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Mészáros B, Veres DS, Nagyistók L, Kovács BG, Kukor Z, Valent S. A meta-analysis on first-trimester blood count parameters-is the neutrophil-to-lymphocyte ratio a potentially novel method for first-trimester preeclampsia screening? Front Med (Lausanne) 2024; 11:1336764. [PMID: 38633299 PMCID: PMC11021791 DOI: 10.3389/fmed.2024.1336764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 03/11/2024] [Indexed: 04/19/2024] Open
Abstract
Objective Meta-analysis focusing on the role of first-trimester neutrophil-to-lymphocyte ratio (NLR) in the prediction of preeclampsia. Data sources PubMed, Scopus, Web of Science, Cochrane Library, and Embase databases were queried from inception up to December 31, 2022. Study eligibility criteria The study included all types of original research that was conducted in humans and values of NLR were measured during the first trimester, among patients who later developed preeclampsia, compared to the values of control groups. Study appraisal and synthesis methods Two reviewers independently performed data abstraction and quality appraisal, and disagreements were resolved by consensus and, if necessary, by the opinion of a third reviewer. During the analysis, PRISMA and MOOSE guidelines were followed. All statistical analyses were made with R. Results For the research on the predictive role of NLR values in the first trimester for preeclampsia, a total of 6 studies were selected for analysis, covering 2,469 patients. The meta-analysis revealed a 95% confidence interval (CI) for the effect size of 0.641 to 1.523, with a prediction interval of 0.027 to 2.137. Conclusion Based on the analysis, NLR is a promising biochemical marker for future pieces of research that try to find new screening methods for first-trimester preeclampsia. We encourage other researchers to examine NLR's predictive value combined with other markers in preeclampsia screening, this way being able to find new and affordable protocols for first-trimester preeclampsia screening. Systematic review registration identifier CRD42023392663.
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Affiliation(s)
- Balázs Mészáros
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Dániel S. Veres
- Department of Biophysics and Radiation Biology, Semmelweis University, Budapest, Hungary
| | - Luca Nagyistók
- Dél-Pest Centrum Hospital National Hematology and Infectious Diseases Institute, Budapest, Hungary
| | - Bence G. Kovács
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Zoltán Kukor
- Department of Molecular Biology, Institute of Biochemistry and Molecular Biology, Semmelweis University, Budapest, Hungary
| | - Sándor Valent
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
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Ozkan D, Tokgoz Cakir B, Polat Kamaci C, Ozkan M, Iskender C, Tapisiz O, Engin-Üstün Y. Is There a Predictable Cost-Benefit Ratio in Preeclampsia? Cureus 2023; 15:e41051. [PMID: 37519487 PMCID: PMC10374334 DOI: 10.7759/cureus.41051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2023] [Indexed: 08/01/2023] Open
Abstract
Background Preeclampsia (PE) is one of the highest-risk pregnancies and a complicated condition that occurs in 2% to 8% of pregnancies and is associated with markers of a systemic inflammatory response (SIR). In this study, we aimed to determine the role of these markers in predicting PE. Methodology A total of 300 women with singleton pregnancies and cephalic presentation were included in the study. Normotensive pregnant women (n = 149) who met this criterion were included as the control group Pregnant women who met the inclusion criteria for a diagnosis of preeclampsia (n = 151) were included in the study group. Results The baseline characteristics of the study groups showed no significant difference. The hypertensive group was hospitalized significantly earlier than the control group (p < 0.001). We found significantly higher systolic and diastolic blood pressure values in the PE group than in the other group (p < 0.001). The mean neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and aspartate aminotransferase-to-platelet ratio index (APRI) values at hospitalization did not differ significantly between groups (p = 0.639, p = 0.709, and p = 0.066, respectively). In the receiver operating characteristic analysis curves compared with the control group and PE, none of the parameters could predict PE. Conclusions We found that NLR, PLR, and APRI have no clinical significance in assessing developmental risk and predicting PE.
