Evaluation of the Gustave Roussy Immune Score in intrahepatic cholestasis of pregnancy and adverse perinatal outcomes: a retrospective case–control study

Ahmet Arif Filiz; Kubilay Çanga; Gülşan Karabay; Recep Taha Ağaoğlu; Özgür Volkan Akbulut; Ahmet Kurt; Alper İçalan; Dinçer Sümer; S. Ahmet Erol; Şevki Çelen

Evaluation of the Gustave Roussy Immune Score in intrahepatic cholestasis of pregnancy and adverse perinatal outcomes: a retrospective case–control study

Abstract

Aims: To evaluate the Gustave Roussy Immune (GRIm) score and its individual components in women with intrahepatic cholestasis of pregnancy, and to explore their discriminatory performance for intrahepatic cholestasis of pregnancy and composite adverse perinatal outcomes. Methods: This retrospective case–control study included 130 females with singleton pregnancies in the third trimester: 65 diagnosed with intrahepatic cholestasis of pregnancy and 65 controls. Females with conditions that could substantially affect hepatic, inflammatory, or hematologic parameters were excluded. The GRIm score was calculated by assigning one point for each of the following: serum lactate dehydrogenase above 245 U/L, serum albumin below 35 g/L, and a neutrophil-to-lymphocyte ratio above 6. Group comparisons and receiver operating characteristic curve analyses were performed. Optimal cut-offs were determined using the Youden index. Results: The median GRIm score was higher in females with intrahepatic cholestasis of pregnancy than in controls [1 (1-2) vs. 0 (0–1); p<0.001]. Serum albumin below 35 g/L (70.8% vs. 27.7%; p<0.001) and lactate dehydrogenase above 245 U/L (32.3% vs. 10.8%; p=0.003) were more frequent in the intrahepatic cholestasis group, whereas the difference in neutrophil-to lymphocyte ratio above 6 was not statistically significant (20.0% vs. 9.2%; p=0.082). The GRIm score demonstrated moderate discriminatory performance for intrahepatic cholestasis of pregnancy, with an area under the curve of 0.740 (95% confidence interval, 0.655–0.825; p<0.001). A threshold of ≥2 provided 36.9% sensitivity and 95.4% specificity. Serum albumin showed similar discriminatory performance, with an area under the curve of 0.753. For composite adverse perinatal outcomes, the GRIm score yielded an area under the curve of 0.705 (95% confidence interval, 0.586–0.824; p=0.001), with 46.2% sensitivity and 85.6% specificity at a threshold of ≥2. Conclusion: The GRIm score demonstrated moderate discriminatory performance for intrahepatic cholestasis of pregnancy and composite adverse perinatal outcomes, mainly characterized by high specificity but limited sensitivity. Its performance was not superior to that of serum albumin alone. Therefore, the GRIm score should not be used as a standalone diagnostic or prognostic tool, but may warrant further investigation as an adjunct to established clinical and laboratory assessments in prospective, externally validated studies.

Keywords

Ethical Statement

This retrospective case–control study was conducted at Etlik City Hospital between January 1, 2024 and January 31, 2025. Ethics approval was obtained from the institutional ethics committee (Approval number: AEŞH-BADEK-2025-0251). The study adhered to the principles of the Declaration of Helsinki. Due to the retrospective design, the requirement for informed consent was waived in accordance with institutional policy.

