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

Maternal Neutrophil Inflammation Markers Predict Bronchopulmonary Dysplasia in Preeclamptic Pregnancies

PROBLEM

Preeclampsia (PE) and bronchopulmonary dysplasia (BPD) are severe disorders that significantly affect maternal and neonatal health worldwide. This study evaluated the predictive value of maternal hematologic indicators in PE patients for the risk of offspring BPD.

METHOD OF STUDY

A retrospective cohort study was conducted enrolling infants born before 34 weeks' gestation between September 2017 and December 2019 at the Third Affiliated Hospital of Guangzhou Medical University. Logistic regression analysis was used to evaluate the association between maternal hematologic indicators and offspring BPD. Subgroup analysis was performed to explore the interaction effects between maternal hematologic indicators and PE on neonatal BPD risk.

RESULTS

Data from 510 preterm infants and their mothers were analyzed. After adjusting for potential confounders, interaction effects between maternal white blood cell count (WBC), absolute neutrophil count (ANC), and PE on offspring BPD were observed (p for interaction <0.05). Among normotensive mothers, elevated WBC or ANC did not significantly increase the risk of offspring BPD (OR [95% CI]: 1.02 [0.93-1.12] for both). In contrast, in PE patients, higher levels of WBC and ANC were independently associated with offspring BPD risk (OR [95% CI]: 1.24 [1.06-1.47] and 1.22 [1.05-1.44], respectively). Moreover, WBC > 11.90 and NLR > 7.65 in PE patients were identified as independent predictors of neonatal BPD (OR [95% CI]: 4.88 [1.27-21.04] and 4.67 [1.41-17.27], respectively).

CONCLUSIONS

Neutrophil-related hematologic indicators, including WBC, ANC, and NLR in PE patients, are significantly and independently associated with the development of BPD. These findings highlight the potential of neutrophils as a promising focus for investigating the relationship between these maternal and neonatal disorders.

Predictive value of the neutrophil-to-lymphocyte ratio for epidural labor analgesia-associated intrapartum fever: a retrospective single-center study

BACKGROUND

Studies have indicated that epidural analgesia increases the risk of maternal fever during labor, possibly due to non-infectious inflammation. The neutrophil-to-lymphocyte ratio (NLR) is a crucial indicator of inflammation, with a higher NLR potentially signaling worse patient adverse outcomes. The present study explores whether NLR has clinical predictive value for epidural analgesia-related maternal fever (ERMF).

METHODS

A retrospective analysis was performed for 1602 women who voluntarily requested analgesia for epidural labor from January 2023 to June 2024. Univariate and multivariate logistic regression analyses were applied to identify the factors influencing intrapartum fever, and the association between NLR and ERMF was explored. The receiver operating characteristic (ROC) curve was used to assess the area under the curve (AUC) of NLR for intrapartum fever, and the nearest ascending index was utilized to determine the cut-off value.

RESULTS

A total of 1602 parturients were included, of which 160 (10%) had intrapartum fever. Body mass index (BMI) (OR = 1.132, 95% CI: 1.027-1.246, P = 0.012), the duration of the first stage of labor (OR = 1.002, 95% CI: 1.001-1.003, P < 0.001), percentage of lymphocytes (OR = 1.205, 95%CI: 1.073-1.354, P = 0.012) and NLR (OR = 1.964, 95% CI: 1.462-2.639, P < 0.001) were independent risk factors for intrapartum fever. High NLR levels were associated with a higher incidence of ERMF at subgroups of ages < 35 years (OR = 1.343, 95%CI: 1.215-1.486, P < 0.001), ages ≥ 35 years (OR = 1.274, 95%CI: 1.105-1.468, P = 0.01), BMI < 24 kg/m2 (OR = 1.326, 95% CI: 1.176-1.495, P < 0.001), BMI ≥ 24 kg/m2 (OR = 1.515, 95%CI: 1.147-2.000, P = 0.003), first stage of labor < 600 min (OR = 1.466, 95%CI: 1.241-1.733, P < 0.001), and first stage of labor ≥ 600 min (OR = 1.257, 95%CI: 1.109-1.424, P < 0.001). Maternal NLR levels greater than 6.305 (AUC = 0.702, 95%CI: 0.634-0.768, P < 0.001) were good predicators of intrapartum fever.

CONCLUSIONS

High NLR is associated with EMRF, and NLR is a viable predictor of early identification of the occurrence of EMRF, which may be beneficial for pregnancy outcomes.

Prediction Models for Late-Onset Preeclampsia: A Study Based on Logistic Regression, Support Vector Machine, and Extreme Gradient Boosting Models

Background: Preeclampsia, affecting 2-4% of pregnancies worldwide, poses a substantial risk to maternal health. Late-onset preeclampsia, in particular, has a high incidence among preeclampsia cases. However, existing prediction models are limited in terms of the early detection capabilities and often rely on costly and less accessible indicators, making them less applicable in resource-limited settings. Objective: To develop and evaluate prediction models for late-onset preeclampsia using general information, maternal risk factors, and laboratory indicators from early gestation (6-13 weeks). Methods: A dataset of 2000 pregnancies, including 110 late-onset preeclampsia cases, was analyzed. General information and maternal risk factors were collected from the hospital information system. Relevant laboratory indicators between 6 and 13 weeks of gestation were examined. Logistic regression was used as the baseline model to assess the predictive performance of the support vector machine and extreme gradient boosting models for late-onset preeclampsia. Results: The logistic regression model, only considering general information and risk factors, identified 19.1% of cases, with a false positive rate of 0.4%. When selecting 15 factors encompassing general information, risk factors, and laboratory indicators, the false positive rate increased to 0.7% and the detection rate improved to 27.3%. The support vector machine model, only considering general information and risk factors, achieved a detection rate of 27.3%, with a false positive rate of 0.0%. After including all the laboratory indicators, the false positive rate increased to 7.7% but the detection rate significantly improved to 54.5%. The extreme gradient boosting model, only considering general information and risk factors, achieved a detection rate of 31.6%, with a false positive rate of 1.5%. After including all the laboratory indicators, the false positive rate remained at 0.7% but the detection rate increased to 52.6%. Additionally, after adding the laboratory indicators, the areas under the ROC curve for the logistic regression, support vector machine, and extreme gradient boosting models were 0.877, 0.839, and 0.842, respectively. Conclusion: Compared with the logistic regression model, both the support vector machine and extreme gradient boosting models significantly improved the detection rates for late-onset preeclampsia. However, the support vector machine model had a comparatively higher false positive rate. Notably, the logistic regression and extreme gradient boosting models exhibited high negative predictive values of 99.3%, underscoring their effectiveness in accurately identifying pregnant women less likely to develop late-onset preeclampsia. Additionally, logistic regression showed the highest areas under the ROC curve, suggesting that the traditional model has unique advantages in relation to prediction.