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Affiliation(s)
- Dogukan Ozkan
- Obstetrics and Gynaecology, Etlik Zübeyde Hanim EAH, Ankara, TUR
| | | | | | - Merve Ozkan
- Obstetrics and Gynaecology, Etlik Zübeyde Hanim EAH, Ankara, TUR
| | | | - Omer Tapisiz
- Obstetrics and Gynaecology, Etlik Zübeyde Hanim EAH, Ankara, TUR
| | - Yaprak Engin-Üstün
- Obstetrics and Gynecology, University of Health Sciences Etlik Zübeyde Hanim Women's Health Training and Research Hospital, Ankara, TUR
- Obstetrics and Gynecology, Zekai Tahir Burak Women's Health Research and Education Hospital, Ankara, TUR
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Lu HW, Hsu HS. Detecting Preeclampsia Severity Using Maternal-Obstetrical Characteristics and Complete Blood Cell Counts. Int J Gen Med 2022; 15:8715-8726. [PMID: 36582253 PMCID: PMC9793784 DOI: 10.2147/ijgm.s392915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose This study aimed to use the combination of maternal-obstetrical characteristics (MOCs) and complete blood cell counts (CBCs) with different red blood cell (RBC) indices as an alternative tool to detect preeclampsia (PE) severity immediately before delivery. Patients and Methods This retrospective study included all singleton pregnancies delivered after 24 weeks of gestation from April 2016 to April 2020. Patients were divided into four different groups: non-hypertensive (NH), gestational hypertension (GH), PE, and severe PE (SPE). Univariate and forward stepwise multivariate logistic regression analysis was conducted using MOCs, CBCs, and RBC indices. The calculation was performed between SPE and other non-hypertensive and hypertensive (GH, PE) groups. Moreover, the area under the curve (AUC) for the receiver operating characteristic curve, sensitivity, and specificity were estimated. Results The combined variables for differentiating SPE from NH were maternal age >29.5 years, weight >27.24, gestational age <272 days at the time of blood withdrawal, platelet count <217.5×103/μL, Srivastava indices <6.35, and Siradah indices <43.02 (AUC, 0.834; 95% confidence interval [CI], 0.773-0.895). The combined variables for differentiating SPE from GH were maternal age >29.5 years, body mass index >25.28, gestational age <268.5 days at the time of blood withdrawal, mean corpuscular volume <78.85 fL, and platelet count <234.5×103/μL (AUC, 0777; 95% CI, 0.703-0.852). The combined variables for differentiating SPE from PE were maternal age >32.5 years, mean corpuscular hemoglobin concentration >34.55 g/dL, and Siradah indices <40.05 (AUC, 0.745; 95% CI, 0.656-0.833). Conclusion The combination of selected variables from MOCs and CBCs with RBC indices before delivery showed satisfactory results for detecting PE severity.
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Affiliation(s)
- Hsiao-Wen Lu
- Department of Obstetrics and Gynecology, Cardinal Tien Hospital, New Taipei City, Taiwan,Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Han-Shui Hsu
- Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan,Correspondence: Han-Shui Hsu, Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St, Beitou Dist, Taipei, 112, Taiwan, Tel +886-2-22875-7546, Email
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Factors Associated with the Severity of Pregnancy-Related Hypertensive Disorder: Significance of Clinical, Laboratory, and Histopathological Features. Diagnostics (Basel) 2022; 12:diagnostics12092188. [PMID: 36140589 PMCID: PMC9498006 DOI: 10.3390/diagnostics12092188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/07/2022] [Accepted: 09/07/2022] [Indexed: 11/17/2022] Open
Abstract
The purpose of this paper is to evaluate the association of maternal clinical and laboratory features and placental histopathological changes with disease severity in pregnancy-related hypertensive disorders. From January 2021 to December 2021, clinical and laboratory data at the time of delivery and histopathological features of the placenta were collected from pregnant women with pregnancy-related hypertensive disorders at a single institution. The women were classified according to the pregnancy-related hypertensive disorder clinical severity, and each variable was compared accordingly. Gestational age-matched normotensive groups were also compared. Univariate and multivariate regression analyses were used to identify factors influencing pregnancy-related hypertensive disorder severity. Fifty-eight pregnancies were analyzed. Maternal albumin levels before delivery (beta coefficient −0.83, p = 0.043) and increased placental syncytial knots (beta coefficient 0.71, p = 0.026) are important parameters that are closely related to disease severity in women with pregnancy-related hypertensive disorders. The combination of albumin, PAPP-A, total bilirubin, and eGFR levels appears to be optimal for predicting pregnancy-related hypertensive disorder severity.
