Research Article
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The performance of various serum parameters in blood during the first trimester in the early detection of pre-eclampsia

Year 2024, Volume: 7 Issue: 4, 451 - 458, 30.07.2024
https://doi.org/10.32322/jhsm.1500190

Abstract

Aims: The aim of this study is to examine the alterations in various serum parameters within the circulatory system throughout the first trimester and assess their efficacy in identifying pre-eclampsia at an early stage.
Methods: This retrospective analysis undertook an examination of the medical records pertaining to 225 pregnancies that met the eligibility criteria at a tertiary referral center, spanning the years 2018 to 2021. Furthermore, an examination of laboratory parameters during the first trimester was performed, which included neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune inflammation index, systemic inflammation response index, pan-immune inflammation value, AST-to-platelet ratio index, delta neutrophil index, and prognostic nutritional index (PNI). A receiver operating characteristic curve analysis was performed to determine the optimal cut-off values for inflammatory and nutritional biomarkers to predict early- onset pre-eclampsia.
Results: The group of individuals with early-onset pre-eclampsia displayed notably elevated levels of neutrophil, lymphocyte, PCT, MPV, ALT, and creatinine, while displaying significantly reduced levels of albumin, bilirubin, PLR, MLR, and PNI (p<0.05, for all). The statistical significance of the area under the curve for PNI, albumin, PLR, MLR, and bilirubin values was observed to be greater than 0.5 (p<0.05, for all).
Conclusion: This article is the first to examine the efficacy of the first trimester PNI value in early detection of pre-eclampsia patients. According to this study, PNI, albumin, PLR, MLR, and bilirubin show potential as useful indicators for predicting the likelihood of developing pre-eclampsia at an early stage in the first trimester.

Ethical Statement

Approval to conduct the study was obtained from the Health Sciences University Etlik Zubeyde Hanim Maternity, Teaching and Research Hospital Local Ethics Committee (Date: 28.02.2024, Decision No: 02) and was conducted following the guidelines of the Helsinki Declaration.

Supporting Institution

None.

Thanks

None.

