelet/lymphocyte), were evaluated for predicting the severity of HEG. RESULTS There was a positive correlation between the increased degree of ketonuria and SII. The cut-off value of SII for predicting the severity of HEG was 1071.8 (AUC 0.637, 95% CI (0.582-0.693), p<.001), and sensitivity and specificity were 59% and 59%, respectively. The cut-off value of SII to predict the length of hospitalization was 1073.6(AUC: 0.565, 95% CI: (0.501-0.628), p= 0.039); sensitivity and specificity were 56.3% and 55.5%, respectively CONCLUSIONS: : The clinical utility of SII in predicting HEG severity is limited due to relatively low sensitivity and specificity. Further research is needed to determine the importance of inflammatory indices in HEG patients.
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Sim JH, Cho HS, Jang DM, Park HS, Choi WJ, Park JY. Effect of intraoperative blood transfusion on inflammatory response in parturients with placenta previa undergoing cesarean section: A prospective observational study. Heliyon 2023; 9:e13375. [PMID: 36846661 PMCID: PMC9950829 DOI: 10.1016/j.heliyon.2023.e13375] [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: 07/29/2022] [Revised: 12/31/2022] [Accepted: 01/27/2023] [Indexed: 02/05/2023] Open
Abstract
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.
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ERTÜRK AKSAKAL S, GÜVENÇ SAÇINTI H, KİYKAC ALTINBAŞ Ş, TAPISIZ ÖL, ENGİN-ÜSTÜN Y. The role of systemic inflammatory markers in prediction of medical treatment failure in patients with tubo-ovarian abscess. EGE TIP DERGISI 2022. [DOI: 10.19161/etd.1128214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim: Aimed to evaluate the role of systemic inflammatory markers and Aspartate aminotransferase to Platelet Ratio Index (APRI) sore in predicting medical treatment failure in patients with Tubo-ovarian abscess (TOA).
Materials and Methods: Patients (n=240) hospitalized with a diagnosis of TOA between August 2016 - October 2020 were included in the study. Patients' demographic and clinical characteristics and mean C-Reactive protein (CRP) level, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and APRI score measured on admission were also recorded. The role of these parameters was investigated in predicting medical treatment failure in patients who only received medical treatment or who needed surgical treatment.
Results: The mean age (40.95 ± 6.96 vs. 38.09 ± 7.69), abscess size (67.57 ± 19.86 mm vs. 52.78 ± 16.63 mm), CRP level, (140.61 ± 110.88 vs. 75.24 ± 36.64 mg/L), white blood cell count (13818.86 ± 5445.80 and 11845.31 ± 4424.39 μL), neutrophil count (11146.81 ± 5284.83 and 9242.03 ± 4278.60 μL) and NLR (9.52 ± 6.88 and 6.64 ± 6.30) of patients who received surgical treatment were significantly higher than those who received only medical treatment. In receiver operating characteristics (ROC) analysis area under the curve (AUC) 0.607 was statistically significant for CRP with a cut-off value of 11.57 to predict medical treatment failure (95% 0.531-0.682, sensitivity 63.3%, specificity 55.4%).
Conclusion: NLR, PLR and APRI score are ineffective in predicting the need for surgical treatment. CRP could be used as a marker in predicting the need for surgical treatment in patients with TOA.
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Affiliation(s)
- Sezin ERTÜRK AKSAKAL
- Jinekoloji/Ürojinekoloji Kliniği, Sağlık Bilimleri Üniversitesi, Etlik Zübeyde Hanım Kadın Hastalıkları Eğitim ve Araştırma Hastanesi, Ankara, Türkiye
| | - Huriye GÜVENÇ SAÇINTI
- Jinekoloji/Ürojinekoloji Kliniği, Sağlık Bilimleri Üniversitesi, Etlik Zübeyde Hanım Kadın Hastalıkları Eğitim ve Araştırma Hastanesi, Ankara, Türkiye
| | - Şadıman KİYKAC ALTINBAŞ
- Jinekoloji/Ürojinekoloji Kliniği, Sağlık Bilimleri Üniversitesi, Etlik Zübeyde Hanım Kadın Hastalıkları Eğitim ve Araştırma Hastanesi, Ankara, Türkiye
| | - Ömer Lütfi TAPISIZ
- Jinekoloji/Ürojinekoloji Kliniği, Sağlık Bilimleri Üniversitesi, Etlik Zübeyde Hanım Kadın Hastalıkları Eğitim ve Araştırma Hastanesi, Ankara, Türkiye
| | - Yaprak ENGİN-ÜSTÜN
- Jinekoloji/Ürojinekoloji Kliniği, Sağlık Bilimleri Üniversitesi, Etlik Zübeyde Hanım Kadın Hastalıkları Eğitim ve Araştırma Hastanesi, Ankara, Türkiye
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ERTÜRK AKSAKAL S, GÜVENÇ SAÇINTI H, KİYKAC ALTINBAŞ Ş, TAPISIZ ÖL, ENGİN-ÜSTÜN Y. The role of systemic inflammatory markers in prediction of medical treatment failure in patients with tubo-ovarian abscess. EGE TIP DERGISI 2022. [DOI: 10.19161/etd.1125743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim: Aimed to evaluate the role of systemic inflammatory markers and Aspartate aminotransferase to Platelet Ratio Index (APRI) sore in predicting medical treatment failure in patients with Tubo-ovarian abscess (TOA).
Materials and Methods: Patients (n=240) hospitalized with a diagnosis of TOA between August 2016 - October 2020 were included in the study. Patients' demographic and clinical characteristics and mean C-Reactive protein (CRP) level, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and APRI score measured on admission were also recorded. The role of these parameters was investigated in predicting medical treatment failure in patients who only received medical treatment or who needed surgical treatment.