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Gelaw Y, Asrie F, Walle M, Getaneh Z. The value of eosinophil count in the diagnosis of preeclampsia among pregnant women attending the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2021. BMC Pregnancy Childbirth 2022; 22:557. [PMID: 35820860 PMCID: PMC9274180 DOI: 10.1186/s12884-022-04892-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 07/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Currently, studies showed that eosinophil count had clinical significance in the diagnosis and prognosis of diseases. But, the clinical significance of eosinophil count in pregnancy specifically in preeclampsia (PE) is not well studied. The main objective of the present study was to assess the diagnosis value of eosinophils counts among pregnant women with PE. METHODS A comparative cross-sectional study was conducted on a total of 126 pregnant women at the University of Gondar Comprehensive Specialized Hospital, using a convenient sampling technique. Socio-demographic and clinical data were collected by questionnaire and datasheet from patient's charts, respectively. A total of six ml of blood was collected from each study participant; three ml for complete cell count analysis using Sysmex XS-500i hematology analyzer and three ml for liver function tests using Humastar 200 chemistry analyzer. The data were entered into Epi-data and exported to SPSS 20 for analysis. The independent t-test was used for normally distributed data and, the Mann-Whitney U test was used for non-normally distributed data. Binary logistic regression and receiver operative curve analyses were also done to assess the diagnosis value of eosinophils count. P-value < 0.05 was considered statistically significant. RESULTS The eosinophils count of PE pregnant women were significantly lower than the normotensive (NT) pregnant women (median (IQR): 50 (10-200) vs. 120 (60 - 270); (p = 0.002). The eosinophil count ≤ 55 cells/µL had an AUC of 0.66 (95% CI; 0.56-0.75) for diagnosis of PE with a sensitivity of 50.8%, specificity of 77.8%, and positive and negative predictive value of 69.6% and 61.3%, respectively. The abnormal AST and ALT results were significantly higher among PE pregnant women compared to NT pregnant women (AOR: 14.86; 95% CI: 4.97-44.4 and Fischer exact test p-value = 0.001, respectively). CONCLUSION The eosinophil count ≤ 55cells/µl had a reasonable/acceptable AUC which may use in the diagnosis of PE. AST and ALT were also significantly higher in PE pregnant women compared to NT pregnant women. Multicenter longitudinal studies with a large sample size are recommended to verify the role of eosinophil count in the diagnosis of PE.
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Affiliation(s)
- Yemataw Gelaw
- College of Medicine and Health Sciences, School Biomedical and Laboratory Sciences, Department of Hematology and Immunohematology, University of Gondar, Gondar, Ethiopia.
| | - Fikir Asrie
- College of Medicine and Health Sciences, School Biomedical and Laboratory Sciences, Department of Hematology and Immunohematology, University of Gondar, Gondar, Ethiopia
| | - Muluken Walle
- College of Medicine and Health Sciences, Department of Medical Laboratory Science, Jigijiga University, Jigijiga, Ethiopia
| | - Zegeye Getaneh
- College of Medicine and Health Sciences, School Biomedical and Laboratory Sciences, Department of Hematology and Immunohematology, University of Gondar, Gondar, Ethiopia
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First Trimester Mean Platelet Volume, Neutrophil to Lymphocyte Ratio, and Platelet to Lymphocyte Ratio Values Are Useful Markers for Predicting Preeclampsia. Ochsner J 2022; 21:364-370. [PMID: 34984051 PMCID: PMC8675624 DOI: 10.31486/toj.21.0026] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background: Preeclampsia complicates 2% to 8% of all pregnancies. Systemic inflammatory response (SIR) markers are widely used in the diagnosis of many inflammatory diseases and in the prediction of complicated pregnancies. This study examined the diagnostic value of SIR markers during the first trimester of pregnancy to predict preeclampsia development. Methods: This retrospective case-control study was conducted from January 2020 to May 2020. We included 94 patients diagnosed with mild preeclampsia, 107 patients diagnosed with severe preeclampsia, and 100 normotensive pregnant patients as controls. We obtained the first trimester (6 to 14 weeks) complete blood cell counts for all patients. We used a receiver operating characteristic curve to evaluate the cutoff, sensitivity, and specificity values. Results: First trimester mean platelet volume (MPV), neutrophil to lymphocyte ratio (NLR), and platelet to lymphocyte ratio (PLR) values were significantly higher in patients who developed preeclampsia in later pregnancy weeks. The optimal cutoff value for MPV was 10.65 fL, with a sensitivity of 63.7% and a specificity of 65.0%. The best predictor for preeclampsia was NLR at an optimal cutoff value of 4.12, with a sensitivity of 82.1% and specificity of 62.0%. At a cutoff value of 131.8, PLR predicted preeclampsia with a sensitivity rate of 65.0% and a specificity rate of 60.2%. Conclusion: The results of this study suggest that first trimester MPV, NLR, and PLR values are clinically useful markers in the prediction of preeclampsia. The increased first trimester values of MPV, NLR, and PLR also indicate that inflammation may play a crucial role in preeclampsia pathogenesis.