References

  • ACOG Practice Bulletin No. 202: Gestational Hypertension and Preeclampsia. Obstet Gynecol. 2019;133(1):1. doi:10.1097/AOG.0000000000003018
  • Sahai K, Saraswathy S, Yadav TP, Arora D, Krishnan M. Pre-eclampsia: molecular events to biomarkers. Med J Armed Forces India. 2017;73(2):167-174. doi:10.1016/j.mjafi.2016.09.001
  • Laresgoiti-Servitje E. A leading role for the immune system in the pathophysiology of preeclampsia. J Leukoc Biol. 2013;94(2):247-257. doi:10.1189/jlb.1112603
  • Shah TJ, Walsh SW. Activation of NF-kappaB and expression of COX-2 in association with neutrophil infiltration in systemic vascular tissue of women with preeclampsia. Am J Obstet Gynecol. 2007;196(1):48.e1-8. doi:10.1016/j.ajog.2006.08.038
  • Mate A, Reyes-Goya C, Santana-Garrido Á, Vázquez CM. Lifestyle, maternal nutrition and healthy pregnancy. Curr Vasc Pharmacol. 2021;19(2):132-140. doi:10.2174/1570161118666200401112955
  • Dou W, Zhao X, Lü Q, et al. Association between nutrition factors in the third trimeter and preeclampsia:a case-control study. Wei Sheng Yan Jiu. 2019;48(2):232-237.
  • Belovic DK, Plešinac S, Dotlić J, et al. Biochemical markers for prediction of hypertensive disorders of pregnancy. J Med Biochem. 2019;38(1):71-82. doi:10.2478/jomb-2018-0001
  • Karaşin SS, Çift T. The role of ischemia-modified albumin as a biomarker in preeclampsia. Rev Bras Ginecol Obstet. 2020; 42:133-139.
  • Afrose D, Chen H, Ranashinghe A, et al. The diagnostic potential of oxidative stress biomarkers for preeclampsia: systematic review and meta-analysis. Biol Sex Differ. 2022;13(1):26. doi:10. 1186/s13293-022-00436-0
  • Bayram F, Karaşin SS. The predictive role of neutrophil-lymphocyte ratio, platelet lymphocyte ratio, and other complete blood count parameters in eclampsia and HELLP syndrome. J Sur Med. 2021;5(12):1202-1205.
  • Mirkovic L, Tulic I, Stankovic S, Soldatovic I. Prediction of adverse maternal outcomes of early severe preeclampsia. Pregnancy Hypertens. 2020;22:144-150. doi:10.1016/j.preghy.2020.09.009
  • Magee LA, Smith GN, Bloch C, et al. Guideline No. 426: Hypertensive disorders of pregnancy: diagnosis, prediction, prevention, and management. J Obstet Gynaecol Can. 2022; 44(5):547-571.e1. doi:10.1016/j.jogc.2022.03.002
  • Tan MY, Syngelaki A, Poon LC, et al. Screening for pre-eclampsia by maternal factors and biomarkers at 11-13 weeks’ gestation. Ultrasound Obstet Gynecol. 2018;52(2):186-195. doi:10.1002/uog. 19112
  • Çendek BD, Bayraktar B, Körpe B, Ustun Y, Keskin HL, Erel Ö. Ischemia-modified albumin levels in threatened abortion and missed abortion compared to healthy pregnancies. J Exper Clin Med. 2024;41(1):102-107.
  • Rossi A, Bortolotti N, Vescovo S, et al. Ischemia-modified albumin in pregnancy. Eur J Obstet Gynecol Reprod Biol. 2013; 170(2):348-351.
  • Berry EB, Eykholt R, Helliwell RJ, Gilmour RS, Mitchell MD, Marvin KW. Peroxisome proliferator-activated receptor isoform expression changes in human gestational tissues with labor at term. Mol Pharmacol. 2003;64(6):1586-1590.
  • Szilagyi JT, Avula V, Fry RC. Perfluoroalkyl substances (PFAS) and their effects on the placenta, pregnancy, and child development: a potential mechanistic role for placental peroxisome proliferator-activated receptors (PPARs). Curr Envir Health Rpt. 2020;7(3):222-230. doi:10.1007/s40572-020-00279-0
  • Peng L, Yang H, Ye Y, et al. Role of peroxisome proliferator-activated receptors (PPARs) in trophoblast functions. Int J Molecular Sci. 2021;22(1):433.
  • Pham J, Rajan KAN, Li P, Parast MM. The role of Sirtuin1–PPARγ axis in placental development and function. J Molecular Endocrinology. 2018;60(4):R201-R212.
  • Psilopatis I, Vrettou K, Fleckenstein FN, Theocharis S. The role of peroxisome proliferator-activated receptors in preeclampsia. Cells. 2023;12(4):647.
  • Çintesun E, Incesu Çintesun FN, Ezveci H, Akyürek F, Çelik Ç. Systemic inflammatory response markers in preeclampsia. J Lab Physicians. 2018;10(3):316-319. doi:10.4103/JLP.JLP_144_17
  • Serin S, Avcı F, Ercan O, Köstü B, Bakacak M, Kıran H. Is neutrophil/lymphocyte ratio a useful marker to predict the severity of pre-eclampsia? Pregnancy Hypertension: Int J Women’s Cardiovas Health. 2016;6(1):22-25.