Results: The mean age (40.95 ± 6.96 vs. 38.09 ± 7.69), abscess size (67.57 ± 19.86 mm vs. 52.78 ± 16.63 mm), CRP level, (140.61 ± 110.88 vs. 75.24 ± 36.64 mg/L), white blood cell count (13818.86 ± 5445.80 and 11845.31 ± 4424.39 μL), neutrophil count (11146.81 ± 5284.83 and 9242.03 ± 4278.60 μL) and NLR (9.52 ± 6.88 and 6.64 ± 6.30) of patients who received surgical treatment were significantly higher than those who received only medical treatment. In receiver operating characteristics (ROC) analysis area under the curve (AUC) 0.607 was statistically significant for CRP with a cut-off value of 11.57 to predict medical treatment failure (95% 0.531-0.682, sensitivity 63.3%, specificity 55.4%).
Conclusion: NLR, PLR and APRI score are ineffective in predicting the need for surgical treatment. CRP could be used as a marker in predicting the need for surgical treatment in patients with TOA.
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Affiliation(s)
- Sezin ERTÜRK AKSAKAL
- Jinekoloji/Ürojinekoloji Kliniği, Sağlık Bilimleri Üniversitesi, Etlik Zübeyde Hanım Kadın Hastalıkları Eğitim ve Araştırma Hastanesi, Ankara, Türkiye
| | - Huriye GÜVENÇ SAÇINTI
- Jinekoloji/Ürojinekoloji Kliniği, Sağlık Bilimleri Üniversitesi, Etlik Zübeyde Hanım Kadın Hastalıkları Eğitim ve Araştırma Hastanesi, Ankara, Türkiye
| | - Şadıman KİYKAC ALTINBAŞ
- Jinekoloji/Ürojinekoloji Kliniği, Sağlık Bilimleri Üniversitesi, Etlik Zübeyde Hanım Kadın Hastalıkları Eğitim ve Araştırma Hastanesi, Ankara, Türkiye
| | - Ömer Lütfi TAPISIZ
- Jinekoloji/Ürojinekoloji Kliniği, Sağlık Bilimleri Üniversitesi, Etlik Zübeyde Hanım Kadın Hastalıkları Eğitim ve Araştırma Hastanesi, Ankara, Türkiye
| | - Yaprak ENGİN-ÜSTÜN
- Jinekoloji/Ürojinekoloji Kliniği, Sağlık Bilimleri Üniversitesi, Etlik Zübeyde Hanım Kadın Hastalıkları Eğitim ve Araştırma Hastanesi, Ankara, Türkiye
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Turgut E, Yildirim M, Sakcak B, Ayhan SG, Tekin OM, Sahin D. Predicting miscarriage using systemic immune-inflammation index. J Obstet Gynaecol Res 2022; 48:587-592. [PMID: 35040233 DOI: 10.1111/jog.15156] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 01/04/2022] [Accepted: 01/06/2022] [Indexed: 11/29/2022]
Abstract
AIM To evaluate the clinical significance of the systemic immune-inflammation index (SII) for patients who had miscarriages. MATERIALS The retrospective study included 709 pregnant women who had a miscarriage (nonviable intrauterine pregnancy up to 20 weeks of gestation) and 676 women who carried a viable intrauterine pregnancy up to 20 weeks of gestation-serving as the control group. The study and the control group were compared in terms of demographic characteristics, laboratory test results, and SII values. Furthermore, laboratory test results and SII values were compared between patients in the study group and the control group with a history of genital bleeding (threatened abortion). RESULTS The mean gestational week of pregnancy was 9.5 ± 3 for the control group and 8.3 ± 2.5 for the study group (p = 0.150). The SII values were higher in the study group than in the control group (p = 0.030). In all participants with a clinical history of genital bleeding, the leukocyte count, neutrophil count, neutrophil-to-lymphocyte ratio (NLR), and SII values were higher in the miscarriage group than the group with viable fetus (p = 0.031, p = 0.003, p = 0.002, p < 0.001). Based on a receiver operating characteristic (ROC) curve analysis, the SII cutoff value for miscarriage was 883.95 (109 /L) (62.6% sensitivity, 62% specificity) in patients with a clinical history of threatened abortion. CONCLUSION High SII values in early pregnancy may be used as an additional marker for the prediction of miscarriage, in pregnant women with threatened abortion. Further prediction models including maternal risk factors and multiple markers may be more valuable for clinical practice.
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Affiliation(s)
- Ezgi Turgut
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Muradiye Yildirim
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Bedri Sakcak
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Sule G Ayhan
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Ozlem M Tekin
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Dilek Sahin
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
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Kim MJ, Kim HM, Cha HH, Kim JI, Seong WJ. Correlation between serum markers in the second trimester and preterm birth before 34 weeks in asymptomatic twin pregnancies. Int J Gynaecol Obstet 2021; 156:355-360. [PMID: 34254306 DOI: 10.1002/ijgo.13822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 03/18/2021] [Accepted: 03/19/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine the correlation between the levels of serum markers in the second trimester and preterm birth before 34 weeks in asymptomatic twin pregnancies. METHODS We conducted a retrospective review of the medical records of 102 asymptomatic twin pregnancies delivered at Chilgok Kyungpook National University Hospital between March 2014 and February 2020. Participants were divided into two groups, based on delivery before and after 34 weeks of gestation. Results of the quad test performed at 15-18 weeks and the complete blood count done at 24-28 weeks were compared. RESULTS Preterm birth before 34 weeks of pregnancy was associated with higher levels of maternal α-fetoprotein (1.04 vs 0.98, multiple of median [MoM], P = 0.006), human chorionic gonadotropin (1.76 vs 1.31, MoM, P = 0.000), and inhibin A (1.78 vs 1.04, MoM, P = 0.000). Positive correlations were observed between gestational age at delivery and white blood cell (WBC) markers. Women with preterm delivery had decreased WBC counts (8180 vs 9405 × 103 /µl, P = 0.019) and neutrophil:lymphocyte ratios (3.85 vs 4.92, P = 0.001). CONCLUSION Serum marker levels in the second trimester can be indicators of preterm delivery before 34 weeks in asymptomatic twin pregnancies.