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Aslan MM, Yeler MT, Yuvacı HU, Cerci IA, Cevrioğlu AS, Ozden S. Can the neutrophil-to-lymphocyte ratio (NLR) predicts fetal loss in preeclampsia with severe features? Pregnancy Hypertens 2020; 22:14-16. [PMID: 32693328 DOI: 10.1016/j.preghy.2020.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 07/08/2020] [Accepted: 07/11/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Preeclampsia (PE) is one of the most common causes of major maternal and fetal adverse events including mortality and preterm birth Grill et al. (2009). The neutrophil-to-lymphocyte ratio (NLR) and other hematologic indexes of systemic inflammation have been investigated in patients with PE for the prediction of the severity or presence of the disease. Despite these studies, we found no trials investigating the relationship between NLR and fetal outcomes in PE patients. In this study, we aimed to investigate the relationship between NLR and fetal outcomes. METHODS We retrospectively analyzed the demographic data and laboratory tests to determine the NLR of 175 pregnant women with severe PE admitted to our clinic between January 2015 and December 2018. RESULTS NLR in the first (2.4 ± 1.1 vs 2.9 ± 1.4, P = 0.18) and second trimesters (3.6 ± 0.7 vs 3.8 ± 1.3, P = 0.25) were not different between the groups, but third trimester NLR was significantly higher in patients with fetal loss (6.5 ± 5.4 vs 4.2 ± 2.7, P = 0.009). The area under the receiver operating characteristic curve for NLR in the third trimester was 0.66 and NLR > 3.9 predicted fetal loss with a sensitivity of 75% and a specificity of 61% (0.684, 95% confidence interval 0.48-0.83, P = 0.05). CONCLUSION We demonstrated that third trimester NLR is associated with fetal loss in patients with severe PE.
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Affiliation(s)
- Mehmet Musa Aslan
- Sakarya University Education and Research Hospital, Department of Obstetrics and Gynecology, Turkey.
| | | | - Hilal Uslu Yuvacı
- Sakarya University Education and Research Hospital, Department of Obstetrics and Gynecology, Turkey
| | - Ilker Ali Cerci
- Sakarya University Education and Research Hospital, Department of Obstetrics and Gynecology, Turkey
| | - Arif Serhan Cevrioğlu
- Sakarya University Education and Research Hospital, Department of Obstetrics and Gynecology, Turkey
| | - Selcuk Ozden
- Sakarya University Education and Research Hospital, Department of Obstetrics and Gynecology, Turkey
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Çintesun E, Incesu Çintesun FN, Ezveci H, Akyürek F, Çelik Ç. Systemic inflammatory response markers in preeclampsia. J Lab Physicians 2020; 10:316-319. [PMID: 30078969 PMCID: PMC6052816 DOI: 10.4103/jlp.jlp_144_17] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
PURPOSE Neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), platelet distribution width (PDW), red cell distribution width (RDW), mean platelet volume (MPV), and plateletcrit (PCT) are known as systemic inflammatory response markers. In this study, we aimed to evaluate changes in NLR, PLR, PDW, RDW, MPV, and PCT in preeclampsia (PE) and their use in predicting its severity. MATERIALS AND METHODS This is a retrospective case-control study. The study comprised 64 control group (healthy pregnant females), 51 females with mild PE, and 13 with severe PE. These three groups were compared with demographic data and inflammation markers. RESULTS There were no statistically significant differences between healthy pregnant females and preeclaptic females in terms of median age, hemoglobin, lymphocyte, neutrophil, platelet, NLR, PLR, PDV, RDW, MPV, PCT (P > 0.05). The control group has a higher number of gravity and parity than the PE group (P < 0.001). MPV value is a lower PE group than the control group (P < 0.001). Both gravity and parity were significantly higher in the patients with mild PE than in the control group (P < 0.001). MPV value was statistically higher in the control group compared both mild and severe PE (P < 0.001), however, no statistical difference between mild and severe PE (P = 0.305). CONCLUSIONS MPV may be clinically useful markers in the prediction of PE. Further, prospective multicenter studies are needed to reveal the association between these markers and PE.