  • Wang J, Zhu QW, Cheng XY, et al. Assessment efficacy of neutrophil-lymphocyte ratio and monocyte-lymphocyte ratio in preeclampsia. J Reprod Immunol. 2019;132:29-34. doi:10.1016/j.jri.2019.02.001
  • Kudret U, Özçil MD. Predicting severe preeclampsia ımportance of hemogram ınflammatory markers. Medical J Mustafa Kemal Uni. 2022;13(45):86-96. doi:10.17944/mkutfd.1034264
  • Seyhanli Z, Bayraktar B, Baysoz OB, et al. The role of first trimester serum inflammatory indexes (NLR, PLR, MLR, SII, SIRI, and PIV) and the β-hCG to PAPP-A ratio in predicting preeclampsia. J Reprod Immunol. 2024;162:104190. doi:10.1016/j.jri.2023.104190
  • Bektaş O, Bektaş K, Taşın C. The role of systemic inflammatory indexes in predicting preeclampsia and its severity. Perinatal J. 2019;27(2).
  • Cui HX, Chen C, Jung YM, et al. Neutrophil-to-lymphocyte ratio (NLR) as a predictive index for liver and coagulation dysfunction in preeclampsia patients. BMC Pregnancy Childbirth. 2023;23(1):4. doi:10.1186/s12884-022-05335-1
  • Pyo JY, Park JS, Park YB, Lee SK, Ha YJ, Lee SW. Delta neutrophil index as a marker for differential diagnosis between flare and infection in febrile systemic lupus erythematosus patients. Lupus. 2013;22(11):1102-1109. doi:10.1177/0961203313499957
  • Cho HY, Jung I, Kim SJ, Park YW, Kim YH, Kwon JY. Increased delta neutrophil index in women with severe preeclampsia. Am J Reprod Immunol. 2017;78(3). doi:10.1111/aji.12705
  • Ozkan D, Ibanoglu MC, Adar K, et al. Efficacy of blood parameters in predicting the severity of gestational hypertension and preeclampsia. J Obstet Gynaecol. 2023;43(1):2144175. doi:10.1080/01443615.2022.2144175
  • American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine in collaboration with, Metz TD, et al. Obstetric Care Consensus #10: Management of Stillbirth: (Replaces Practice Bulletin Number 102, March 2009). Am J Obstet Gynecol. 2020;222(3):B2-B20. doi:10.1016/j.ajog.2020.01.017
  • Şaşmaz Mİ, Ayvaz MA, Dülger AC, Kuday Kaykısız EK, Güven R. Aspartate-aminotransferase to platelet ratio index score for predicting HELLP syndrome. Am J Emerg Med. 2020;38(3):459-462. doi:10.1016/j.ajem.2019.02.014
  • Loaeza-del-Castillo A, Paz-Pineda F, Oviedo-Cárdenas E, Sánchez-Avila F, Vargas-Vorácková F. AST to platelet ratio index (APRI) for the noninvasive evaluation of liver fibrosis. Ann Hepatol. 2008;7(4):350-357.
  • Maziashvili G, Juliana K, Siva Subramania Pillai Kanimozhi V, et al. The use of systemic inflammatory markers from routine blood tests in predicting preeclampsia and the impact of age on marker levels. Cureus. 2023;15(3):e35836. doi:10.7759/cureus.35836
  • Amaral LM, Wallace K, Owens M, LaMarca B. Pathophysiology and current clinical management of preeclampsia. Curr Hypertens Rep. 2017;19(8):61. doi:10.1007/s11906-017-0757-7
  • Laresgoiti-Servitje E, Gómez-López N, Olson DM. An immunological insight into the origins of pre-eclampsia. Hum Reprod Update. 2010;16(5):510-524. doi:10.1093/humupd/dmq007
  • Achamrah N, Ditisheim A. Nutritional approach to preeclampsia prevention. Curr Opinion Clin Nutr Metabol Care. 2018;21(3):168-173.
  • Wolf HT, Hegaard HK, Huusom LD, Pinborg AB. Multivitamin use and adverse birth outcomes in high-income countries: a systematic review and meta-analysis. Am J Obstetrics Gynecol. 2017;217(4):404-e1.
  • Feng Z, Wen H, Ju X, et al. The preoperative prognostic nutritional index is a predictive and prognostic factor of high-grade serous ovarian cancer. BMC Cancer. 2018;18(1):883. doi:10.1186/s12885-018-4732-8
  • Komura N, Mabuchi S, Yokoi E, et al. Prognostic significance of the pretreatment prognostic nutritional index in patients with epithelial ovarian cancer. Oncotarget. 2019;10(38):3605.
  • Horwich TB, Kalantar-Zadeh K, MacLellan RW, Fonarow GC. Albumin levels predict survival in patients with systolic heart failure. Am Heart J. 2008;155(5):883-889. doi:10.1016/j.ahj.2007.11.043
  • Wei S, Lian L, Li G, Wang J, Chen G, Yu L. Low prognostic nutritional index contributes to high adverse events in preeclampsia. Dis Markers. 2022;2022:1187742. doi:10.1155/2022/ 1187742
Year 2024, Volume: 7 Issue: 4, 451 - 458, 30.07.2024
https://doi.org/10.32322/jhsm.1500190