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Affiliation(s)
- Mi Ju Kim
- Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University Hospital, Kyungpook National University, Daegu, Republic of Korea
| | - Hyun Mi Kim
- Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University Hospital, Kyungpook National University, Daegu, Republic of Korea
| | - Hyun Hwa Cha
- Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University Hospital, Kyungpook National University, Daegu, Republic of Korea
| | - Jong In Kim
- Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University Hospital, Kyungpook National University, Daegu, Republic of Korea
| | - Won Joon Seong
- Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University Hospital, Kyungpook National University, Daegu, Republic of Korea
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Hessami K, Tabrizi R, Homayoon N, Hashemi A, Heydari ST, Pourhoseini SA. Gestational diabetes mellitus and inflammatory biomarkers of neutrophil-lymphocyte ratio and platelet-lymphocyte ratio: a systematic review and meta-analysis. Biomarkers 2021; 26:491-498. [PMID: 33950777 DOI: 10.1080/1354750x.2021.1926542] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
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.
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Affiliation(s)
- Kamran Hessami
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Tabrizi
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nahid Homayoon
- Department of Obstetrics and Gynecology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Atefe Hashemi
- Department of Obstetrics and Gynecology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Taghi Heydari
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
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Ge Y, Liu X, Huang H. Advances in the role of silence information regulator family in pathological pregnancy. Zhejiang Da Xue Xue Bao Yi Xue Ban 2021; 50:335-344. [PMID: 34402258 PMCID: PMC8710262 DOI: 10.3724/zdxbyxb-2021-0183] [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: 01/29/2021] [Accepted: 04/27/2021] [Indexed: 06/13/2023]
Abstract
Aberrant maternal inflammation and oxidative stress are the two main mechanisms of pathological pregnancy. The silence information regulator (sirtuin) family is a highly conserved family of nicotinamide adenine dinucleotide (NAD)-dependent deacylases. By regulating the post-translational modification of proteins, sirtuin is involved in various biological processes including oxidative stress and inflammation. Nowadays, emerging evidence indicates that sirtuin may be closely related to the occurrence and development of pathological pregnancy. The down-regulation of sirtuin can cause spontaneous preterm delivery by promoting uterine contraction and rupture of fetal membranes, cause gestational diabetes mellitus through promoting oxidative stress and affecting the activity of key enzymes in glucose metabolism, cause preeclampsia by reducing the proliferation and invasion ability of trophoblasts, cause intrahepatic cholestasis of pregnancy by promoting the production of bile acids and T helper 1 cell (Th1) cytokines, and cause intrauterine growth restriction through inducing mitochondrial dysfunction. Moreover, the expression and activation of sirtuin can be modulated through dietary interventions, thus sirtuin is expected to become a new target for the prevention and treatment of pregnancy complications. This article reviews the role of the sirtuin family in the occurrence and development of pathological pregnancy and its influence on the development of the offspring.
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Soysal C, Işıkalan MM, Bıyık İ, Erten Ö, İnce O. The relationship between inflammation markers and ketonuria in hyperemesis gravidarum. J Obstet Gynaecol Res 2021; 47:3078-3083. [PMID: 34107554 DOI: 10.1111/jog.14857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 04/08/2021] [Accepted: 05/08/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Hyperemesis gravidarum is an illness that starts in early pregnancy and manifests itself with oral intake problems, electrolyte imbalance, ketonuria, and weight loss. Inflammation is closely associated with the hyperemesis gravidarum, and inflammatory indicators have been studied to understand its pathophysiology. This study investigates the relationship of ketonuria levels with inflammatory markers platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), and neutrophil-to-lymphocyte ratio (NLR) for hyperemesis gravidarum patients. MATERIAL AND METHODS This retrospective case control study was conducted at Kütahya Medical Sciences University Tertiary Research and Training Hospital between December 2019 and December 2020. A total of 173 pregnancies, 82 of them with hyperemesis gravidarum and 91 of them low-risk pregnancies were included in the study. The patients' demographic profiles and laboratory parameters were recorded. The patients were divided into hyperemesis gravidarum and control groups and the groups were compared for the levels of inflammation markers. For the hyperemesis gravidarum group, the relationship between ketonuria levels and the inflammation severity was investigated. RESULTS MLR, NLR, PLR levels were higher in the hyperemesis gravidarum group than the control group in a statistically significant way (p < 0.001 for all of the comparisons). The hyperemesis gravidarum group was subdivided into four groups based on their ketonuria levels, and their MLR, NLR, PLR levels were compared. The differences between the groups were statistically significant (p < 0.001) and the indicators increased with the ketonuria levels. Finally, ketonuria levels had a positive and significant correlation with MLR (rho =0.67, p < 0.001), PLR (rho =0.67, p < 0.001), and NLR (rho =0.8, p < 0.001). CONCLUSION Hyperemesis gravidarum patients have higher levels of hematologic inflammation indicators than healthy pregnant patients. For these patients, the levels of the indicators increase with ketonuria levels.
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Affiliation(s)
- Cenk Soysal
- Department of Gynecology and Obstetrics, Kütahya Health Sciences University, Kutahya, Turkey
| | - Mehmet Murat Işıkalan
- Department of Obstetrics and Gynecology, Maternal-Fetal Medicine Unit, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - İsmail Bıyık
- Department of Gynecology and Obstetrics, Kütahya Health Sciences University, Kutahya, Turkey
| | - Özlem Erten
- Department of Gynecology and Obstetrics, Kütahya Health Sciences University, Kutahya, Turkey
| | - Onur İnce
- Department of Gynecology and Obstetrics, Kütahya Health Sciences University, Kutahya, Turkey
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Kale İ, Helvacıoğlu Ç, Muğurtay TE. Evaluation of complete blood count parameters in the first trimester: an early indicator of miscarriage? JOURNAL OF CLINICAL AND INVESTIGATIVE SURGERY 2021. [DOI: 10.25083/2559.5555/6.1.9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective. Investigation of the relationship between the first trimester complete blood count parameters and miscarriage. Materials and Methods. The study group consisted of 39 patients who admitted to the hospital with the diagnosis of abortus imminens between January 2016 and December 2019, and whose pregnancy ended as miscarriage before the 20th week. The control group consisted of 200 randomly selected healthy pregnant women, with follow-up and delivery in our hospital. Patient information was obtained retrospectively from the hospital records. Results. Age and BMI of both groups were similar. There was no significant difference between the two groups in terms of basophil, neutrophil, eosinophil, lymphocyte, monocyte, platelets, RBC, hemoglobin, hematocrit, MCV, MCH, MCHC, RDW, MPV, Pct and PDW, while leukocyte and neutrophil counts was statistically significantly higher in the miscarriage group (p=0,002, p=0,001, respectively). NLR was statistically higher in the miscarriage group (p=0,005), PLR was also higher in the miscarriage group, but this did not reach statistical significance (p=0,056). Both groups were similar in terms of MLR. Conclusions. High NLR levels obtained from the hemogram results in the first trimester seems to be associated with miscarriage. NLR can be an easy, cheap and useful tool for predicting pregnancy prognosis in patients with abortus imminens.
