Association between PUQE-based severity of hyperemesis gravidarum and systemic inflammatory indices

To evaluate the relationship between systemic inflammatory indices and the severity of hyperemesis gravidarum (HG) using the Pregnancy-Unique Quantification of Emesis (PUQE) score, and to assess their predictive value for hospitalization.

This prospective case-control study included 80 first-trimester pregnant women: 40 with HG and 40 healthy controls. Demographic, hematological, and biochemical data were analyzed. Systemic inflammatory indices-neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII)-were calculated from complete blood counts. Correlations between PUQE score, urinary ketone levels, and these indices were assessed using Spearman's test, and ROC analysis was used to determine predictive performance for hospitalization.

Compared with controls, HG patients had significantly higher PUQE scores, white blood cell, neutrophil, monocyte, and platelet counts, and lower hemoglobin and sodium levels (all p < 0.05). NLR, MLR, PLR, and SII were markedly elevated in HG (all p < 0.001). PUQE and urinary ketone levels correlated positively with NLR (r = 0.703 and 0.786), MLR (r = 0.415 and 0.503), PLR (r = 0.469 and 0.563), and SII (r = 0.746 and 0.832) (all p < 0.001). SII showed the highest diagnostic accuracy for hospitalization (AUC = 0.973, 95% CI: 0.924-1.000).

Systemic inflammatory indices, particularly SII and NLR, are significantly associated with the clinical severity of hyperemesis gravidarum and may serve as supportive markers for identifying patients at increased risk of hospitalization. These easily obtainable and inexpensive hematological markers may aid in identifying patients at higher risk who require inpatient management.