Abstract

References

  • ACOG Practice Bulletin No. 202: Gestational Hypertension and Preeclampsia. Obstet Gynecol. 2019;133(1):1. doi:10.1097/AOG.0000000000003018
  • Sahai K, Saraswathy S, Yadav TP, Arora D, Krishnan M. Pre-eclampsia: molecular events to biomarkers. Med J Armed Forces India. 2017;73(2):167-174. doi:10.1016/j.mjafi.2016.09.001
  • Laresgoiti-Servitje E. A leading role for the immune system in the pathophysiology of preeclampsia. J Leukoc Biol. 2013;94(2):247-257. doi:10.1189/jlb.1112603
  • Shah TJ, Walsh SW. Activation of NF-kappaB and expression of COX-2 in association with neutrophil infiltration in systemic vascular tissue of women with preeclampsia. Am J Obstet Gynecol. 2007;196(1):48.e1-8. doi:10.1016/j.ajog.2006.08.038
  • Mate A, Reyes-Goya C, Santana-Garrido Á, Vázquez CM. Lifestyle, maternal nutrition and healthy pregnancy. Curr Vasc Pharmacol. 2021;19(2):132-140. doi:10.2174/1570161118666200401112955
  • Dou W, Zhao X, Lü Q, et al. Association between nutrition factors in the third trimeter and preeclampsia:a case-control study. Wei Sheng Yan Jiu. 2019;48(2):232-237.
  • Belovic DK, Plešinac S, Dotlić J, et al. Biochemical markers for prediction of hypertensive disorders of pregnancy. J Med Biochem. 2019;38(1):71-82. doi:10.2478/jomb-2018-0001
  • Karaşin SS, Çift T. The role of ischemia-modified albumin as a biomarker in preeclampsia. Rev Bras Ginecol Obstet. 2020; 42:133-139.
  • Afrose D, Chen H, Ranashinghe A, et al. The diagnostic potential of oxidative stress biomarkers for preeclampsia: systematic review and meta-analysis. Biol Sex Differ. 2022;13(1):26. doi:10. 1186/s13293-022-00436-0
  • Bayram F, Karaşin SS. The predictive role of neutrophil-lymphocyte ratio, platelet lymphocyte ratio, and other complete blood count parameters in eclampsia and HELLP syndrome. J Sur Med. 2021;5(12):1202-1205.
  • Mirkovic L, Tulic I, Stankovic S, Soldatovic I. Prediction of adverse maternal outcomes of early severe preeclampsia. Pregnancy Hypertens. 2020;22:144-150. doi:10.1016/j.preghy.2020.09.009
  • Magee LA, Smith GN, Bloch C, et al. Guideline No. 426: Hypertensive disorders of pregnancy: diagnosis, prediction, prevention, and management. J Obstet Gynaecol Can. 2022; 44(5):547-571.e1. doi:10.1016/j.jogc.2022.03.002
  • Tan MY, Syngelaki A, Poon LC, et al. Screening for pre-eclampsia by maternal factors and biomarkers at 11-13 weeks’ gestation. Ultrasound Obstet Gynecol. 2018;52(2):186-195. doi:10.1002/uog. 19112
  • Çendek BD, Bayraktar B, Körpe B, Ustun Y, Keskin HL, Erel Ö. Ischemia-modified albumin levels in threatened abortion and missed abortion compared to healthy pregnancies. J Exper Clin Med. 2024;41(1):102-107.
  • Rossi A, Bortolotti N, Vescovo S, et al. Ischemia-modified albumin in pregnancy. Eur J Obstet Gynecol Reprod Biol. 2013; 170(2):348-351.
  • Berry EB, Eykholt R, Helliwell RJ, Gilmour RS, Mitchell MD, Marvin KW. Peroxisome proliferator-activated receptor isoform expression changes in human gestational tissues with labor at term. Mol Pharmacol. 2003;64(6):1586-1590.