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Evaluation of third-trimester neutrophil-lymphocyte and platelet-lymphocyte ratios and their correlation with birth weight. JOURNAL OF SURGERY AND MEDICINE 2021. [DOI: 10.28982/josam.918863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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14
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Pace NP, Vassallo J. Association Between Neutrophil-Lymphocyte Ratio and Gestational Diabetes-A Systematic Review and Meta-Analysis. J Endocr Soc 2021; 5:bvab051. [PMID: 34095691 PMCID: PMC8169042 DOI: 10.1210/jendso/bvab051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Indexed: 12/21/2022] Open
Abstract
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.
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Affiliation(s)
- Nikolai Paul Pace
- Centre for Molecular Medicine and Biobanking, Faculty of Medicine and Surgery, University of Malta, MSD2080 Msida, Malta
| | - Josanne Vassallo
- Centre for Molecular Medicine and Biobanking, Faculty of Medicine and Surgery, University of Malta, MSD2080 Msida, Malta.,Department of Medicine, Faculty of Medicine and Surgery, University of Malta, MSD2080, Msida, Malta
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KANZA GÜL D, ŞOLT A. Kan eozinofil-bazofil oranı, eozinofil-lenfosit oranı ve bazofil-lenfosit oranı değerleri gebelikteki intrahepatik kolestazın şiddetini tahmin edebilir mi? CUKUROVA MEDICAL JOURNAL 2020. [DOI: 10.17826/cumj.834063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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16
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Can systemic inflammation markers obtained from complete blood count in the first trimester play a role in predicting early pregnancy loss? JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.833018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Sonaglioni A, Esposito V, Caruso C, Nicolosi GL, Bianchi S, Lombardo M, Gensini GF, Ambrosio G. Association between neutrophil to lymphocyte ratio and carotid artery wall thickness in healthy pregnant women. Eur J Obstet Gynecol Reprod Biol 2020; 255:98-104. [PMID: 33113405 DOI: 10.1016/j.ejogrb.2020.10.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/12/2020] [Accepted: 10/14/2020] [Indexed: 12/26/2022]
Abstract
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.
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Affiliation(s)
- Andrea Sonaglioni
- Department of Cardiology, Ospedale San Giuseppe MultiMedica, Via San Vittore 12, 20123, Milan, Italy.
| | - Valentina Esposito
- Department of Gynecology and Obstetrics, Ospedale San Giuseppe MultiMedica, Via San Vittore 12, 20123, Milan, Italy
| | - Chiara Caruso
- Department of Gynecology and Obstetrics, Ospedale San Giuseppe MultiMedica, Via San Vittore 12, 20123, Milan, Italy
| | - Gian Luigi Nicolosi
- Department of Cardiology, Policlinico San Giorgio, Via Agostino Gemelli 10, 33170, Pordenone, Italy
| | - Stefano Bianchi
- Department of Gynecology and Obstetrics, Ospedale San Giuseppe MultiMedica, Via San Vittore 12, 20123, Milan, Italy
| | - Michele Lombardo
- Department of Cardiology, Ospedale San Giuseppe MultiMedica, Via San Vittore 12, 20123, Milan, Italy
| | - Gian Franco Gensini
- Department of Cardiology, Ospedale San Giuseppe MultiMedica, Via San Vittore 12, 20123, Milan, Italy
| | - Giuseppe Ambrosio
- Cardiology and Cardiovascular Pathophysiology, Azienda Ospedaliero-Universitaria "S. Maria della Misericordia", Perugia, Italy
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Bannaga A, Arasaradnam RP. Neutrophil to lymphocyte ratio and albumin bilirubin grade in hepatocellular carcinoma: A systematic review. World J Gastroenterol 2020; 26:5022-5049. [PMID: 32952347 PMCID: PMC7476180 DOI: 10.3748/wjg.v26.i33.5022] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/10/2020] [Accepted: 08/25/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is a frequent cause of cancer related death globally. Neutrophil to lymphocyte ratio (NLR) and albumin bilirubin (ALBI) grade are emerging prognostic indicators in HCC.
AIM To study published literature of NLR and ALBI over the last five years, and to validate NLR and ALBI locally in our centre as indicators of HCC survival.
METHODS A systematic review of the published literature on PubMed of NLR and ALBI in HCC over the last five years. The search followed the guidelines of the preferred reporting items for systematic reviews and meta-analyses. Additionally, we also investigated HCC cases between December 2013 and December 2018 in our centre.
RESULTS There were 54 studies describing the relation between HCC and NLR and 95 studies describing the relation between HCC and ALBI grade over the last five years. Our local cohort of patients showed NLR to have a significant negative relationship to survival (P = 0.011). There was also significant inverse relationship between the size of the largest HCC nodule and survival (P = 0.009). Median survival with alpha fetoprotein (AFP) < 10 KU/L was 20 mo and with AFP > 10 KU/L was 5 mo. We found that AFP was inversely related to survival, this relationship was not statically significant (P = 0.132). Mean survival for ALBI grade 1 was 37.7 mo, ALBI grade 2 was 13.4 months and ALBI grade 3 was 4.5 mo. ALBI grades performed better than Child Turcotte Pugh score in detecting death from HCC.