Platelet indices in preeclampsia: comparative analysis with normotensive pregnant women

BACKGROUND

To compare platelet count (PC), mean platelet volume (MPV), and platelet distribution width (PDW) between women with preeclampsia (PE) and normotensive pregnant women, and evaluate their effectiveness as predictors of PE.

RESEARCH DESIGN AND METHODS

This cross-sectional study at Nishtar Hospital, Multan, included 141 women: 74 normotensive and 67 preeclamptic. Data was collected using an automated hematology analyzer and analyzed with SPSS version 26 and ROC curves.

RESULTS

Mean age was 27.45 ± 5.18 years for cases and 28.41 ± 5.28 years for controls (p = 0.280). Gestational age was lower in the preeclamptic group (31.97 ± 4.07 weeks) compared to controls (33.92 ± 3.30 weeks) (p = 0.002). Blood pressures were higher in preeclamptic women (p < 0.001). Platelet count was lower in preeclamptic women (183.42 ± 95.69) vs. controls (256.42 ± 77.98) (p < 0.001). MPV (10.98 ± 1.55 vs. 9.79 ± 1.59, p < 0.001) and PDW (16.82 ± 5.70vs. 14.20 ± 2.40, p < 0.001) were higher in preeclamptic women. ROC analysis showed PDW had an AUC of 0.73 and MPV an AUC of 0.71.

CONCLUSIONS

PDW and MPV are significantly altered in preeclamptic women and can aid in early detection, potentially enhancing management.

Predictive value of neutrophil-to-lymphocyte ratio on admission for intrapartum maternal fever in parturients undergoing epidural analgesia: A retrospective cohort study using propensity score-matched analysis

OBJECTIVE

To identify the predictive value of the neutrophil-to-lymphocyte ratio (NLR) on admission for intrapartum maternal fever in parturients undergoing epidural analgesia (EA).

METHODS

In this retrospective cohort study, propensity score matching (PSM) was applied to address covariates. Univariate and multivariate regression analyses were implemented in sequence to find out the factors influencing intrapartum fever. The receiver operating characteristics curve was applied to determine the area under the curve (AUC) of NLR for intrapartum fever.

RESULTS

NLR and duration of EA were independent risk factors for intrapartum fever. The AUC of the combined indicator (NLR + duration of EA) was higher than that of NLR (AUC = 0.583, 95% confidence interval [CI] 0.53-0.64) and duration of EA (AUC = 0.702, 95% CI 0.66-0.75), reaching 0.715 (95% CI 0.67-0.76; p < 0.001). NLR increased predictive performance for intrapartum fever when added to the duration of EA (net reclassification index 0.076, p = 0.022; integrated discrimination improvement 0.020, p = 0.002).

CONCLUSION

NLR has limited predictive power for intrapartum fever. The combination of NLR and duration of epidural analgesia may be considered a promising predictor for intrapartum maternal fever in parturients undergoing epidural analgesia.

SYNOPSIS

The neutrophil-to-lymphocyte ratio is an accessible predictor for the early identification of parturients at risk of intrapartum fever.

Role of Systemic Immune-Inflammation Index, Systemic Inflammation Response Index, and Pan-Immune Inflammation Value in the Prediction of Preeclampsia: A Retrospective Cohort Study

OBJECTIVE

The aim of the study was to investigate the role of systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and pan-immune inflammation value (PIV) calculated from first trimester complete blood count (CBC) in predicting preeclampsia without (PE) and with severe features (PE-SF).

METHODS

This retrospective cohort study included 126 women with PE, 126 women with PE-SF, and 126 women with healthy, normotensive pregnancies delivered at a large tertiary referral hospital between 2018 and 2022. The main outcome measures were SII, SIRI, and PIV.

RESULTS

SII scores differed significantly between the control versus PE and control versus PE-SF groups, while SIRI scores showed a significant difference between the control versus PE and PE versus PE-SF groups. However, the PIV values showed a significant difference in all three groups. According to the receiver operating characteristic analysis performed for the discriminatory power of SII, SIRI, and PIV, the area under the curve (AUC) values were 0.801, 0.609, and 0.774 for the prediction of PE and 0.535, 0.701, and 0751 for the prediction of PE-SF, respectively. An SII with a cutoff value of > 620.59×103/µL (sensitivity 81%, specificity 67%) and an SIRI with a cutoff value of > 0.94×103/µL (sensitivity 74%, specificity 69%) had the highest discriminatory power for the prediction of PE and PE-SF, respectively.

CONCLUSION

Our results suggest an association between high SII, PIV, and SIRI results and an increased risk of future PE and could be used as a first trimester screening test to improve decision making in the prediction of PE.

Relationship between hypertensive disease stages of pregnancy and plateletcrit values: A retrospective cohort study

Objective

The aim of this study was to investigate the correlation between plateletcrit (PCT) and stages of hypertensive disease of pregnancy by comparing values in groups with healthy pregnancies, gestational hypertension [GHT], preeclampsia with proteinuria [PE + P] and severe preeclampsia with proteinuria [sPE + P]. The secondary aim was to investigate how proteinuria affects PCT values in these patients.

Materials and methods

This was a retrospective cohort study. Patients who had been hospitalized for labor were included in the study. The following groups were created: healthy pregnancies (n = 36), [GHT] (n = 36), [PE + P] (n = 36) and [sPE + P] (n = 36). PCT and platelet values from blood tests performed immediately after hospitalization were compared among the four groups. Additionally, the PCT and platelet values in the early pregnancy period of same patients were determined and compared.

Results

There were no statistically significant differences among the groups in terms of age, gravidity or parity (p > 0.05). The mean platelet counts of the groups ranged from 219,250/mm3 to 241,310/mm3. There were no significant differences among the groups (with or without proteinuria) in terms of the platelet counts or PCT values (p > 0.05). A reducing or enhancing effect of proteinuria on the PCT value was not observed. Additionally, based on data from the early weeks of pregnancy, there were no significant differences among the groups in terms of the platelet counts or PCT values (p > 0.05).

Conclusions

PCT may not be appropriate to use for the diagnosis or prediction of sPE in patients whose platelet counts have not decreased. A normal PCT value should not be interpreted as the absence of progression to sPE. There is a need for new PCT and PE studies that take platelet counts into account and include women in the early weeks of pregnancy.

Cogent integration of inflammatory biomarkers and perioperative complications of thyroid surgery in thyroidology

OBJECTIVE

Back to the sources, postoperative nausea and vomiting, hypo- and hypertension, heart rate alterations, and hypoxemia due to laryngospasm might be considered perioperative complications.

METHODS

This cross-sectional study was conducted at an Education and Research Hospital between January 2018 and June 2023. The study included a total of 437 cases of thyroid surgery. The demographic data such as age, sex, co-morbidities of the instances, hypotension, hypertension, bradycardia, hypoxemia, and postoperative nausea and vomiting, as well as laboratory data were obtained and analyzed.