  • Szilagyi JT, Avula V, Fry RC. Perfluoroalkyl substances (PFAS) and their effects on the placenta, pregnancy, and child development: a potential mechanistic role for placental peroxisome proliferator-activated receptors (PPARs). Curr Envir Health Rpt. 2020;7(3):222-230. doi:10.1007/s40572-020-00279-0
  • Peng L, Yang H, Ye Y, et al. Role of peroxisome proliferator-activated receptors (PPARs) in trophoblast functions. Int J Molecular Sci. 2021;22(1):433.
  • Pham J, Rajan KAN, Li P, Parast MM. The role of Sirtuin1–PPARγ axis in placental development and function. J Molecular Endocrinology. 2018;60(4):R201-R212.
  • Psilopatis I, Vrettou K, Fleckenstein FN, Theocharis S. The role of peroxisome proliferator-activated receptors in preeclampsia. Cells. 2023;12(4):647.
  • Çintesun E, Incesu Çintesun FN, Ezveci H, Akyürek F, Çelik Ç. Systemic inflammatory response markers in preeclampsia. J Lab Physicians. 2018;10(3):316-319. doi:10.4103/JLP.JLP_144_17
  • Serin S, Avcı F, Ercan O, Köstü B, Bakacak M, Kıran H. Is neutrophil/lymphocyte ratio a useful marker to predict the severity of pre-eclampsia? Pregnancy Hypertension: Int J Women’s Cardiovas Health. 2016;6(1):22-25.
  • Wang J, Zhu QW, Cheng XY, et al. Assessment efficacy of neutrophil-lymphocyte ratio and monocyte-lymphocyte ratio in preeclampsia. J Reprod Immunol. 2019;132:29-34. doi:10.1016/j.jri.2019.02.001
  • Kudret U, Özçil MD. Predicting severe preeclampsia ımportance of hemogram ınflammatory markers. Medical J Mustafa Kemal Uni. 2022;13(45):86-96. doi:10.17944/mkutfd.1034264
  • Seyhanli Z, Bayraktar B, Baysoz OB, et al. The role of first trimester serum inflammatory indexes (NLR, PLR, MLR, SII, SIRI, and PIV) and the β-hCG to PAPP-A ratio in predicting preeclampsia. J Reprod Immunol. 2024;162:104190. doi:10.1016/j.jri.2023.104190
  • Bektaş O, Bektaş K, Taşın C. The role of systemic inflammatory indexes in predicting preeclampsia and its severity. Perinatal J. 2019;27(2).
  • Cui HX, Chen C, Jung YM, et al. Neutrophil-to-lymphocyte ratio (NLR) as a predictive index for liver and coagulation dysfunction in preeclampsia patients. BMC Pregnancy Childbirth. 2023;23(1):4. doi:10.1186/s12884-022-05335-1
  • Pyo JY, Park JS, Park YB, Lee SK, Ha YJ, Lee SW. Delta neutrophil index as a marker for differential diagnosis between flare and infection in febrile systemic lupus erythematosus patients. Lupus. 2013;22(11):1102-1109. doi:10.1177/0961203313499957
  • Cho HY, Jung I, Kim SJ, Park YW, Kim YH, Kwon JY. Increased delta neutrophil index in women with severe preeclampsia. Am J Reprod Immunol. 2017;78(3). doi:10.1111/aji.12705
  • Ozkan D, Ibanoglu MC, Adar K, et al. Efficacy of blood parameters in predicting the severity of gestational hypertension and preeclampsia. J Obstet Gynaecol. 2023;43(1):2144175. doi:10.1080/01443615.2022.2144175
  • American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine in collaboration with, Metz TD, et al. Obstetric Care Consensus #10: Management of Stillbirth: (Replaces Practice Bulletin Number 102, March 2009). Am J Obstet Gynecol. 2020;222(3):B2-B20. doi:10.1016/j.ajog.2020.01.017
