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Predictive Value of Neutrophils, Lymphocytes, Platelets, Neutrophil-Lymphocyte Ratio (NLR), and Platelets-Lymphocyte
Emad Elmaradny1, Saud Aman1, Mohammed Alaskar1
1Department of Obstetrics and Gynecology, Al Yamamah Hospital, Riyadh, Saudi Arabia.
Introduction:
Maternal neutrophils (N), lymphocyte, platelets (PLTs), neutrophil-lymphocyte ratio (NLR), and platelets-lymphocyte ratio (PLR) have been used to predict preterm birth. We studied changes in these markers in preterm labor (PTL) and whether they can serve as single or combined predictive indicators.
Material And Methods:
Patients in premature labor participated in a retrospective case-control study. CBC, Hb, HCT, lymphocytes, N, PLTs, NLR, and PLR were measured and compared between total preterm cases (20 0/7-36 6/7 weeks) and normal pregnancies. Subgroups of early preterm labor (EPL) (20 0/7-33 6/7 weeks) and late preterm labor (LPL) (34 0/7-36 6/7 weeks) were also compared with gestational-age-matched controls. ROC curves were utilized to estimate the cutoff, specificity, sensitivity, and area under the curve (AUC) for every marker. According to cutoff levels of each marker, a score system was created (0-4). Combined Score Index and Systemic Immune-Inflammatory Index (SII) were calculated for total, early, and late preterm groups.
Results:
A total of 1000 patients with PTL were included. No significant difference was found in lymphocytes between groups. N, PLTs, NLR, and PLR were significantly higher in total PTL vs. controls. In EPL, N, PLTs, NLR, and PLR were significantly elevated (p ≤ 0.0001, 0.0001, 0.0002, and 0.0009). Similarly, LPL showed significant differences (p ≤ 0.0003, 0.01, 0.0008, and 0.05). These markers were also significantly higher in EPL vs. LPL (p ≤ 0.0001, 0.05, 0.0001, and 0.05). AUC values in early preterm for N, PLTs, NLR, and PLR were 0.640, 0.626, 0.627, and 0.593, respectively, and in late preterm, 0.611, 0.568, 0.610, and 0.581-indicating a weak predictive value. A high score index (3-4) was more frequent in total (57%), early (31.7%), and late (50.27%) preterm compared with controls (38.5%, 15.56%, and 31.86%). AUC of Combined Score Index was 0.604, 0.630, and 0.611 and for SII, 0.660, 0.684, and 0.622 in total, early, and late preterm, respectively, showing statistically significant but weak predictive values.
Conclusion:
Significant changes in N, PLTs, NLR, and PLR (both as individual and combined markers) are observed in PTL groups, but their predictive value for prematurity remains limited.