CONCLUSION NLR and ALBI grade in HCC predict survival better than the conventional alpha fetoprotein. ALBI grade performs better than Child Turcotte Pugh score. These markers are done as part of routine clinical care and in cases of normal alpha fetoprotein, these markers could give a better understanding of the patient disease progression. NLR and ALBI grade could have a role in modified easier to learn staging and prognostic systems for HCC.
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Affiliation(s)
- Ayman Bannaga
- Department of Gastroenterology and Hepatology, University Hospital Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, West Midlands, United Kingdom
- Warwick Medical School, University of Warwick, Coventry CV4 7HL, West Midlands, United Kingdom
| | - Ramesh P Arasaradnam
- Department of Gastroenterology and Hepatology, University Hospital Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, West Midlands, United Kingdom
- Warwick Medical School, University of Warwick, Coventry CV4 7HL, West Midlands, United Kingdom
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Çintesun E, Akar S, Gul A, Çintesun FNI, Sahin G, Ezveci H, Akyürek F, Çelik Ç. Subclinical inflammation markers in hyperemesis gravidarum and ketonuria: A case-control study. J Lab Physicians 2020; 11:149-153. [PMID: 31160855 PMCID: PMC6543934 DOI: 10.4103/jlp.jlp_151_18] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Subclinical inflammation markers play a significant role in hyperemesis gravidarum (HEG). Simple hematological markers such as mean platelet volume (MPV), platelet distribution width (PDW), neutrophil-to-lymphocyte ratio (NLR), red cell distribution width (RDW), plateletcrit (PCT), and platelet-to-lymphocyte ratio (PLR) have been shown to reflect inflammatory burden and disease activity in several disorders. Ketonuria is a parameter used in the diagnosis of severe HEG, but its correlation with disease severity remains controversial. The relationship of subclinical inflammation markers with degree of ketonuria has not been examined previously. In this study, we aimed to determine the diagnostic value of these subclinical inflammation markers and the relationship between these markers and grade of ketonuria in patients with HEG. MATERIALS AND METHODS A total of 94 pregnant women with a diagnosis of HEG and 100 gestational age-matched healthy pregnant women were enrolled in this retrospective study. MPV, PDW, NLR, PLR, PCT, and ketonuria were calculated and analyzed from complete blood cell counts and total urine analyses. RESULTS Lymphocyte count was significantly higher in the control group (P < 0,001); NLR and PLR values were significantly higher in the HEG group (P < 0,001). Among inflammation markers, RDW increased significantly (P = 0,008) with an increase in ketonuria in patients with HEG. A statistically significant correlation was found between white blood cell (WBC) and NLR, PLR, PCT. A moderate uphill relationship was observed between NLR and WBC and a weak uphill linear relationship was observed between WBC and PLR and between WBC and PCT. CONCLUSIONS PLR and NLR can be considered effective markers to aid in the diagnosis of HEG. No marker was found to correlate with ketonuria grade except RDW, although the relationship of the severity of ketonuria with severity of disease is controversial. RDW increases as the degree of ketonuria increases.
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Affiliation(s)
- Ersin Çintesun
- Department of Obstetrics and Gynecology, Faculty of Medicine, Selçuk University, Selçuklu, Konya, Turkey
| | - Serra Akar
- Department of Obstetrics and Gynecology, Faculty of Medicine, Selçuk University, Selçuklu, Konya, Turkey
| | - Ayhan Gul
- Department of Obstetrics and Gynecology, Faculty of Medicine, Selçuk University, Selçuklu, Konya, Turkey
| | - Feyza Nur Incesu Çintesun
- Department of Obstetrics and Gynecology, Konya Training and Research Hospital, Selçuklu, Konya, Turkey
| | - Gözde Sahin
- Department of Obstetrics and Gynecology, Faculty of Medicine, Selçuk University, Selçuklu, Konya, Turkey
| | - Huriye Ezveci
- Department of Biochemistry, Faculty of Medicine, Selçuk University, Selçuklu, Konya, Turkey
| | - Fikret Akyürek
- Department of Obstetrics and Gynecology, Konya Training and Research Hospital, Selçuklu, Konya, Turkey
| | - Çetin Çelik
- Department of Obstetrics and Gynecology, Faculty of Medicine, Selçuk University, Selçuklu, Konya, Turkey
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Kan E, Emektar E, Corbacioglu K, Safak T, Sariaydin T, Cevik Y. Evaluation of relationship between inflammatory markers and hyperemesis gravidarum in patients admitted to emergency department. Am J Emerg Med 2020; 38:292-295. [DOI: 10.1016/j.ajem.2019.05.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 05/02/2019] [Accepted: 05/03/2019] [Indexed: 02/02/2023] Open
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Dincgez Cakmak B, Dundar B, Ketenci Gencer F, Yildiz DE, Bayram F, Ozgen G, Aydin Boyama B. Assessment of relationship between serum vascular adhesion protein-1 (VAP-1) and gestational diabetes mellitus. Biomarkers 2019; 24:750-756. [DOI: 10.1080/1354750x.2019.1684562] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Burcu Dincgez Cakmak
- Department of Obstetrics and Gynecology, Bursa Yuksek Ihtisas Research and Training Hospital, University of Health Sciences, Bursa, Turkey
| | - Betul Dundar
- Department of Obstetrics and Gynecology, Bursa Yuksek Ihtisas Research and Training Hospital, University of Health Sciences, Bursa, Turkey
| | - Fatma Ketenci Gencer
- Department of Obstetrics and Gynecology, Gaziosmanpasa Taksim Research and Training Hospital, University of Health Sciences, Istanbul, Turkey
| | - Durkadin Elif Yildiz
- Department of Obstetrics and Gynecology, Gaziosmanpasa Taksim Research and Training Hospital, University of Health Sciences, Istanbul, Turkey
| | - Feyza Bayram
- Department of Obstetrics and Gynecology, Bursa Yuksek Ihtisas Research and Training Hospital, University of Health Sciences, Bursa, Turkey
| | - Gulten Ozgen
- Department of Obstetrics and Gynecology, Bursa Yuksek Ihtisas Research and Training Hospital, University of Health Sciences, Bursa, Turkey
| | - Burcu Aydin Boyama
- Department of Obstetrics and Gynecology, Medipol University Esenler Hospital, Istanbul, Turkey
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Christoforaki V, Zafeiriou Z, Daskalakis G, Katasos T, Siristatidis C. First trimester neutrophil to lymphocyte ratio (NLR) and pregnancy outcome. J OBSTET GYNAECOL 2019; 40:59-64. [PMID: 31609136 DOI: 10.1080/01443615.2019.1606171] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
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.
