Inflammation-driven pathogenesis of hyperemesis gravidarum: assessing the role of pan-immune-inflammation value and...

Hyperemesis gravidarum (HG) is a severe form of nausea and vomiting during pregnancy that frequently leads to hospitalization and significant maternal morbidity. Despite its clinical significance, the pathogenesis of HG remains poorly understood, with systemic inflammation emerging as a possible contributing factor. The aim of this study was to investigate the role of novel inflammatory markers, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and pan-immune-inflammation value (PIV), in the pathophysiology of HG and their association with disease severity.

This retrospective case-control study included 259 pregnant women (159 with HG and 100 healthy controls) enrolled in Inonu University School of Medicine between January 2020 and August 2023. Hematologic parameters, including leukocyte, neutrophil, lymphocyte, and platelet counts and ketonuria levels, were collected from electronic medical records. Inflammatory indices (NLR, PLR, SII, and PIV) were calculated and their diagnostic performance was evaluated using receiver-operating characteristic (ROC) curve analysis. Logistic regression was used to assess the risk factors for HG. Statistical analyses were performed using SPSS version 22, with p < 0.05 considered significant.

The HG group had significantly higher NLR (p = 0.004), PLR (p = 0.003), SII (p < 0.001), and PIV (p < 0.001) compared to controls. ROC analysis revealed that NLR [cut-off: 5.67, area under the curve (AUC) 0.608, 95% confidence interval (CI) 0.545-0.668, p = 0.002], PLR (cut-off: 154.5, AUC 0.610, 95% CI 0.547-0.669, p = 0.002), SII (cut-off: 948.4, AUC: 0.636, 95% CI 0.575-0.695, p < 0.001), and PIV (cut-off: 866.51, AUC 0.637, 95% CI 0.575-0.696, p < 0.001) showed moderate diagnostic performance with high specificity (70-94%) but variable sensitivity (25.8-55.3%). Logistic regression identified low gestational age and increased platelet distribution width (PDW) as significant risk factors for HG (p < 0.05), while PIV and other inflammatory markers did not emerge as independent predictors.

This study emphasizes the role of systemic inflammation in HG as evidenced by increased inflammatory indices in HG patients. NLR, PLR, SII, and PIV prove to be promising diagnostic markers for HG and offer high specificity and sensitivity. However, their lack of correlation with ketonuria suggests that inflammation alone cannot fully explain the severity of the disease. These findings highlight the need for further research to validate these markers and explore their potential for the development of personalized treatment strategies for HG.