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Affiliation(s)
- Ersin Çintesun
- Department of Obstetrics and Gynecology, Selcuk University, Konya, Turkey
| | | | - Huriye Ezveci
- Department of Obstetrics and Gynecology, Selcuk University, Konya, Turkey
| | - Fikret Akyürek
- Department of Biochemistry, Selçuk University, Konya, Turkey
| | - Çetin Çelik
- Department of Obstetrics and Gynecology, Selcuk University, Konya, Turkey
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Zheng WF, Zhan J, Chen A, Ma H, Yang H, Maharjan R. Diagnostic value of neutrophil-lymphocyte ratio in preeclampsia: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e18496. [PMID: 31861035 PMCID: PMC6940150 DOI: 10.1097/md.0000000000018496] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Neutrophil-lymphocyte ratio (NLR) is one of the markers of systemic inflammation. Recent studies have associated NLR with diagnosis of preeclampsia (PE). However, due to small sample sizes and different research design, the diagnostic value of NLR in PE patients is not well understood. In this study, we evaluate the potential diagnostic value of NLR in PE. METHODS We searched PubMed, Embase, Cochrane Library, the Chinese National Knowledge Infrastructure (CNKI) databases, Wanfang data, VIP database and China Biomedical Literature Database systematically for relevant literatures up to May 20, 2018. All analyses were conducted using Meta-DiSc1.4 and Stata 12.0 software. Sensitivity, specificity and other measures of accuracy of NLR for the diagnosis of PE were pooled. Meta-regression was performed to identify the sources of heterogeneity. RESULTS This meta-analysis included a total of 7 studies. The pooled sensitivity and specificity were 0.74 (95% CI 0.71-0.76) and 0.64 (95%CI 0.61-0.68), positive likelihood ratio, 2.62 (95%CI1.79-3.84); negative likelihood ratio, 0.34 (95%CI 0.24-0.48); diagnostic odds ratio, 8.44 (95%CI 4-17.78), and area under the curve was 0.82. Meta regression showed that sample size was the main source of heterogeneity. Deeks funnel plot showed that there was no statistical significance for the evaluation of publication bias (P = .16). CONCLUSION Current evidence suggests that the diagnostic accuracy of NLR has unsatisfactory specificity but acceptable sensitivity for diagnosis of PE. Further large-scale prospective studies are required to validate the potential applicability of using NLR alone or in combination other markers as PE diagnostic biomarker and explore potential factors that may influence the accuracy of NLR for PE diagnosis.
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Örgül G, Aydın Haklı D, Özten G, Fadiloğlu E, Tanacan A, Beksaç MS. First trimester complete blood cell indices in early and late onset preeclampsia. Turk J Obstet Gynecol 2019; 16:112-117. [PMID: 31360585 PMCID: PMC6637787 DOI: 10.4274/tjod.galenos.2019.93708] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 05/20/2019] [Indexed: 12/01/2022] Open
Abstract
Objective This study aimed to compare the first trimester complete blood count (CBC) indices of pregnancies complicated by early-onset preeclampsia (EOPE) or late-onset preeclampsia (LOPE). Material and Methods A retrospective case-control study was conducted with 186 patients. Patients were classified into three subgroups: EOPE, LOPE, and control groups. First trimester CBC results were obtained for each patient. Hemoglobin, hematocrit, red blood cell distribution width, mean corpuscular volume, white blood cell (WBC) count, neutrophil, eosinophil, basophil, lymphocyte, monocyte, mean platelet volume, platelet distribution width, plateletcrit, and platelet count were compared. The neutrophil lymphocyte ratio was calculated by dividing the absolute lymphocyte count by the absolute neutrophil count. The platelet lymphocyte ratio was calculated by dividing the absolute lymphocyte count by the absolute platelet count. Results The total number of cases was 21, 42, and 123, in the EOPE, LOPE, and control groups, respectively. There were statistically significant differences in the total WBC and neutrophil counts between the three groups (both p<0.05). WBC and neutrophil counts were found to be highest in the EOPE group, and the LOPE group had higher levels compared with controls. The optimal cut-off values to predict EOPE for WBC and neutrophil counts were 9.55×103/ μL (sensitivity 71.4% and specificity 70.7%) and 6.45×103/μL (sensitivity 66.7% and specificity 74.8%), respectively. Conclusion Increased first trimester WBC and neutrophil counts may be predictive for EOPE.
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Affiliation(s)
- Gökçen Örgül
- Hacettepe University Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Perinatology, Ankara, Turkey
| | - Duygu Aydın Haklı
- Hacettepe University Faculty of Medicine, Department of Biostatistics, Ankara, Turkey
| | - Gonca Özten
- Hacettepe University Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Perinatology, Ankara, Turkey
| | - Erdem Fadiloğlu
- Hacettepe University Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Perinatology, Ankara, Turkey
| | - Atakan Tanacan
- Hacettepe University Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Perinatology, Ankara, Turkey
| | - Mehmet Sinan Beksaç
- Hacettepe University Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Perinatology, Ankara, Turkey
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Sisti G, Faraci A, Silva J, Upadhyay R. Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio and Complete Blood Count Components in the First Trimester Do Not Predict HELLP Syndrome. ACTA ACUST UNITED AC 2019; 55:medicina55060219. [PMID: 31141974 PMCID: PMC6630708 DOI: 10.3390/medicina55060219] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 05/15/2019] [Accepted: 05/22/2019] [Indexed: 01/01/2023]
Abstract
Background and Objectives: Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), mean platelet volume (MPV), and other components of the routine complete blood count (CBC) were found to be sensitive biomarkers of preeclampsia and other inflammatory obstetric conditions in previous studies, with conflicting results. We speculated that the same associations existed with hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome in the first trimester of pregnancy. Materials and Methods: We conducted a retrospective case–control study at a tertiary care hospital in NY (USA), in the time frame between January 2016 and December 2018. Our population consisted of pregnant women in the first trimester: We compared patients with HELLP syndrome (cases) with healthy patients (controls) matched by age, body mass index (BMI), parity, and race. Patients with preeclampsia, infection, and fever were excluded. Venous blood samples were obtained as part of the routine work-up during the first prenatal visit in the first trimester, which includes a CBC. The main outcomes were NLR and PLR, and the secondary outcomes were hemoglobin, RDW, platelet count, MPV, neutrophils, and lymphocytes. Results: There were 10 patients in each group. There were no differences in NLR and PLR levels and other CBC components between the two groups. Conclusions: In our study NLR, PLR, and other CBC components did not predict HELLP syndrome. We speculate that HELLP syndrome has a sudden increase of tissue inflammation in the third trimester that is not manifested during the early phases of placentation. Larger studies are needed to evaluate the true ability of NLR, PLR, and CBC components to predict HELLP syndrome in the first trimester.