  • Şaşmaz Mİ, Ayvaz MA, Dülger AC, Kuday Kaykısız EK, Güven R. Aspartate-aminotransferase to platelet ratio index score for predicting HELLP syndrome. Am J Emerg Med. 2020;38(3):459-462. doi:10.1016/j.ajem.2019.02.014
  • Loaeza-del-Castillo A, Paz-Pineda F, Oviedo-Cárdenas E, Sánchez-Avila F, Vargas-Vorácková F. AST to platelet ratio index (APRI) for the noninvasive evaluation of liver fibrosis. Ann Hepatol. 2008;7(4):350-357.
  • Maziashvili G, Juliana K, Siva Subramania Pillai Kanimozhi V, et al. The use of systemic inflammatory markers from routine blood tests in predicting preeclampsia and the impact of age on marker levels. Cureus. 2023;15(3):e35836. doi:10.7759/cureus.35836
  • Amaral LM, Wallace K, Owens M, LaMarca B. Pathophysiology and current clinical management of preeclampsia. Curr Hypertens Rep. 2017;19(8):61. doi:10.1007/s11906-017-0757-7
  • Laresgoiti-Servitje E, Gómez-López N, Olson DM. An immunological insight into the origins of pre-eclampsia. Hum Reprod Update. 2010;16(5):510-524. doi:10.1093/humupd/dmq007
  • Achamrah N, Ditisheim A. Nutritional approach to preeclampsia prevention. Curr Opinion Clin Nutr Metabol Care. 2018;21(3):168-173.
  • Wolf HT, Hegaard HK, Huusom LD, Pinborg AB. Multivitamin use and adverse birth outcomes in high-income countries: a systematic review and meta-analysis. Am J Obstetrics Gynecol. 2017;217(4):404-e1.
  • Feng Z, Wen H, Ju X, et al. The preoperative prognostic nutritional index is a predictive and prognostic factor of high-grade serous ovarian cancer. BMC Cancer. 2018;18(1):883. doi:10.1186/s12885-018-4732-8
  • Komura N, Mabuchi S, Yokoi E, et al. Prognostic significance of the pretreatment prognostic nutritional index in patients with epithelial ovarian cancer. Oncotarget. 2019;10(38):3605.
  • Horwich TB, Kalantar-Zadeh K, MacLellan RW, Fonarow GC. Albumin levels predict survival in patients with systolic heart failure. Am Heart J. 2008;155(5):883-889. doi:10.1016/j.ahj.2007.11.043
  • Wei S, Lian L, Li G, Wang J, Chen G, Yu L. Low prognostic nutritional index contributes to high adverse events in preeclampsia. Dis Markers. 2022;2022:1187742. doi:10.1155/2022/ 1187742
There are 42 citations in total.

Details

Primary Language English
Subjects Obstetrics and Gynaecology
Journal Section Original Article
Authors

Büşra Demir Çendek 0000-0002-6338-1408

Tuğba Ağbal 0000-0001-7749-0907

Arife Akay 0000-0001-9640-2714

Müjde Can İbanoğlu 0000-0002-8413-2064

Yaprak Engin Üstün 0000-0002-1011-3848

Publication Date July 30, 2024
Submission Date June 12, 2024
Acceptance Date July 19, 2024
Published in Issue Year 2024 Volume: 7 Issue: 4

Cite

AMA Demir Çendek B, Ağbal T, Akay A, İbanoğlu MC, Engin Üstün Y. The performance of various serum parameters in blood during the first trimester in the early detection of pre-eclampsia. J Health Sci Med / JHSM. July 2024;7(4):451-458. doi:10.32322/jhsm.1500190

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