RESULTS

Of 437 cases, 334 (76%) were females and 103 (24%) were males, with a mean age of 51.83±11.91 years and 55.32±11.87 years, respectively. No statistical significance was realized between the complications, co-morbid diseases, and age. Notably, no liaison between the complications after awakening from the anesthesia and preoperative laboratory parameters was discerned. However, a high but no significant relationship was revealed between the platelet-to-lymphocyte ratio (P/L) in cases with hypoxemia and hypotension. Finally, no significance between laboratory values, bradycardia, hypertension, and postoperative nausea and vomiting was distinguished.

CONCLUSION

We postulate that the so-called inflammatory biomarkers measured at the time of preoperative examination in the blood count concept selectively do not enrich for anticipating complications that arise in the perioperative echelon.

Evaluating Hematological Inflammatory Markers as Predictors of Preeclampsia

Background: Preeclampsia, affecting 2–8% of pregnancies, is characterized by new-onset hypertension, proteinuria, and edema, stemming from placental dysfunction and subsequent inflammatory cascade activation. This study aimed to test the predictive ability of hematological indices in predicting preeclampsia. Therefore, predicting the diagnosis of preeclampsia earlier with higher accuracy could potentially preserve the lives of both the mother and the fetus, while also reducing the rates of complications. Methods: This retrospective study included two groups: patients with preeclampsia and a matched control group without additional medical conditions, both having undergone childbirth in the same gestational week. The primary difference between the groups was the preeclampsia diagnosis. Hematological parameters and inflammatory indices were compared for analysis. Results: Statistical significance was observed between derived neutrophil-lymphocyte ratio (dNLR), systemic immune-inflammation index (SIRI) and pan-immune inflammation value (PIV) between groups. The dNLR and PIV showed predictive relevance for preeclampsia (p < 0.05). However, their predictive performance was weak (under the curve (AUC) <0.5). A composite index (CoI) combining these indices achieved a higher AUC of 0.62, indicating limited better predictive performance capability. Conclusions: These findings affirm the correlation between preeclampsia and increased inflammation. Inflammatory markers like the dNLR, SIRI, and PIV showed statistical significance but were not practically useful in clinical settings due to their low sensitivity and specificity. The results highlight the necessity of exploring a CoI, which combines these markers, to enhance predictive accuracy and clinical utility.

Role of hematological indices in predicting preeclampsia and its severity: retrospective case-control study

Preeclampsia (PE) is a serious condition that threatens pregnancy with severe sequelae on both the mother and infant. Early detection of PE will lead to favorable outcomes, and using readily available markers like hematological indices is an attractive choice. Examine the diagnostic utility of hematological indices in pregnant women to predict preeclampsia and its severity. In a retrospective case-control study that included 252 women, all had their complete blood picture evaluated during their first and third trimesters as part of their outpatient antenatal care during their pregnancy. They were also divided into 3 groups: healthy pregnant women (control), non-severe PE, and severe PE, each involving 84 women. The changes in platelet to lymphocyte ratio (PLR) between 1st and 3rd trimesters showed an excellent ability to differentiate between severe PE and control (area under the curve = 0.954, cutoff ≤ -5.45%) and a good ability to differentiate between severe PE and non-severe PE (area under the curve = 0.841, cutoff ≤ -7.89%). Neutrophil to lymphocyte ratio showed a good to excellent ability to differentiate between severe PE and non-severe PE compared to control in the first and third trimesters and the percentage change between them. Changes in neutrophil to lymphocyte ratio and PLR strongly predict preeclampsia and its severity since they offer more predictive values than measuring NLP and PLR at different stages of pregnancy individually.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSION

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

Identification of the role of DAB2 and CXCL8 in uterine spiral artery remodeling in early-onset preeclampsia

Aberrant remodeling of uterine spiral arteries (SPA) is strongly associated with the pathogenesis of early-onset preeclampsia (EOPE). However, the complexities of SPA transformation remain inadequately understood. We conducted a single-cell RNA sequencing analysis of whole placental tissues derived from patients with EOPE and their corresponding controls, identified DAB2 as a key gene of interest and explored the mechanism underlying the communication between Extravillous trophoblast cells (EVTs) and decidual vascular smooth muscle cells (dVSMC) through cell models and a placenta-decidua coculture (PDC) model in vitro. DAB2 enhanced the motility and viability of HTR-8/SVneo cells. After exposure to conditioned medium (CM) from HTR-8/SVneoshNC cells, hVSMCs exhibited a rounded morphology, indicative of dedifferentiation, while CM-HTR-8/SVneoshDAB2 cells displayed a spindle-like morphology. Furthermore, the PDC model demonstrated that CM-HTR-8/SVneoshDAB2 was less conducive to vascular remodeling. Further in-depth mechanistic investigations revealed that C-X-C motif chemokine ligand 8 (CXCL8, also known as IL8) is a pivotal regulator governing the dedifferentiation of dVSMC. DAB2 expression in EVTs is critical for orchestrating the phenotypic transition and motility of dVSMC. These processes may be intricately linked to the CXCL8/PI3K/AKT pathway, underscoring its central role in intricate SPA remodeling.

Prognostic value of systemic immune-inflammation index in the diagnosis of preeclampsia

Background

Preeclampsia is a serious complication of pregnancy with negative consequences for the mother and fetus. It was aimed to investigate whether the systemic immune inflammation index is a parameter that will facilitate the diagnosis of preeclampsia.

Methods

This retrospective and single-center study included patients diagnosed with preeclampsia after admission to the emergency department and those who met the inclusion criteria. Vital parameters, demographic data, medical history, white blood cell count, platelet count, neutrophil count, systemic immune-inflammation index values, biochemical parameters, and gestational weeks were analyzed in each patient.

Results

A total of 40 patients with preeclampsia (preeclampsia group) and 40 normal pregnant women (control group) were included. Laboratory tests revealed that the mean WBC, neutrophil, and lymphocyte counts were significantly higher in the preeclampsia group than in the control group, whereas the preeclampsia group had a significantly lower mean platelet count than the control group (p < 0.001). The sensitivity and specificity for the cut-off value of 758.39 × 109/L systemic immune-inflammation index in pregnant patients with preeclampsia was 77.5% and 67.5%, respectively (AUC: 0.705; 95% CI: 0.587-0.823; p = 0.002). No significant difference was observed between the mean neutrophil-to-lymphocyte ratio in preeclampsia diagnosis.

Conclusion

The systemic immune-inflammation index may be used as a marker to help in establishing the diagnosis of preeclampsia. We believe that this index is an important prognostic indicator because it concurrently evaluates neutrophil and lymphocyte values-which indicate the inflammation process-and platelet count, i.e., an indicator of coagulopathy.

