Evaluation of albumin-based inflammatory markers as diagnostic tools in HELLP syndrome

Objective To evaluate the role of inflammatory and albumin-related indices in the diagnosis and prognosis of HELLP syndrome, with a focus on parameters such as NLR, NPAR, CAR, and FAR. Materials and methods This retrospective study analyzed 126 pregnant women, including 58 with HELLP syndrome and 68 healthy controls, admitted to the Perinatology Department of Etlik City Hospital between January 2023 and September 2024. Demographic and clinical data, including age, gestational week, and laboratory parameters, were collected. Specific inflammatory indices, including Neutrophil-to-Lymphocyte Ratio (NLR), Hemoglobin-Albumin-Lymphocyte-Platelet Score (HALP), Neutrophil Percentage-to-Albumin Ratio (NPAR), C-Reactive Protein-to-Albumin Ratio (CAR) and Fibrinogen-to-Albumin Ratio (FAR) were calculated and compared between the groups. Receiver Operating Characteristic (ROC) analysis was performed to assess the diagnostic performance of these indices. Statistical analyses were conducted with a confidence level of 95%, and p-values less than 0.05 were considered significant. Results Significant differences were observed between the HELLP group and healthy controls in terms of inflammatory and nutritional indices. NLR, NPAR, CAR, and FAR were significantly higher in the HELLP group compared to controls (p < 0.001 for all). ROC analysis revealed good diagnostic performance for CAR (AUC = 0.88, p < 0.001) and NPAR (AUC = 0.84, p < 0.001), while FAR also demonstrated high sensitivity and specificity (AUC = 0.82, p < 0.001). Additionally, PLR values were significantly lower in the HELLP group (p = 0.004), indicating its potential diagnostic relevance. PIV demonstrated the highest diagnostic performance among the markers evaluated (AUC = 0.790, sensitivity = 78%, specificity = 68%), followed by SII (AUC = 0.746). PLR and NAR showed moderate diagnostic accuracy with AUC values of 0.704 and 0.700, respectively. Conclusion Inflammatory and albumin-related indices, particularly CAR, NPAR, and FAR, show good diagnostic accuracy in identifying HELLP syndrome. These parameters may be valuable tools for early diagnosis and effective management of HELLP syndrome by enabling clinicians to identify patients at higher risk of complications, initiate timely interventions, and monitor disease progression more accurately, thus potentially improving maternal and fetal outcomes.