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Details

Primary Language

English

Subjects

Obstetrics and Gynaecology

Journal Section

Research Article

Authors

Ahmet Arif Filiz ^*
0000-0002-6137-0270
Türkiye

Kubilay Çanga
0009-0002-1881-1170
Türkiye

Gülşan Karabay
0000-0003-2567-2850
Türkiye

Recep Taha Ağaoğlu
0000-0002-6570-1006
Türkiye

Özgür Volkan Akbulut
0000-0002-1960-2146
Türkiye

Ahmet Kurt
0000-0001-8402-5675
Türkiye

Alper İçalan
0009-0000-1076-0810
Türkiye

Dinçer Sümer
0000-0002-7034-6811
Türkiye

S. Ahmet Erol
0000-0002-2494-4896
Türkiye

Şevki Çelen
0000-0001-7033-3474
Türkiye

Publication Date

October 25, 2026

Submission Date

July 28, 2026

Acceptance Date

August 30, 2026

Published in Issue

Year 2026 Volume: 7 Number: 5

IZ

https://izlik.org/JA59HF73AT

Cite

RIS / Bibtex

APA

Filiz, A. A., Çanga, K., Karabay, G., Ağaoğlu, R. T., Akbulut, Ö. V., Kurt, A., İçalan, A., Sümer, D., Erol, S. A., & Çelen, Ş. (2026). Evaluation of the Gustave Roussy Immune Score in intrahepatic cholestasis of pregnancy and adverse perinatal outcomes: a retrospective case–control study. Journal of Medicine and Palliative Care, 7(5), 965-971. https://izlik.org/JA59HF73AT

AMA

1.Filiz AA, Çanga K, Karabay G, et al. Evaluation of the Gustave Roussy Immune Score in intrahepatic cholestasis of pregnancy and adverse perinatal outcomes: a retrospective case–control study. J Med Palliat Care / JOMPAC / jompac. 2026;7(5):965-971. https://izlik.org/JA59HF73AT

Chicago

Filiz, Ahmet Arif, Kubilay Çanga, Gülşan Karabay, et al. 2026. “Evaluation of the Gustave Roussy Immune Score in Intrahepatic Cholestasis of Pregnancy and Adverse Perinatal Outcomes: A Retrospective Case–control Study”. Journal of Medicine and Palliative Care 7 (5): 965-71. https://izlik.org/JA59HF73AT.

EndNote

Filiz AA, Çanga K, Karabay G, Ağaoğlu RT, Akbulut ÖV, Kurt A, İçalan A, Sümer D, Erol SA, Çelen Ş (October 1, 2026) Evaluation of the Gustave Roussy Immune Score in intrahepatic cholestasis of pregnancy and adverse perinatal outcomes: a retrospective case–control study. Journal of Medicine and Palliative Care 7 5 965–971.

IEEE

[1]A. A. Filiz et al., “Evaluation of the Gustave Roussy Immune Score in intrahepatic cholestasis of pregnancy and adverse perinatal outcomes: a retrospective case–control study”, J Med Palliat Care / JOMPAC / jompac, vol. 7, no. 5, pp. 965–971, Oct. 2026, [Online]. Available: https://izlik.org/JA59HF73AT

ISNAD

Filiz, Ahmet Arif - Çanga, Kubilay - Karabay, Gülşan - Ağaoğlu, Recep Taha - Akbulut, Özgür Volkan - Kurt, Ahmet - İçalan, Alper - Sümer, Dinçer - Erol, S. Ahmet - Çelen, Şevki. “Evaluation of the Gustave Roussy Immune Score in Intrahepatic Cholestasis of Pregnancy and Adverse Perinatal Outcomes: A Retrospective Case–control Study”. Journal of Medicine and Palliative Care 7/5 (October 1, 2026): 965-971. https://izlik.org/JA59HF73AT.

JAMA

1.Filiz AA, Çanga K, Karabay G, Ağaoğlu RT, Akbulut ÖV, Kurt A, İçalan A, Sümer D, Erol SA, Çelen Ş. Evaluation of the Gustave Roussy Immune Score in intrahepatic cholestasis of pregnancy and adverse perinatal outcomes: a retrospective case–control study. J Med Palliat Care / JOMPAC / jompac. 2026;7:965–971.

MLA

Filiz, Ahmet Arif, et al. “Evaluation of the Gustave Roussy Immune Score in Intrahepatic Cholestasis of Pregnancy and Adverse Perinatal Outcomes: A Retrospective Case–control Study”. Journal of Medicine and Palliative Care, vol. 7, no. 5, Oct. 2026, pp. 965-71, https://izlik.org/JA59HF73AT.

Vancouver

1.Ahmet Arif Filiz, Kubilay Çanga, Gülşan Karabay, Recep Taha Ağaoğlu, Özgür Volkan Akbulut, Ahmet Kurt, Alper İçalan, Dinçer Sümer, S. Ahmet Erol, Şevki Çelen. Evaluation of the Gustave Roussy Immune Score in intrahepatic cholestasis of pregnancy and adverse perinatal outcomes: a retrospective case–control study. J Med Palliat Care / JOMPAC / jompac [Internet]. 2026 Oct. 1;7(5):965-71. Available from: https://izlik.org/JA59HF73AT