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

OBJECTIVE

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

Liver damage parameters and peripheral blood parameters for prediction and diagnosis of intrahepatic cholestasis in pregnancy

OBJECTIVE

Intrahepatic cholestasis of pregnancy (ICP) manifests in late pregnancy. Elevated serum bile acid is a diagnostic criterion: however, its measurement is troublesome. Prediction of ICP by blood markers is not established. Serum bile acid level is associated with liver damage and inflammation. We hypothesized that the following markers could predict the occurrence of ICP and have diagnostic value for it: Liver damage-indicating scores (albumin-bilirubin [ALBI], Model for End-Stage Liver Disease [MELD], aspartate aminotransferase-to-platelet ratio [APRI]) and inflammatory markers (platelet-to-lymphocyte ratio [PLR] and neutrophil-to-lymphocyte ratio [NLR]).

METHODS

Eighty ICP patients and 200 controls were studied. The values of MELD, APRI, ALBI, PLR, and NLR were measured in the 1st trimester and at the time of diagnosis.

RESULTS

Patients with ICP had significantly higher ALBI, MELD, and APRI scores both in the first trimester and at diagnosis. Multivariate logistic regression (MLR) showed that age, ALBI, MELD, and APRI scores were statistically significant (p < 0.05). By receiver operating characteristic (ROC) analysis, the sensitivity of MELD, ALBI, APRI, and NLR in the first trimester was 62%, 73%, 58%, and 29%, respectively, and MELD, ALBI, APRI, and PLR at diagnosis was 28%, 38%, 57%, and 8%, respectively, with a fixed false-positive rate of 10%.

CONCLUSION

This study has demonstrated the usability of the MELD, ALBI, and APRI scores in predicting and diagnosing ICP. They are easy to obtain and might be used in routine practice.

The novel role of activating receptor KIR2DS5 in preeclampsia

Preeclampsia (PE) is a serious complication of pregnancy. Decidual natural killer (dNK) cells were reported to participate in the remodeling of spiral arteries through producing a group of cytokines, including granulocyte-macrophage colony stimulating factor (GM-CSF). KIR2DS5 is an activating receptor of NK cells that specifically recognizes HLA-C2 on trophoblasts. Currently, there are no reports regarding the precise mechanism of KIR2DS5 in PE. This study included 30 PE patients and 30 healthy pregnant women. We found that the expressions of KIR2DS5 were significantly lower in PE deciduae compared to those of healthy pregnancies. By transfecting knockdown and overexpression lentivirus vectors of KIR2DS5 into dNK cells isolated from deciduae of early pregnancy, we altered the KIR2DS5 expression level in dNK cells. Then, these dNK cells and trophoblast cell lines were co-cultured as trophoblast-dNK cells. In the trophoblast-dNK cells, we examined the influence of KIR2DS5 on the biological manifestations of trophoblasts. As anticipated, overexpression of KIR2DS5 could facilitate cell proliferation, migration, and invasion. Furthermore, increased expression of KIR2DS5 inhibited cell apoptosis and enhanced the progression of cells from theG1 to theS stage. Further mechanistic study demonstrated a positive relationship between KIR2DS5 and GM-CSF in trophoblast-dNK cells. Accordingly, our observations indicated that a decrease in KIR2DS5 could reduce the expression of GM-CSF via the JAK2/STAT5 pathway, resulting in the failure of the activated signal to be transmitted to dNK cells and ultimately leading to the occurrence of PE. KIR2DS5 may be a new contributor for the prediction and diagnosis of PE.

Is platelet to lymphocyte ratio predictive of preeclampsia? A systematic review and meta-analysis

BACKGROUND

To evaluate the value of the platelet-to-lymphocyte ratio (PLR) in predicting preeclampsia (PE) in pregnant women.

METHODS

PubMed, EMBASE and Web of Science databases were searched for observational studies (cohort, case-control or cross-sectional) that reported pre-treatment maternal PLR values in women with and without PE. The analysis was done using a random effects model. Pooled effect sizes were reported as weighted mean difference (WMD) with 95% confidence intervals (CIs). Newcastle-Ottawa Scale (NOS) was used to evaluate the risk of bias.

RESULTS

Twenty-five studies with 7755 patients were included in this meta-analysis. PLR was comparable in patients with PE and healthy pregnant women (WMD -2.97; 95% CI: -11.95 to 6.02; N = 16). Patients with mild (WMD -3.00; 95% CI: -17.40 to 11.41; N = 12) and severe PE (WMD -5.77; 95% CI: -25.48 to 13.94; N = 14) had statistically similar PLR, compared to healthy controls.

CONCLUSIONS

Our findings show similar PLR in PE and healthy pregnancies. PLR, therefore, may not be used to differentiate between PE and normal pregnancy or for assessing the severity of PE. The majority of included studies were case-control, potentially introducing bias, and we identified evidence of publication bias as well.

Investigations of leukocyte and inflammatory markers in pregnancies complicated by preeclampsia

OBJECTIVES

Preeclampsia is a frequent and potentially fatal pregnancy complication. It can be challenging to make a timely diagnosis. Identifying clinically useful biochemical markers would be a remedying tool to support the diagnosis of preeclampsia. The aim was to investigate differential cell counts and acute phase reactants as diagnostic markers of preeclamptic third-trimester pregnancies and in relation to pregnancy term, gravidity and the severity of hypertension.

METHODS

Based on a cohort of 421 pregnant women, we included 174 participants (case n = 84, control n = 90) during the third trimester. Peripheral blood was sampled to measure differential white blood cell counts and acute phase reactants on the day of inclusion.

RESULTS

The neutrophil-to-lymphocyte ratio and plasma haptoglobin levels were significantly increased in healthy pregnancies compared with preeclamptic pregnancies. Plasma ferritin levels and albumin levels were respectively increased and decreased in cases of preeclampsia compared with controls. Albumin was specific among multigravida. Plasma transferrin and high-sensitivity C-reactive protein (hs-CRP) levels were significantly decreased and increased, respectively, in cases with preterm preeclampsia compared with term preeclampsia.

CONCLUSION

Plasma ferritin and albumin levels reflected higher inflammation in cases with preeclampsia compared with healthy pregnancies; the same did plasma transferrin and hs-CRP levels in preterm versus term preeclampsia. When considering the normal ranges plasma albumin and hs-CRP levels identified preeclamptic from healthy third-trimester pregnancies and preterm from term preeclampsia cases, respectively, with near-acceptable diagnostic performances. Further validation of the diagnostic value will require larger sample-sized studies with paired plasma and serum samples.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

The prognostic value of neutrophile/lymphocyte ratio and serum chemerin to predict maternal-fetal complications in pregnant systemic lupus erythematosus patients

BACKGROUND

Pregnancy in SLE continues to be a challenge. The neutrophil-to-lymphocyte ratio (NLR) and chemerin are predictors of preeclampsia in the general population; however, their role as predictors of maternal-fetal complications in pregnant SLE patients has not been analyzed.

OBJECTIVE

To investigate the prognostic value of NLR and serum chemerin, to predict maternal-fetal complications in pregnant SLE patients, and compare both biomarkers among three study groups.