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Affiliation(s)
- Viktoria Christoforaki
- Department of Obstetrics and Gynaecology, University Hospital of Heraklion, Heraklion, Greece
| | | | - George Daskalakis
- First Department of Obstetrics and Gynaecology, "Alexandra" Maternity Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodoros Katasos
- Department of Obstetrics and Gynaecology, Agios Nikolaos General Hospital, Agios Nikolaos, Crete, Greece
| | - Charalampos Siristatidis
- Third Department of Obstetrics and Gynaecology, "Attikon" Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Yildiz Altun A, Demirel İ, Bolat E, Özcan S, Altun S, Aksu A, Beştaş A. The Relationship Between the Preoperative Neutrophil-to-Lymphocyte Ratio and Postoperative Nausea and Vomiting in Patients Undergoing Septorhinoplasty Surgery. Aesthetic Plast Surg 2019; 43:861-865. [PMID: 30767038 DOI: 10.1007/s00266-019-01325-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 01/28/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Postoperative nausea and vomiting (PONV) is one of the most common complications during the postoperative period. In the literature, there are many factors associated with PONV risk, but it is claimed that inflammation increases this risk. The neutrophil-to-lymphocyte ratio (NLR) is a cheap parameter to use in the diagnosis and follow-up of systemic inflammatory diseases. In this study, we aimed to investigate whether the preoperative NLR was a marker for PONV and to determine its relation with antiemetic use. METHODS Eighty patients who were planned to undergo elective septorhinoplasty and were in ASA I-II were prospectively included in the study. The NLR value was calculated by dividing the number of neutrophils by the number of lymphocytes obtained from the preoperative complete blood count. The patients were divided into two groups of 40 patients: patients with an NLR < 2 (group 1) and patients with an NLR > 2 (group 2). Nausea and vomiting during the first 24 h in the recovery room and in the related clinic and antiemetic requirement were recorded. RESULTS The rate of nausea-vomiting in the recovery room and in the postoperative 24-h period in group 1 was significantly lower than in group 2 (p < 0.05). The rate of use of antiemetics in the recovery room and in the postoperative 24-h period in group 1 was significantly lower than in group 2 (p < 0.05). CONCLUSION NLR values above 2 calculated in the preoperative period may be an indicator of PONV risk. Antiemetic prophylaxis may be given according to this value. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Aysun Yildiz Altun
- Department of Anaesthesiology and Reanimation, Fırat University School of Medicine, Elazig, Turkey.
| | - İsmail Demirel
- Department of Anaesthesiology and Reanimation, Fırat University School of Medicine, Elazig, Turkey
| | - Esef Bolat
- Department of Anaesthesiology and Reanimation, Fırat University School of Medicine, Elazig, Turkey
| | - Sibel Özcan
- Department of Anaesthesiology and Reanimation, Fırat University School of Medicine, Elazig, Turkey
| | - Serdar Altun
- Department of Plastic and Reconstructive Surgery, Fırat University School of Medicine, Elazig, Turkey
| | - Ahmet Aksu
- Department of Anaesthesiology and Reanimation, Fırat University School of Medicine, Elazig, Turkey
| | - Azize Beştaş
- Department of Anaesthesiology and Reanimation, Fırat University School of Medicine, Elazig, Turkey
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Siristatidis C, Christoforaki V, Zafeiriou Z, Mastorakos G, Vrantza T, Daskalakis G. First trimester neutrophil-to-lymphocyte ratio (NLR) and pregnancy outcomes in medically assisted reproduction (MAR): a case control study. Gynecol Endocrinol 2019; 35:434-438. [PMID: 30614314 DOI: 10.1080/09513590.2018.1534949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
As success rates after medically assisted reproduction (MAR) technologies have remained constantly limited during the last years, there has been a systematic effort to predict clinical outcomes. There is currently weak evidence to name the neutrophil-to-lymphocyte ratio (NLR), as an accurate predictor in MAR. Through a case control study, and by setting strict eligibility criteria, we enrolled 66 women (35 with negative outcome and 31 cycles with live birth), in terms of NLR at the time of oocyte retrieval. Clinical and IVF cycle characteristics were comparable in a normalized population. There was a positive correlation between NLR and the age of the woman (r = 0.310, p=.011 and rs =0.363, p=.033). Higher odds ratios (ORs) of MAR positive outcome were detected only at higher NLR values, when NLR was divided into quartiles, but only in the 4th quartile [OR =4.33 (95%CI: 1.02-10.79)]. ROC curve resulted on an AUC equal to 0.660 (95%CI: 0.529-0.791) and p value .025. The estimated specificity, sensitivity and cutoff point were 0.57, 0.548, and 1.98, respectively, while PPV and NPV values were 70.6% and 59.3%, respectively. In conclusion, NLR was positively correlated with maternal age; in our study cohort, MAR failure was associated with lower NLR values.
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Affiliation(s)
- Charalampos Siristatidis
- a Third Department Department of Obstetrics and Gynaecology, Assisted Reproduction Unit , "Attikon Hospital", Medical School, National and Kapodistrian University of Athens , Athens , Greece
| | - Viktoria Christoforaki
- b Department of Obstetrics and Gynaecology , University Hospital of Heraklion , Heraklion , Greece
| | - Zafeiris Zafeiriou
- c "Theagenio" Anticancer Hospital of Thessaloniki , Thessaloniki , Greece
| | - George Mastorakos
- d Second Department of Obstetrics and Gynaecology , Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens , Athens , Greece
| | - Tereza Vrantza
- a Third Department Department of Obstetrics and Gynaecology, Assisted Reproduction Unit , "Attikon Hospital", Medical School, National and Kapodistrian University of Athens , Athens , Greece
| | - George Daskalakis
- e First Department of Obstetrics and Gynaecology , Alexandra Hospital, Medical School, National and Kapodistrian University of Athens , Athens , Greece
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Hershko Klement A, Hadi E, Asali A, Shavit T, Wiser A, Haikin E, Barkan Y, Biron-Shental T, Zer A, Gadot Y. Neutrophils to lymphocytes ratio and platelets to lymphocytes ratio in pregnancy: A population study. PLoS One 2018; 13:e0196706. [PMID: 29787560 PMCID: PMC5963784 DOI: 10.1371/journal.pone.0196706] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 04/18/2018] [Indexed: 12/13/2022] Open
Abstract
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.