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Affiliation(s)
- Giovanni Sisti
- Lincoln Medical and Mental Health Center, Department of Obstetrics and Gynecology, Bronx, NY 10451, USA.
| | - Andrea Faraci
- Lincoln Medical and Mental Health Center, Department of Obstetrics and Gynecology, Bronx, NY 10451, USA.
| | - Jessica Silva
- Lincoln Medical and Mental Health Center, Department of Obstetrics and Gynecology, Bronx, NY 10451, USA.
| | - Ruchi Upadhyay
- Lincoln Medical and Mental Health Center, Department of Obstetrics and Gynecology, Bronx, NY 10451, USA.
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Qiu Y, Wen Y, Li G, Tao Z, Yan X, Zang N, Zhong M, Huang Q. [Maternal neutrophil-to-lymphocyte ratio as a prognostic biomarker for placental inflammatory response in late pregnancy]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2019; 38:1131-1134. [PMID: 30377109 DOI: 10.12122/j.issn.1673-4254.2018.09.18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To investigate the association between maternal serum neutrophil-lymphocyte ratio (NLR) and placental inflammatory response (PIR) in late pregnancy. METHODS We retrospectively analyzed the clinical and follow-up data of 478 pregnant women undergoing routine prenatal examination and delivery in our hospital in the year 2016. According to the placental pathological results, the women were divided into PIR group (238 cases) and control group (240 cases). The levels of serum inflammatory makers including leukocytes, neutrophils, lymphocytes, C-reactive protein (CRP) and NLR were compared between the two groups to analyze the association of these markers with PIR. Multivariate analysis was performed to identify the independent risk factors of PIR. Logistic regression model was established and the area under the receiver operating characteristic curve (ROC) was used for analyzing the prognostic value of these makers in late pregnancy. RESULTS The areas under the curve (AUC) of leukocytes, neutrophils, lymphocytes, CRP and NLR were 0.698 (95%CI: 0.485-0.766), 0.716 (95%CI: 0.453-0.783), 0.329 (95%CI: 0.228-0.431), 0.725 (95%CI: 0.677-0.765) and 0.801 (95%CI: 0.742-0.856), respectively. After adjusting the confounders, multivariate logistic regression analysis showed that preterm labor (OR=2.446, 95%CI: 1.003-4.590), premature rupture of membranes (OR=2.304, 95%CI: 1.049-4.161), NLR > 7 (OR=3.268, 95%CI: 2.071-6.920), and CRP > 15 mg/L (OR=2.137, 95%CI: 1.412-8.236) were independent risk factors for PIR. CONCLUSIONS An increased NLR in late pregnancy can serve as an effective indicator for predicting the risk of PIR.