METHODS

Design: Analytical cross-sectional study of cases and controls with the following study groups: systemic lupus erythematosus (SLE), preeclampsia, and healthy. NLR and chemerin serum were determined between 20 and 25 weeks of gestation. Patients were evaluated every 4-6 weeks until pregnancy resolution. Maternal and fetal outcomes were registered. We employed Receiver Operating Characteristic (ROC) curves to validate prognostic values.

RESULTS

Seventy pregnant patients were included: 20 with SLE, 20 with preeclampsia, and 30 healthy pregnant women; NLR values were 4 (2.3-5.6) in SLE, 6 (4.6-9.2) in preeclampsia, and 2.8 (2.1-2.9) in the group of healthy women (p = .0001). Chemerin levels were: 26 (15.3-56.2) in SLE, 96 (37.3-146.2) in preeclampsia, and 24.6 ng/mL (15.3-47.4) in the healthy group (p = .007) Maternal complications were observed in 11 (55%), 20 (100%), and 8 (26%) per group, respectively. Thrombocytopenia was the most frequent complication in all pregnant women, followed by hypertensive disorders. Fetal complications were registered in 12 (60%), 16 (80%), and 2 (6.7%), respectively. Congenital malformations and prematurity were the most frequent fetal complications. NLR had good diagnostic accuracy in predicting maternal-fetal complications (AUROC 0.715) p = .015, CI 95% 0.56-0.86, cut-off point level: 2.9, sensitivity 61%, specificity 78%, positive predictive value (PPV) 65%, negative predictive value (NPV) 75%. Regarding chemerin, a cut-off point level >43 ng/mL had a sensitivity of 75%, specificity of 72% AUROC 0.75, p = .001, CI 95% 0.61-0.89, PPV 51.7% NPV 87.8%, meaning that 51.7% of patients with chemerin levels >43 ng/mL have or will have preeclampsia.

CONCLUSION

The NLR may help predict maternal-fetal complications in SLE pregnancy, constituting a marker of subclinical inflammation. Chemerin levels may be associated with preeclampsia. These biomarkers could improve the care of SLE patients with timely intervention of potential complications during pregnancy.

Mean platelet volume and neutrophil/lymphocyte ratio in adolescent idiopathic scoliosis: can they be predictive value in diagnosis?

In our study, we evaluated whether mean platelet volume (MPV) and neutrophil lymphocyte ratio (NLR) are predictive values in the diagnosis of Adolescent Idiopathic Scoliosis in patients diagnosed with scoliosis in our clinic. Approximately 15000 patients who applied to our spine outpatient clinic with the suspicion of scoliosis between 2011 and 2018 were reviewed retrospectively. 292 patients were included in the study. The patients were divided into 3 groups. Group 1; control group group 2; group with the possibility of developing scoliosis under follow-upand group 3; the patient group diagnosed with scoliosis. Spinal curvature degrees of the patients were measured using the Cobb method. The MPV and NLR values of the patients were compared with the degree of curvature measured by the cobb method. NLR was 2.17 ± 2.10 K/ul in Group 1, 2.42 ± 1.76 K/ul in Group 2, and 2.72 ± 3.91 K/ul in Group 3. Although the NLR of the 3rd group was higher than the other 2 groups, it was not statistically significant. (p > 0.05). MPV was 7.90 ± 1.07 fL in Group 1, 7.95 ±1.39 fL in Group 2, 8.33 ± 1.37 fL in Group 3.MPV was higher in Group 3 and was found to be statistically significant (p=0.024). After adjusting for the effects of gender and age variables on the groups, the difference in MPV between groups became more significant (p=0.017) . While there was no statistically significant difference between the groups in terms of NLR, it was observed that MPV was statistically significantly higher in patients with AIS.Could this relationship be a promising inflammatory marker for AIS? We think that this question should be answered by studies involving larger patient and control groups.

Platelet count in preeclampsia: a systematic review and meta-analysis

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.

Rectal bleeding in pregnant women

The article presents a review of scientific literature on the main causes of rectal bleeding in pregnant women. Anatomical, biochemical and hormonal changes during pregnancy often lead to the progression of typical benign diseases (chronic hemorrhoids, anal fissure, etc.), radical surgical treatment of which can be carried out in the puerperal period. However, Crohn’s disease, ulcerative colitis or malignant colorectal polyps can be triggered by pregnancy and affect its course – this requires immediate examination and drug therapy. Pregnancy causes many physiological changes that affect the interpretation of routine biochemical and hematological examination methods. It is known that pregnancy requires increased iron content, the pregnancy courses often with anemia. The erythrocytes sedimentation rate varies significantly depending on the severity of anemia and the pregnancy term. Therefore, it is necessary to carefully analyze the main clinical manifestations of various intraluminal diseases that can potentially cause rectal bleeding in pregnant women.This article also describes the directions of diagnostic search and treatment strategy of rectal bleeding during pregnancy. Chronic hemorrhoids often accompany pregnancy in the third trimester. Some researchers indicate that up to 75% of pregnant women have complaints which are typical for chronic hemorrhoids. An anal fissure in lateral positions should cause suspicion of Crohn’s disease, tuberculosis, syphilis, human immunodeficiency virus, acquired immunodeficiency syndrome, dermatological diseases (most often psoriasis) and anal carcinoma.Bleeding in sexually acquired proctitis is usually mild and is often accompanied by minor purulent discharge. Rectal bleeding can be a sign of both ulcerative colitis and Crohn’s proctitis or sigmoiditis, but it is more typical for ulcerative colitis. Other associated clinical features are diarrhea, abdominal pain, urge to defecate, and specific extraintestinal manifestations (peripheral arthropathy, sacroiliitis, ankylosing spondylitis, conjunctivitis, iridocyclitis, episcleritis, aphthous skin ulcers, erythema nodosum, or pyoderma gangrenosum). If the bleeding is caused by a benign polyp, endoscopic polypectomy solves the bleeding problem.Therefore, rectal bleeding in pregnant women is diagnosed quite often. In most cases, it is caused by benign diseases of the rectum (chronic hemorrhoids or anal fissure), which are amenable to conservative therapy and usually do not threaten the life and health of a woman or a child. However, there is a rate of pregnant women whose rectal bleeding is caused by colorectal diseases, which require a comprehensive approach to diagnosis and treatment. In these women, the benefit and risk should be determined when choosing a diagnostic and treatment algorithm.

Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios and prognosis after aneurysmal subarachnoid hemorrhage: a cohort study

BACKGROUND

 Subarachnoid hemorrhage (SAH) prognosis remains poor. Vasospasm mechanism might be associated with inflammation. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been studied as inflammation markers and prognostic predictors.

OBJECTIVE

 We aimed to investigate NLR and PLR in admission as predictors of angiographic vasospasm and functional outcome at 6 months.