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Affiliation(s)
- Anat Hershko Klement
- Obstetrics and Gynecology Division, Meir Medical Center, Kfar Saba, Israel and Tel Aviv University, Tel Aviv, Israel
- * E-mail:
| | - Efrat Hadi
- Obstetrics and Gynecology Division, Meir Medical Center, Kfar Saba, Israel and Tel Aviv University, Tel Aviv, Israel
| | - Aula Asali
- Obstetrics and Gynecology Division, Meir Medical Center, Kfar Saba, Israel and Tel Aviv University, Tel Aviv, Israel
| | - Tal Shavit
- Obstetrics and Gynecology Division, Meir Medical Center, Kfar Saba, Israel and Tel Aviv University, Tel Aviv, Israel
| | - Amir Wiser
- Obstetrics and Gynecology Division, Meir Medical Center, Kfar Saba, Israel and Tel Aviv University, Tel Aviv, Israel
| | - Einat Haikin
- Obstetrics and Gynecology Division, Meir Medical Center, Kfar Saba, Israel and Tel Aviv University, Tel Aviv, Israel
| | - Yael Barkan
- Obstetrics and Gynecology Division, Meir Medical Center, Kfar Saba, Israel and Tel Aviv University, Tel Aviv, Israel
- Clalit Health Services, Netanya, Israel
| | - Tal Biron-Shental
- Obstetrics and Gynecology Division, Meir Medical Center, Kfar Saba, Israel and Tel Aviv University, Tel Aviv, Israel
| | - Alona Zer
- The Institute for Oncology, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Yifat Gadot
- Obstetrics and Gynecology Division, Kaplan Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
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Fossum S, Vikanes ÅV, Næss Ø, Vos L, Grotmol T, Halvorsen S. Hyperemesis gravidarum and long-term mortality: a population-based cohort study. BJOG 2017; 124:1080-1087. [PMID: 27981734 PMCID: PMC5484313 DOI: 10.1111/1471-0528.14454] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2016] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To investigate whether exposure to hyperemesis gravidarum (HG) is associated with increased maternal long-term mortality. DESIGN Population-based cohort study. SETTING Medical Birth Registry of Norway (1967-2002) linked to the Cause of Death Registry. POPULATION Women in Norway with singleton births in the period 1967-2002, with and without HG. Women were followed until 2009 or death. METHODS Cox proportional hazard regression model was applied to estimate hazard ratios (HRs) with 95% confidence interval (CI). MAIN OUTCOME MEASURES The primary outcome was all-cause mortality during follow up. Secondary outcomes were cause-specific mortality (cardiovascular mortality, deaths due to cancer, external causes or mental and behavioural disorders). RESULTS Of 999 161 women with singleton births, 13 397 (1.3%) experienced HG. During a median follow up of 26 years (25 902 036 person-years), 43 470 women died (4.4%). Women exposed to HG had a lower risk of long-term all-cause mortality compared with women without HG (crude HR 0.82; 95% CI 0.75-0.90). When adjusting for confounders, this reduction was no longer significant (adjusted HR 0.92; 95% CI 0.84-1.01). Women exposed to HG had a similar risk of cardiovascular death as women not exposed (adjusted HR 1.04; 95% CI 0.83-1.29), but a lower long-term risk of death from cancer (adjusted HR 0.86; 95% CI 0.75-0.98). CONCLUSION In this large population-based cohort study, HG was not associated with an increased risk of long-term all-cause mortality. Women exposed to HG had no increase in mortality due to cardiovascular disease, but had a reduced risk of death from cancer. TWEETABLE ABSTRACT Population-based cohort study: Hyperemesis was not associated with an increased risk of long-term mortality.
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Affiliation(s)
- S Fossum
- Department of CardiologyOslo University Hospital UllevalOsloNorway
- Epidemiological DivisionNational Institute of Public HealthOsloNorway
| | - ÅV Vikanes
- The Intervention CenterOslo University HospitalOsloNorway
| | - Ø Næss
- University of OsloOsloNorway
- Epidemiological DivisionNational Institute of Public HealthOsloNorway
| | - L Vos
- Cancer Registry of NorwayOsloNorway
| | | | - S Halvorsen
- Department of CardiologyOslo University Hospital UllevalOsloNorway
- University of OsloOsloNorway
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Yanagisawa S, Papaioannou AI, Papaporfyriou A, Baker JR, Vuppusetty C, Loukides S, Barnes PJ, Ito K. Decreased Serum Sirtuin-1 in COPD. Chest 2017; 152:343-352. [PMID: 28506610 PMCID: PMC5540026 DOI: 10.1016/j.chest.2017.05.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 03/17/2017] [Accepted: 05/01/2017] [Indexed: 11/27/2022] Open
Abstract
Background The protein deacetylase sirtuin-1 (SIRT1) is an antiaging molecule that is decreased in the lung in patients with COPD. Recently, SIRT1 was reported to be detectable in serum, but serum SIRT1 (s120S) levels have not yet been reported in patients with COPD. Methods Serum SIRT1 protein of all samples was measured by Western blot, and the SIRT1 protein band densities were calculated and compared with clinical parameters. Results Several molecular sizes of SIRT1, including 120 kDa (actual size) and fragments (102 and 75 kDa) were quantified by Western blot. Among them, only the 120-kDa s120S was significantly decreased in patients with COPD compared with the control subjects without COPD (s120S ratio in healthy subjects = 0.90 ± 0.34 vs those with COPD = 0.68 ± 0.24; P = .014) and was positively correlated with airway obstruction (FEV1/FVC, r = 0.31; P = .020); its severity measured by FEV1 % predicted (r = 0.29; P = .029). s120S also showed a positive correlation with BMI (r = 0.36; P = .0077) and diffusing capacity of the lung per unit volume (the carbon monoxide transfer coefficient: KCO%) (r = 0.32; P = .025). It was also significantly decreased with increasing severity of lung emphysema (r = –0.40; P = .027) and with a clinical history of frequent COPD exacerbations (infrequent vs frequent, 0.76 ± 0.20 vs 0.56 ± 0.26; P = .027). SIRT1 was not detected in supernatant of A549 and primary epithelial cells in normal culture conditions. Conclusions s120S was decreased in the patients with COPD, potentially as reflected by the reduced SIRT1 within cells as a result of oxidative stress, and might be a potential biomarker for certain disease characteristics of COPD.
