Correlation of maternal neutrophil to lymphocyte ratio with fetal birth weight in preeclampsia
Keywords:Preeclampsia, Neutrophil lymphocyte ratio, fetal birth weight
Preeclampsia (PE) is a generalized inflammatory disorder complicating gestation, with most of cases developing in the third trimester. To evaluate the neutrophil to lymphocyte ratio (NLR) in diagnosed cases of preeclampsia and determine its correlation with fetal birth weight, a cross sectional analytical study was performed in Shaikh Zayed Medical Complex and Jinnah Hospital, Lahore. The participants included 60 cases of preeclampsia and 60 normotensive controls in third trimester of pregnancy. All the participants were in the age group of 20-40 years and BMI of 18-25.Total and differential leukocyte count was checked by automated hemoanalyzer and neutrophil lymphocyte ratio was calculated. Fetal birth weight was recorded immediately after birth. Statistical analysis was performed by SPSS (version 20). The p value of <0.05 was considered significant. NLR was significantly high (p-value < 0.001) in the preeclamptic group with a median value of 2.64(2.0-3.8) as compared to 1.87(1.7-2.0) in the healthy group. The fetal birth weight was significantly low (p-value < 0.001) in the pregnancies complicated with preeclampsia. High NLR was negatively correlated with fetal birth weight in preeclampsia (p-value < 0.01). On logistic regression significant association of high NLR with low fetal birth weight was found after controlling for the confounder gestational age, with an Odds ratio (OR) of 8.28 ( 95% confidence Interval 2.84-24.17). The area under the Receiver operating characteristic (ROC) curve for NLR was 0.8. The optimum cutoff value of NLR was 2.3 with 79% sensitivity and76% specificity. High maternal NLR in the third trimester in preeclampsia negatively correlates with fetal birth weight and is a simple promising biomarker to predict low fetal birth weight.
AKıL, M. A., BILIK, M. Z., ACET, H., TUNÇ, S. Y., ERTAŞ, F., AYDıN, M. & ALAN, S. (2015). Mean platelet volume and neutrophil lymphocyte ratio as new markers of preeclampsia severity. Kosuyolu Heart J, 18, 84-88.
AOUACHE, R., BIQUARD, L., VAIMAN, D. & MIRALLES, F. (2018). Oxidative stress in preeclampsia and placental diseases. Int J Mol Sci 19, 1496.
ARBEL, Y., FINKELSTEIN, A., HALKIN, A., BIRATI, E. Y., REVIVO, M., ZUZUT, M., SHEVACH, A., BERLINER, S., HERZ, I. & KEREN, G. (2012). Neutrophil/lymphocyte ratio is related to the severity of coronary artery disease and clinical outcome in patients undergoing angiography. Atherosclerosis, 225, 456-460.
BACKES, C. H., MARKHAM, K., MOOREHEAD, P., CORDERO, L., NANKERVIS, C. A. & GIANNONE, P. J. (2011). Maternal preeclampsia and neonatal outcomes. J Pregnancy, 2011.
CAN, M., SANCAR, E., HARMA, M., GUVEN, B., MUNGAN, G. & ACIKGOZ, S. (2011). Inflammatory markers in preeclamptic patients. Clin Chem Lab Med, 49, 1469-1472.
CATARINO, C., SANTOS-SILVA, A., BELO, L., ROCHA-PEREIRA, P., ROCHA, S., PATRÍCIO, B., QUINTANILHA, A. & REBELO, I. (2012). Inflammatory disturbances in preeclampsia: relationship between maternal and umbilical cord blood. J Pregnancy, 2012.
DENNY, K. J., WOODRUFF, T. M., TAYLOR, S. M. & CALLAWAY, L. K. (2013). Complement in pregnancy: a delicate balance. Am J Reprod Immunol, 69, 3-11.
DERZSY, Z., PROHÁSZKA, Z., RIGÓ JR, J., FÜST, G. & MOLVAREC, A. (2010). Activation of the complement system in normal pregnancy and preeclampsia. Mol Immunol, 47, 1500-1506.
DEVECI, K., SOGUT, E., EVLIYAOGLU, O. & DURAS, N. (2009). Pregnancy‐associated plasma protein‐A and C‐reactive protein levels in pre‐eclamptic and normotensive pregnant women at third trimester. J Obstet Gynaecol Res, 35, 94-98.
GUTHRIE, G. J., CHARLES, K. A., ROXBURGH, C. S., HORGAN, P. G., MCMILLAN, D. C. & CLARKE, S. J. (2013). The systemic inflammation-based neutrophil–lymphocyte ratio: experience in patients with cancer. Crit Rev Oncol Hematol, 88, 218-230.