METHODS

 This cohort study included consecutive aneurysmal SAH patients admitted to a tertiary center. Complete blood count was recorded at admission before treatment. White blood cell count, neutrophil count, lymphocyte count, platelet count, NLR, and PLR were collected as independent variables. Vasospasm occurrence-modified Rankin scale (mRS), Glasgow outcome scale (GOS), and Hunt-Hess score at admission and at 6 months were recorded as dependent variables. Multivariable logistic regression models were used to adjust for potential confounding and to assess the independent prognostic value of NLR and PLR at admission.

RESULTS

 A total of 74.1% of the patients were female, with mean age of 55.6 ± 12.4 years. At admission, the median Hunt-Hess score was 2 (interquartile range [IQR] 1), and the median mFisher was 3 (IQR 1). Microsurgical clipping was the treatment for 66.2% of the patients. Angiographic vasospasm incidence was 16.5%. At 6 months, the median GOS was 4 (IQR 0.75), and the median mRS was 3 (IQR 1.5). Twenty-one patients (15.1%) died. Neutrophil-to-lymphocyte ratio and PLR levels did not differ between favorable and unfavorable (mRS > 2 or GOS < 4) functional outcomes. No variables were significantly associated with angiographic vasospasm.

CONCLUSION

 Admission NLR and PLR presented no value for prediction of functional outcome or angiographic vasospasm risk. Further research is needed in this field.

Cysteinyl Leukotriene and Systemic Inflammatory Levels in Preeclampsia

Background In this study, we aimed to demonstrate the efficacy of cysteinyl leukotriene levels, which play a role in inflammation, in predicting the severity of preeclampsia (PE) and to determine whether this marker can be used as a screening tool. Methods In this cross-sectional analytic study, we classified pregnant women who were normotensive (control) or PE or severe PE (SPE) between March 2019 and July 2019. Singleton pregnant 60 women who met the following criteria for the diagnosis of PE were included in the study group. We identified 30 patients with PE and 30 patients with SPE. Normotensive pregnant women (n=30) who met this criterion were included as a control group by randomly selecting them on odd days of the week. Results All pregnant women who participated in the study had a singleton pregnancy, and maternal age ranged from 18 to 40 years, with a mean age of 28.77±6.37 years. The mean gestational week of the group was 35.54±3.247 weeks. Gestational age was higher in women in the control group (p=0.018), shock index was higher in women in the control group (p < 0.001), and body mass index (BMI) value was lower in this group than in the other groups (p=0.002). The values of mean arterial pressure (MAP) were found to have a strong correlation with shock index value and a weak and negative correlation with gestational week and platelet/lymphocyte ratio (p < 0.05). The mean cysteinyl leukotriene levels of 206.15 pg/mL for the control group, 273.2 pg/mL for PE, and 211.85 pg/mL for SPE were calculated. However, no statistically significant difference was found between the groups (p=0.707). Conclusion We found that cysteinyl leukotrienes were not clinically important in assessing the risk for developing PE and predicting SPE. Alanine aminotransferase, white blood cell, lymphocyte, C-reactive protein, platelet/lymphocyte ratio, and shock index were positively correlated with the value of MAP.

Relationship between Platelet-to-Lymphocyte Ratio and Lymphocyte-to-Monocyte Ratio with Spontaneous Preterm Birth: A Systematic Review and Meta-analysis

Background

Spontaneous preterm birth is one of the most common pregnancy complications in obstetric clinical practice, and its etiology is complex. The problems of low survival and high morbidity rates of premature infants need to be solved urgently. The platelet-to-lymphocyte ratio (PLR) and lymphocyte-to-monocyte ratio (LMR) are two novel biomarkers of inflammation, and several studies have linked PLR and LMR to spontaneous preterm birth. These systematic review and meta-analysis are aimed at analyzing the relationship between PLR and LMR in patients with spontaneous preterm birth to provide new ideas for the early prevention and treatment of spontaneous preterm births.

Methods

Cochrane Library, EMBASE, PubMed, and China National Knowledge Infrastructure databases were inspected to gather PLR and LMR in patients with spontaneous preterm birth, all from the database to February 2022. Interstudy heterogeneity was evaluated using Cochran's Q test and I 2 statistic. Differences in PLR and LMR between patients with spontaneous preterm birth and full-term controls were evaluated by computing standardized mean differences and 95% confidence intervals. Publication bias and sensitivity analyses were also performed.

Results

Nine studies were included in the meta-analysis based on the inclusion and exclusion criteria. The meta-analysis showed that serum PLR values were remarkably larger for patients with spontaneous preterm birth than for full-term controls (SMD = 0.49, 95% CI: 0.13 to 0.84, P = 0.007), whereas the difference between serum LMR in patients with spontaneous preterm birth and full-term controls was not statistically significant (SMD: 0.35, 95% CI: -0.18, 0.88, P = 0.199). The results of Begg's and Egger's tests revealed that the publication bias of the meta-analysis was not significant. The outcomes of the sensitivity analysis showed that the individual studies did not influence the meta-analysis results.

Conclusions

Current evidence shows that PLR is strongly associated with spontaneous preterm birth, whereas LMR is not. PLR has a certain clinical value in diagnosing and treating spontaneous preterm births, and our research will provide strong theoretical support for clinical work. In the future, it will be necessary to further explore the reasons for the increased PLR in the serum of patients with spontaneous preterm birth and other mechanisms inducing spontaneous preterm birth.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Preeclampsia has an association with both platelet count and mean platelet volume: A systematic review and meta-analysis

Background

Preeclampsia (PE) is a pregnancy-specific disorder characterized by endothelial dysfunction, and activation of the coagulation system. Alteration of PLT parameters is the common hematological abnormality observed in women with PE. The main aim of this study was to systematically review previous studies from around the world to generate evidence about the relationship between platelet count (PC) and PE, as well as mean platelet volume (MPV) and PE, by calculating the pooled weighted mean difference (WMD) of PC and MPV between PE and normotensive (NT) groups.

Methods

Relevant articles which were published in the English language from January 10, 2011, to January 10, 2021, were systematically searched through PubMed, Web of Science, and African journals online. In addition, reference probing of published articles searching was employed through Google Scholar and Google for searching grey literature. The methodological qualities of articles were assessed using Joana Brigg’s institute critical appraisal checklist. A random-effects model was used to estimate pooled WMD of PLT parameters between the two groups with the respective 95% confidence intervals (CI) using Stata version 11.0. The I2 statistics and Egger’s regression test were used to assess heterogeneity and publication bias among included studies, respectively.

Results

A total of 25 articles were included in this systematic review and meta-analysis. Of which, 23 studies were used in each PC and MPV analysis. The overall pooled WMD of PC and MPV between PE and NT groups were -41.45 × 109/L [95% CI; -51.8, -31.0] and 0.98 fl [95% CI; 0.8, 1.1], respectively. The pooled WMD revealed that PC decreased significantly in the PE group compared to the NT group while MPV increased significantly in the PE group.

Conclusions

This systematic review and meta-analysis indicated that there is a significant decrease in PC and a significant increase in MPV during PE development among pregnant women. As a result, a change in these parameters among pregnant women may indicate the development of PE.