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Affiliation(s)
- Satoru Yanagisawa
- Airway Disease Section, National Heart and Lung Institute, Imperial College London, London, England
| | | | - Anastasia Papaporfyriou
- First Respiratory Medicine Department, University of Athens, Sotiria Hospital, Athens, Greece
| | - Jonathan R Baker
- Airway Disease Section, National Heart and Lung Institute, Imperial College London, London, England
| | - Chaitanya Vuppusetty
- Airway Disease Section, National Heart and Lung Institute, Imperial College London, London, England
| | - Stelios Loukides
- Division of Respiratory Diseases I, National and Kapodistrian University of Athens, Athens, Greece
| | - Peter J Barnes
- Airway Disease Section, National Heart and Lung Institute, Imperial College London, London, England
| | - Kazuhiro Ito
- Airway Disease Section, National Heart and Lung Institute, Imperial College London, London, England.
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Tayfur C, Burcu DC, Gulten O, Betul D, Tugberk G, Onur O, Engin K, Orcun O. Association between platelet to lymphocyte ratio, plateletcrit and the presence and severity of hyperemesis gravidarum. J Obstet Gynaecol Res 2017; 43:498-504. [DOI: 10.1111/jog.13228] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 09/23/2016] [Indexed: 12/15/2022]
Affiliation(s)
- Cift Tayfur
- Department of Obstetrics and Gynecology; Bursa Yuksek Ihtisas Research and Training Hospital; Bursa Turkey
| | - Dincgez Cakmak Burcu
- Department of Obstetrics and Gynecology; Bursa Yuksek Ihtisas Research and Training Hospital; Bursa Turkey
| | - Ozgen Gulten
- Department of Obstetrics and Gynecology; Bursa Yuksek Ihtisas Research and Training Hospital; Bursa Turkey
| | - Dundar Betul
- Department of Obstetrics and Gynecology; Bursa Yuksek Ihtisas Research and Training Hospital; Bursa Turkey
| | - Guclu Tugberk
- Department of Obstetrics and Gynecology; Bursa Yuksek Ihtisas Research and Training Hospital; Bursa Turkey
| | - Ozdenoglu Onur
- Department of Obstetrics and Gynecology; Bursa Yuksek Ihtisas Research and Training Hospital; Bursa Turkey
| | - Korkmazer Engin
- Department of Obstetrics and Gynecology; Bursa Yuksek Ihtisas Research and Training Hospital; Bursa Turkey
| | - Ozdemir Orcun
- Department of Obstetrics and Gynecology; Bursa Yuksek Ihtisas Research and Training Hospital; Bursa Turkey
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Jenabi E, Fereidooni B. The association between maternal smoking and hyperemesis gravidarum: a meta-analysis. J Matern Fetal Neonatal Med 2016; 30:693-697. [DOI: 10.1080/14767058.2016.1183194] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Ensiyeh Jenabi
- Department of Midwifery, Toyserkan Branch, Islamic Azad University, Toyserkan, Iran and
| | - Bita Fereidooni
- Department of Midwfery, Nursing and Midwifery Faculty, Tehran University of Medical Sciences, Tehran, Iran
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Sargın MA, Yassa M, Taymur BD, Celik A, Ergun E, Tug N. Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios: are they useful for predicting gestational diabetes mellitus during pregnancy? Ther Clin Risk Manag 2016; 12:657-65. [PMID: 27217758 PMCID: PMC4853164 DOI: 10.2147/tcrm.s104247] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE We aimed to investigate whether the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) could be utilized to screen for gestational diabetes mellitus (GDM). SUBJECTS AND METHODS NLR and PLR were assessed by retrospective analysis of 762 healthy and pregnant women with GDM. The patients were stratified into four groups, as follows: GDM (n=144), impaired glucose tolerance (n=76), only screen positive (n=238), and control (n=304). RESULTS The leukocyte, neutrophil, and lymphocyte counts were significantly higher in the study groups compared with the control group (P=0.001; P<0.01). There were no statistically significant differences between the groups with respect to the NLR and PLR (P>0.05). CONCLUSION We do not recommend that blood NLR and PLR can be used to screen for GDM. However, increase in the leukocyte count is an important marker for GDM as it provides evidence of subclinical inflammation.
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Affiliation(s)
- Mehmet Akif Sargın
- Department of Obstetrics and Gynecology, Fatih Sultan Mehmet Research and Training Hospital, Istanbul, Turkey
| | - Murat Yassa
- Department of Obstetrics and Gynecology, Fatih Sultan Mehmet Research and Training Hospital, Istanbul, Turkey
| | - Bilge Dogan Taymur
- Department of Obstetrics and Gynecology, Fatih Sultan Mehmet Research and Training Hospital, Istanbul, Turkey
| | - Ayhan Celik
- Department of Obstetrics and Gynecology, Fatih Sultan Mehmet Research and Training Hospital, Istanbul, Turkey
| | - Emrah Ergun
- Department of Obstetrics and Gynecology, Fatih Sultan Mehmet Research and Training Hospital, Istanbul, Turkey
| | - Niyazi Tug
- Department of Obstetrics and Gynecology, Fatih Sultan Mehmet Research and Training Hospital, Istanbul, Turkey
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