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Affiliation(s)
- Yuwen Qiu
- Department of Obstetrics and Gynecology, Nanfang Hospital, Guangzhou 510515, China
| | - Yuwen Wen
- First Clinical Medical College of Southern Medical University, Guangzhou 510515, China
| | - Guang Li
- Department of Obstetrics and Gynecology, Nanfang Hospital, Guangzhou 510515, China
| | - Zixin Tao
- Department of Obstetrics and Gynecology, Nanfang Hospital, Guangzhou 510515, China
| | - Xinyue Yan
- First Clinical Medical College of Southern Medical University, Guangzhou 510515, China
| | - Nailiang Zang
- First Clinical Medical College of Southern Medical University, Guangzhou 510515, China
| | - Mei Zhong
- Department of Obstetrics and Gynecology, Nanfang Hospital, Guangzhou 510515, China
| | - Qitao Huang
- Department of Obstetrics and Gynecology, Nanfang Hospital, Guangzhou 510515, China
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Oxidative stress in healthy pregnancy and preeclampsia is linked to chronic inflammation, iron status and vascular function. PLoS One 2018; 13:e0202919. [PMID: 30204759 PMCID: PMC6133366 DOI: 10.1371/journal.pone.0202919] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 08/07/2018] [Indexed: 01/22/2023] Open
Abstract
Background During normal pregnancy, placental oxidative stress (OS) is present during all three trimesters and is necessary to obtain normal cell function. However, if OS reaches a certain level, pregnancy complications might arise. In preeclampsia (PE), a dangerous pregnancy specific hypertensive disorder, OS induced in the ischemic placenta causes a systemic inflammatory response and activates maternal endothelial cells. In this study, we aimed to quantify superoxide concentrations (as a measure of systemic OS) using electron paramagnetic resonance (EPR) and correlate them to markers of systemic inflammation, iron status and vascular function. Methods Fifty-nine women with a healthy pregnancy (HP), 10 non-pregnant controls (NP) and 28 PE patients (32±3.3weeks) were included. During HP, blood samples for superoxide, neutrophil to lymphocyte ratio (NLR), mean platelet volume (MPV) and iron status were taken at 10, 25 and 39 weeks. Vascular measurements for arterial stiffness (carotid-femoral pulse wave velocity (CF-PWV), augmentation index (AIx), augmentation Pressure (AP)) and microvascular endothelial function (reactive hyperemia index (RHI)) were performed at 35 weeks. In PE, all measurements were performed at diagnosis. CMH (1-hydroxy-3-methoxycarbonyl-2,2,5,5-tetramethylpyrrolidine) was used as spin probe for EPR, since the formed CM radical corresponds to the amount of superoxide. Results Superoxide concentration remains stable during pregnancy (p = 0.92), but is significantly higher compared to the NP controls (p<0.0001). At 25 weeks, there is a significant positive correlation between superoxide and ferritin concentration. (p = 0.04) In PE, superoxide, systemic inflammation and iron status are much higher compared to HP (all p<0.001). During HP, superoxide concentrations correlate significantly with arterial stiffness (all p<0.04), while in PE superoxide is significantly correlated to microvascular endothelial function (p = 0.03). Conclusions During HP there is an increased but stable oxidative environment, which is correlated to ferritin concentration. If superoxide levels increase, there is an augmentation in arterial stiffness. In PE pregnancies, systemic inflammation and superoxide concentrations are higher and result in a deterioration of endothelial function. Together, these findings support the hypothesis that vascular function is directly linked to the amount of OS and that measurement of OS in combination with vascular function tests might be used in the prediction of PE.
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14
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Mannaerts D, Faes E, Gielis J, Van Craenenbroeck E, Cos P, Spaanderman M, Gyselaers W, Cornette J, Jacquemyn Y. Oxidative stress and endothelial function in normal pregnancy versus pre-eclampsia, a combined longitudinal and case control study. BMC Pregnancy Childbirth 2018; 18:60. [PMID: 29482567 PMCID: PMC5827979 DOI: 10.1186/s12884-018-1685-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 02/12/2018] [Indexed: 12/13/2022] Open
Abstract
Background Pre-eclampsia (PE) is related to an impaired endothelial function. Endothelial dysfunction accounts for altered vascular reactivity, activation of the coagulation cascade and loss of vascular integrity. Impaired endothelial function originates from production of inflammatory and cytotoxic factors by the ischemic placenta and results in systemic oxidative stress (OS) and an altered bioavailability of nitric oxide (•NO). The free radical •NO, is an endogenous endothelium-derived relaxing factor influencing endothelial function. In placental circulation, endothelial release of •NO dilates the fetal placental vascular bed, ensuring feto-maternal exchange. The Endopreg study was designed to evaluate in vivo endothelial function and to quantify in vitro OS in normal and pre-eclamptic pregnancies. Methods/design The study is divided into two arms, a prospective longitudinal study and a matched case control study. In the longitudinal study, pregnant patients ≥18 years old with a singleton pregnancy will be followed throughout pregnancy and until 6 months post-partum. In the case control study, cases with PE will be compared to matched normotensive pregnant women. Maternal blood concentration of superoxide (O2•) and placental concentration of •NO will be determined using EPR (electron paramagnetic resonance). Endothelial function and arterial stiffness will be evaluated using respectively Peripheral Arterial Tonometry (PAT), Flow-Mediated Dilatation (FMD) and applanation tonometry. Placental expression of eNOS (endothelial NOS) will be determined using immune-histochemical staining. Target recruitment will be 110 patients for the longitudinal study and 90 patients in the case-control study. Discussion The results of Endopreg will provide longitudinal information on in vivo endothelial function and in vitro OS during normal pregnancy and PE. Adoption of these vascular tests in clinical practice potentially predicts patients at risk to develop cardiovascular events later in life after PE pregnancies. •NO, O2•− and eNOS measurements provide further inside in the pathophysiology of PE. Trial registration This trial has been registered on clinicaltrials.gov. ClinicalTrials.gov Identifier: NCT02603913. Registered October 2015.