The Relationship Between Preeclampsia and Arsenic Concentration in the Peripheral Blood

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.

Immature Platelet Fraction and Thrombin Generation: Preeclampsia Biomarkers

Preeclampsia, a human pregnancy syndrome, is characterized by elevated blood pressure and proteinuria after the 20th week of gestation. Its etiology remains unknown, and its pathophysiological mechanisms are related to placental hypoperfusion, endothelial dysfunction, inflammation, and coagulation cascade activation. Recently, the role of the complement system has been considered. This syndrome is one of the main causes of maternal and fetal mortality and morbidity. This article discusses the hypothesis of preeclampsia being triggered by the occurrence of inadequate implantation of the syncytiotrophoblast, associated with bleeding during the first stage of pregnancy and with augmented thrombin generation. Thrombin activates platelets, increasing the release of antiangiogenic factors and activating the complement system, inducing the membrane attack complex (C5b9). Immature platelet fraction and thrombin generation may be possible blood biomarkers to help the early diagnosis of preeclampsia.

Neutrophil count is a useful marker to predict the severity of preeclampsia

BACKGROUND

At present, pre-eclampsia is a growing concern and still a diagnostic challenge for obstetricians.

AIMS

This study aimed to evaluate whether the relationship of second trimester of pregnancy neutrophil count differed among pregnancies with mild preeclampsia, severe preeclampsia, and healthy status and explore whether or not neutrophil count in the second trimester of pregnancy would be useful as new predictors of subsequent preeclampsia.

PATIENTS AND METHODS

This study involved 933 pregnancies from 1 January 2018 to 30 January 2021, comprising 396 healthy pregnancies, 222 pregnancies with mild preeclampsia, and 315 pregnancies with severe preeclampsia. The relationship between preeclampsia and neutrophil count was analyzed by multiple logistic regression. In addition, maternal placental tissues of three groups were immunohistochemically stained for myeloperoxidase (MPO).

RESULTS

Neutrophil count was significantly higher in pregnancies with preeclampsia (including pregnancies with mild and severe preeclampsia) than that in healthy pregnancies. The neutrophil count level was prominently higher in patients with severe preeclampsia compared with those with mild preeclampsia (p < .001). The neutrophil count level was significantly positively associated with preeclampsia after adjusting for gestational week at time of blood sampling, BMI, and age (β:1.23; 95%CI:1.09-1.36; p < .0001). In addition, MPO expressions of placental tissues in preeclamptic groups were significantly increased than these in healthy pregnant controls (p < .05).

CONCLUSIONS

Increased neutrophil count in the second trimester of pregnancy was significantly positively associated with preeclampsia. Hence, neutrophil count plays a role in predicting the severity of preeclampsia. At the same time, it may be an independent predictor of subsequent preeclampsia.Abbreviations: BMI: body mass index; MPO: myeloperoxidase.

Role of derived neutrophil-to-lymphocyte ratio, uric acid-to-creatinine ratio and Delta neutrophil index for predicting neonatal outcomes in pregnancies with preeclampsia

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.

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

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.

Gestational diabetes mellitus is associated with blood inflammatory indicators in a Chinese pregnant women population

OBJECTIVE

This study aimed to investigate relationships between blood inflammatory and metabolic biomarkers in pregnant Chinese women with gestational diabetes mellitus (GDM) in Southwest China and to compare the contributions of blood inflammatory indicators to GDM identification.

SUBJECTS AND METHODS

In total, 1,347 pregnant women were divided by gestational week into early-, middle- and late-pregnancy groups. Fasting samples were collected for complete blood count (CBC) and biochemical indicator measurements. Receiver operating characteristic (ROC) curves were used to predict GDM. Multivariate logistic regression was used to examine the associations between blood inflammatory indicators and GDM prevalence in pregnant women.

RESULTS

Significant differences were found in blood inflammatory indicators and metabolic markers in different pregnancy trimesters. For the pregnant women with GDM, FPG, 1 h-PG, 2 h-PG levels, NLR and PLR, WBC and neutrophil counts were statistically differences when compared with non-GDM groups. ROC curve analysis indicated that the NLR, PLR, WBC and neutrophil counts have predictive value for GDM from 24-28 gestational weeks. The FPG levels in 24th-28th weeks of pregnant women were positively correlated with the NLR, PLR, 1 h-PG, 2 h-PG levels and negatively correlated with lymphocyte count. Following adjustment for the age, PLR, and FPG level, multivariate logistic regression showed that the NLR was an independent factor predicting GDM in the 24th-28th weeks of pregnancy.

CONCLUSION

The blood inflammatory indicators NLR, PLR, and WBC and neutrophil counts were higher in GDM women than in healthy pregnant women, suggesting that blood inflammatory indicators are associated with GDM.

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

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

Correlation between serum markers in the second trimester and preterm birth before 34 weeks in asymptomatic twin pregnancies

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.

Evaluation of complete blood count parameters in the first trimester: an early indicator of miscarriage?

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.

Assessment of plasma cell-free DNA and ST2 as parameters in gestational hypertension and preeclampsia

The objective of this study was to evaluate the differences and predictive efficacy of circulating cell-free DNA (cfDNA) and human suppression of tumorigenesis 2 (ST2) among women with uncomplicated pregnancies and patients with gestational hypertension (GH) or preeclampsia (PE). This study included patients with GH (n = 41), patients with PE (n = 62), and women with uncomplicated pregnancies (n = 148). The cfDNA concentration was determined by qPCR, and the ST2 levels were measured by ELISA. A receiver operating characteristic curve was employed to measure the diagnostic performance of cfDNA and ST2. Our results showed that ST2 but not cfDNA was increased in the middle and third trimesters of normal pregnancy; ST2 and cfDNA were increased in GH and PE patients compared to women with uncomplicated pregnancies. More importantly, plasma cfDNA and ST2 served as diagnostic biomarkers for GH and PE, and the AUCs were 0.883 and 0.734 for GH and 0.838 and 0.816 for PE, respectively. Moreover, their combination significantly elevated the diagnostic efficiency for GH and PE, with AUCs of 0.906 and 0.916, respectively. Plasma cfDNA and ST2 could be used as parameters for GH and PE.

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

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

Predictors Associated with Outcomes of Epidural Blood Patch in Patients with Spontaneous Intracranial Hypotension

An autologous epidural blood patch (EBP) is a mainstay of treatment in patients with spontaneous intracranial hypotension (SIH). EBP, however, is less effective for SIH than post-dural puncture headaches. Therefore, patients with SIH frequently require an additional EBP. The aim of this study was to identify factors associated with poor response to EBP. This single-center retrospective observational study used the institutional registry records of 321 patients who underwent EBP between September 2001 and March 2016. Patients were divided into two groups, a poor responder group, consisting of patients who underwent EBP at least three times or more, and a good responder group of patients who experienced sufficient symptom relief after two or fewer EBP. The demographic characteristics, clinical features, radiologic findings, procedural data, and laboratory data were analyzed. Univariate analysis showed that the neutrophil-to-lymphocyte ratio (NLR; p = 0.004) and platelet-to-lymphocyte ratio (p = 0.015) were significantly lower in poor than in good responders. Multivariate analysis found that NLR was the only independent factor associated with a poor response (odds ratio = 0.720; p = 0.008). These findings indicate that a low NLR was associated with three or more EBP administrations for the sufficient improvement of symptoms in patients with SIH.