KIRBAS, A., BIBEROGLU, E., DAGLAR, K., İSKENDER, C., ERKAYA, S., DEDE, H., UYGUR, D. & DANISMAN, N. (2014). Neutrophil-to-lymphocyte ratio as a diagnostic marker of intrahepatic cholestasis of pregnancy. Eur J Obstet Gynecol Reprod Biol, 180, 12-15.
KOHLI, S., RANJAN, S., HOFFMANN, J., KASHIF, M., DANIEL, E. A., BOCK, F., NAZIR, S., HUEBNER, H., MERTENS, P. R. & FISCHER, K.-D. (2016). Maternal extracellular vesicles and platelets promote preeclampsia via inflammasome activation in trophoblasts. Blood, 128, 2153-2164.
KURT, R. K., ARAS, Z., SILFELER, D. B., KUNT, C., ISLIMYE, M. & KOSAR, O. (2015). Relationship of red cell distribution width with the presence and severity of preeclampsia. Clin Appl Thromb Hemost, 21, 128-131.
LAU, T. K., PANG, M. W., SAHOTA, D. S. & LEUNG, T. N. (2005). Impact of hypertensive disorders of pregnancy at term on infant birth weight. Acta Obstet Gynecol Scand, 84, 875-877.
MATSUBARA, K., HIGAKI, T., MATSUBARA, Y. & NAWA, A. (2015). Nitric oxide and reactive oxygen species in the pathogenesis of preeclampsia. Int J Mol Sci, 16, 4600-4614.
MOLVAREC, A., ITO, M., SHIMA, T., YONEDA, S., TOLDI, G., STENCZER, B., VÁSÁRHELYI, B., RIGÓ JR, J. & SAITO, S. (2010). Decreased proportion of peripheral blood vascular endothelial growth factor–expressing T and natural killer cells in preeclampsia. Am J Obstet Gynecol, 203, 567. e1-567. e8.
OGGÉ, G., ROMERO, R., CHAIWORAPONGSA, T., GERVASI, M. T., PACORA, P., EREZ, O., KUSANOVIC, J. P., VAISBUCH, E., MAZAKI-TOVI, S. & GOTSCH, F. (2010). Leukocytes of pregnant women with small-for-gestational age neonates have a different phenotypic and metabolic activity from those of women with preeclampsia. J Matern Fetal Neonatal Med, 23, 476-487.
OSUNGBADE, K. O. & IGE, O. K. (2011). Public health perspectives of preeclampsia in developing countries: implication for health system strengthening. J Pregnancy, 2011.
OYLUMLU, M., OZLER, A., YILDIZ, A., OYLUMLU, M., ACET, H., POLAT, N., SOYDINC, H. E., YUKSEL, M. & ERTAS, F. (2014). New inflammatory markers in pre-eclampsia: echocardiographic epicardial fat thickness and neutrophil to lymphocyte ratio. Clin Exp Hypertens, 36, 503-507.
PINHEIRO, M. B., MARTINS-FILHO, O. A., MOTA, A. P. L., ALPOIM, P. N., GODOI, L. C., SILVEIRA, A. C., TEIXEIRA-CARVALHO, A., GOMES, K. B. & DUSSE, L. M. (2013). Severe preeclampsia goes along with a cytokine network disturbance towards a systemic inflammatory state. Cytokine, 62, 165-173.
RIBEIRO, V. R., ROMAO‐VEIGA, M., ROMAGNOLI, G. G., MATIAS, M. L., NUNES, P. R., BORGES, V. T. M., PERACOLI, J. C. & PERACOLI, M. T. S. (2017). Association between cytokine profile and transcription factors produced by T‐cell subsets in early‐and late‐onset pre‐eclampsia. Immunology, 152, 163-173.
SACHAN, R., PATEL, M. L., SACHAN, P. & SHYAM, R. (2017). Diagnostic accuracy of neutrophil to lymphocyte ratio in prediction of nonsevere preeclampsia and severe preeclampsia. J Curr Res Sci Med, 3, 79.
SULIMAN, M. A. R. M., JUMA, A. A. B., ALMADHANI, A. A. A., PATHARE, A. V., ALKINDI, S. S. A. & WERNER, F. U. (2010). Predictive value of neutrophil to lymphocyte ratio in outcomes of patients with acute coronary syndrome. Arch Med Res, 41, 618-622.
TOPTAS, M., ASIK, H., KALYONCUOGLU, M., CAN, E. & CAN, M. M. (2016). Are Neutrophil/Lymphocyte Ratio and Platelet/Lymphocyte Ratio Predictors for Severity of Preeclampsia? Clin. Obstet. Gynaecol., 5, 27-31.
YAVUZCAN, A., CAGLAR, M., USTUN, Y., DILBAZ, S., YIDIZ, E., OZBILGEC, S., KUMRU, S. & OZDEMIR, I. (2014). Mean platelet volume, neutrophil-lymphocyte ratio and platelet-lymphocyte ratio in severe preeclampsia. Ginekol Pol, 85.