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Affiliation(s)
- Dominique Mannaerts
- Departement of Obstetrics and Gynaecology, Antwerp University Hospital, Antwerp, Belgium.,ASTARC, Antwerp Surgical Training, Anatomy and Research Centre, University of Antwerp, Antwerp, Belgium
| | - Ellen Faes
- Departement of Obstetrics and Gynaecology, Antwerp University Hospital, Antwerp, Belgium.,ASTARC, Antwerp Surgical Training, Anatomy and Research Centre, University of Antwerp, Antwerp, Belgium
| | - Jan Gielis
- ASTARC, Antwerp Surgical Training, Anatomy and Research Centre, University of Antwerp, Antwerp, Belgium
| | - Emeline Van Craenenbroeck
- Laboratory for Cellular and Molecular Cardiology and Department of Cardiology, Antwerp University Hospital, Edegem, Belgium.,Research Group Cardiovascular Diseases, Translational Pathophysiological Research, University of Antwerp, Antwerp, Belgium
| | - Paul Cos
- Laboratory for Microbiology, Parasitology and Hygiene (LMPH), University of Antwerp, Antwerp, Belgium
| | - Marc Spaanderman
- Departement of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Wilfried Gyselaers
- Departement of Obstetrics and Gynecology, Ziekenhuis-Oost-Limburg (ZOL), Genk, Belgium
| | - Jerome Cornette
- Departement of Obstetrics and Gynecology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Yves Jacquemyn
- Departement of Obstetrics and Gynaecology, Antwerp University Hospital, Antwerp, Belgium. .,ASTARC, Antwerp Surgical Training, Anatomy and Research Centre, University of Antwerp, Antwerp, Belgium. .,Department of Obstetrics and Gynaecology, Antwerp Surgical Training and Anatomy Research Centre (ASTARC), Antwerp University/Antwerp University Hospital, Antwerp, Belgium.
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15
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Sheikhi M, Rezaei E, Hosseini SH, Shahrakipoor M, Sheikhi M, Soltani S. Nutritional Status in Preeclamptic Women: a Case-Control Study in South East of Iran. NUTRITION AND FOOD SCIENCES RESEARCH 2018. [DOI: 10.29252/nfsr.5.1.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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16
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Sheikhi M, Sharifi-Zahabi E, Paknahad Z. Dietary Antioxidant Capacity and Its Association with Preeclampsia. Clin Nutr Res 2017; 6:47-54. [PMID: 28168181 PMCID: PMC5288552 DOI: 10.7762/cnr.2017.6.1.47] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 01/03/2017] [Accepted: 01/24/2017] [Indexed: 12/19/2022] Open
Abstract
Preeclampsia (PE) is one of the major disorders in pregnancy leading to many adverse maternal outcomes. Although the etiology of PE is not fully understood, resent studies suggest that an imbalance between free radicals production and the antioxidant defense system might have key role. Our aim of the current study was to evaluate the association between dietary total antioxidant capacity (TAC), serum TAC and risk of PE in women with preeclampsia and normal pregnancy. This case-control study conducted on 55 women with preeclampsia and 93 with normal pregnancy. Dietary intakes were obtained by a semi-quantitative food frequency questionnaire (FFQ) with 168 itmes. Dietary TAC was assessed according to United States Department of Agriculture (USDA) Database for oxygen radical absorbance capacity (ORAC), Release 2. Serum TAC was measured by a double-antibody sandwich enzyme-linked immunesorbent assay (ELISA). After adjusting for energy, pre-pregnant body mass index (BMI) and history of PE, no relationship was found between intake of hydrophilic-ORAC (H-ORAC), lipophilic-ORAC (L-ORAC), total phenolics (TP), total-ORAC (T-ORAC), and PE risk. However, serum TAC had a significant positive relationship with the risk of PE after adjusting for energy (odds ratio [OR], 0.07; 95% confidence interval [CI], 0.16-0.35), BMI and history of PE (OR, 0.04; 95% CI, 0.01-0.32). Findings of this study indicate that serum TAC is positively associated with the risk of PE but no association was found between intake of antioxidant indices and PE risk.
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Affiliation(s)
- Mahdiyeh Sheikhi
- Department of Food and Nutrition Policy, Health Deputy, Zahedan University of Medical Sciences, Zahedan 98167-43175, Iran
| | - Elham Sharifi-Zahabi
- Department of Clinical Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran
| | - Zamzam Paknahad
- Department of Clinical Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran
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