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

BACKGROUND

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

AIM

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

METHODS

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

RESULTS

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

CONCLUSION

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

Prevention of preterm delivery by cervical cerclage; a comparison of prophylactic and emergency procedures

Objective:

Prophylactic or emergency type cervical cerclage procedures are being used for treatment of cervical insufficiency. The aim was to review and compare the outcomes of these cerclage types and identify factors affecting outcomes.

Material and Methods:

Retrospective review of seventy-five patients in whom transvaginal cervical cerclage procedures were performed over a seven-year period in a tertiary referral center.

Results:

Twenty seven of 75 (36%) patients were in the emergency cerclage group and 48 (64%) of them were in the prophylactic group. Mean body mass index (BMI), hospitalization time and gestational week at cerclage were significantly higher, whereas latency period was significantly shorter for the emergency group. Mean gestational ages at delivery were 35.6±4.5 and 33.6±5.9 weeks in the prophylactic and emergency groups, respectively (p=0.117). Delivery rates under 34^th gestational week were 20.8% and 37.0% in the prophylactic and emergency groups, respectively (p=0.175). Birthweight, and delivery ≥34^th gestational week was higher in the prophylactic group, whereas complication rate was higher in the emergency group, but these differences were not significant. High BMI was associated with more deliveries before 34-week in the prophylactic group. Pre-cerclage cervical length was shorter in patients who delivered before 34 gestational weeks at delivery.

Conclusion:

Prophylactic and emergency cerclage procedures have comparable results regarding gestational week at delivery. High BMI and low pre-cerclage cervical length may have adverse effects on success of cerclage procedures.

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

OBJECTIVE

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

STUDY DESIGN

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

RESULTS

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

CONCLUSIONS

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

Thromboangiitis Obliterans Biomarker Shifts in Different Acute Phase Stages: A Case Study

Thromboangiitis obliterans (TAO) is a rare vasculopathy that is predominantly seen in young male smokers. Recently, new biomarkers have been shown to be useful in distinguishing TAO from acute phase TAO in an Asian study population. The present case study illustrates their application in a European patient during TAO exacerbation and their association with therapeutic performance.

Advances in biomarker development and potential application for preeclampsia based on pathogenesis

Preeclampsia (PE) is a pregnancy-specific complication that seriously threatens the health and safety of mothers and infants. The etiology of PE has not been fully elucidated, and no effective treatments are currently available. A pregnant woman with PE often has to make a tough choice on either endangering her own health to give a birth or being forced to terminate her pregnancy. It is recommended by the International Federation of Gynecology and Obstetrics that the combination of maternal high-risk factors and biomarkers could form a good strategy for predicting the risk of PE. Such a combination may also enable more effective monitoring and early clinical intervention in high-risk populations to reduce the risk of PE. Therefore, biomarkers validated by extensive clinical research may be formally applied for clinical PE risk prediction. In this review, we summarized data from clinical research on potential biomarkers and classified them according to the current four major hypotheses, namely placental or trophoblast ischemia and hypoxia, vascular endothelial injury, oxidative stress, and immune dysregulation. Additionally, we also discussed the underlying mechanisms by which these potential biomarkers may be involved in the pathogenesis of PE. Finally, we propose that multiple biomarkers reflecting different aspects of the disease pathogenesis should be used in combination to detect the high-risk PE population in support of clinically targeted intervention and prevention of PE. It is expected that tests made of more sensitive and reliable PE biomarkers based on the aforementioned major hypotheses could potentially improve the accuracy of PE prediction in the future.

Predicting bacteraemia in maternity patients using full blood count parameters: A supervised machine learning algorithm approach

INTRODUCTION

Bacteraemia in pregnancy and the post-partum period can lead to maternal and newborn morbidly. The purpose of this study was to use machine learning tools to identify if bacteraemia in pregnant or post-partum women could be predicted by full blood count (FBC) parameters other than the white cell count.

METHODS

The study was performed on 129 women with a positive blood culture (BC) for a clinically significant organism, who had a FBC taken at the same time. They were matched with controls who had a negative BC taken at the same time as a FBC. The data were split in to a training (70%) and test (30%) data set. Machine learning techniques such as recursive partitioning and classification and regression trees were used.

RESULTS

A neutrophil/lymphocyte ratio (NLR) of >20 was found to be the most clinically relevant and interpretable construct of the FBC result to predict bacteraemia. The diagnostic accuracy of NLR >20 to predict bacteraemia was then examined. Thirty-six of the 129 bacteraemia patients had a NLR >20, while only 223 of the 3830 controls had a NLR >20. This gave a sensitivity of 27.9% (95% CI 20.3-36.4), specificity of 94.1% (93.3-94.8), positive predictive value of 13.9% (10.6-17.9) and a negative predictive value (NPV) of 97.4% (97.2-97.7) when the prevalence of bacteraemia was 3%.

CONCLUSION

The NLR should be considered for use in routine clinical practice when assessing the FBC result in patients with suspected bacteraemia during pregnancy or in the post-partum period.

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

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

Association between gestational age at delivery and lymphocyte-monocyte ratio in the routine second trimester complete blood cell count

BACKGROUND

We aimed to determine whether routine second trimester complete blood cell (CBC) count parameters, including neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR), and platelet-lymphocyte ratio (PLR), could predict obstetric outcomes.

METHODS

We included singleton pregnancies for which the 50-g oral glucose tolerance test and CBC were routinely performed between 24 and 28 weeks of gestation in our outpatient clinic from January 2015 to December 2017. The subjects were divided into three groups according to their pregnancy outcomes as follows: group 1, spontaneous preterm births, including preterm labor and preterm premature rupture of membranes; group 2, indicated preterm birth due to maternal, fetal, or placental causes (hypertensive disorder, fetal growth restriction, or placental abruption); and group 3, term deliveries, regardless of the indication of delivery. We compared the CBC parameters using a bivariate correlation test.

RESULTS

The study included 356 pregnancies. Twenty-eight subjects were in group 1, 20 in group 2, and 308 in group 3. There were no significant differences between the three groups in neutrophil, monocyte, lymphocyte, and platelet counts. Although there was no significant difference in NLR, LMR, and PLR between the three groups, LMR showed a negative correlation with gestational age at delivery (r=-0.126, p=0.016).

CONCLUSION

We found that a higher LMR in the second trimester was associated with decreased gestational age at delivery. CBC parameters in the second trimester of pregnancy could be used to predict adverse obstetric outcomes.