The predictive role of neutrophil-lymphocyte ratio, platelet lymphocyte ratio, and other complete blood count parameters in eclampsia and HELLP syndrome

Year 2021, Volume: 5 Issue: 12, 1202 - 1205, 01.12.2021

Feyza Bayram , Süleyman Serkan Karaşin

https://doi.org/10.28982/josam.1008359

Abstract

Background/Aim: Previous studies declared the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio, and other routine complete blood count (CBC) components as sensitive preeclampsia biomarkers. We speculated that the same associations existed with eclampsia and HELLP syndrome.
Methods: This retrospective case-control study was conducted on 120 pregnant women between the ages of 18 and 40 years. Forty-nine patients with HELLP syndrome, 40 patients with eclampsia/preeclampsia, and 40 healthy pregnant women were included in the study. All groups were evaluated in terms of clinical characteristics and first-trimester hematological parameters. The primary outcomes were neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and the secondary results were hemoglobin, red blood distribution width, mean platelet volume, platelet count, neutrophil count, and lymphocyte count.
Results: The median gestational age was 34 weeks (ranging between 23 and 41), with a median birth weight of 2300 grams. The median NLR was 3.9 (1.3-25.1), and the median PLR was 113.6 (20.7-693). The NLR and PLR values were significantly different between the three groups (P=0.014, P=0.002, respectively). NLR was different between normotensive and eclamptic pregnant women. PLR values were higher in normotensive pregnant women than in pregnant women with a history of HELLP. The median red cell distribution width was 44.6 in normotensive women, 41.5 in women with eclampsia, and 44.3 in women with a history of HELLP (P=0.017).
Conclusion: TLR value was higher in pregnant women who had eclampsia. Platelet count and MPV were significantly lower in the HELLP group.

Keywords

Eclampsia, HELLP syndrome, Neutrophil Lymphocyte Ratio, Platelet Lymphocyte Ratio

References

• 1. Ferrazzi E, Stampalija T, Monasta L, Di Martino D, Vonck S, Gyselaers W. Maternal hemodynamics: a method to classify hypertensive disorders of pregnancy. American journal of obstetrics and gynecology. 2018;218:124-e1.
• 2. Gynecologists AC of O and. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ task force on hypertension in pregnancy. Obstetrics and gynecology. 2013;122:1122.
• 3. Steegers EAP, Von Dadelszen P, Duvekot JJ, Pijnenborg R. Pre-eclampsia. The Lancet. 2010;376:631–44.
• 4. Laresgoiti‐Servitje E. A leading role for the immune system in the pathophysiology of preeclampsia. Journal of leukocyte biology. 2013;94:247–57.
• 5. Duley L. The global impact of pre-eclampsia and eclampsia. In: Seminars in perinatology. Elsevier; 2009. p. 130–7.
• 6. Weinstein L. Syndrome of hemolysis, elevated liver enzymes, and low platelet count: a severe consequence of hypertension in pregnancy. American journal of obstetrics and gynecology. 1982;142:159–67.
• 7. Sibai BM. Diagnosis, controversies, and management of the syndrome of hemolysis, elevated liver enzymes, and low platelet count. Obstetrics & Gynecology. 2004;103:981–91.
• 8. Kınay T, Küçük C, Kayıkçıoğlu F, Karakaya J. Severe preeclampsia versus HELLP syndrome: maternal and perinatal outcomes at< 34 and≥ 34 weeks’ gestation. Balkan medical journal. 2015;32:359.
• 9. Vigil-de Gracia PE, Tenorio-Maranon FR, Cejudo-Carranza E, Helguera-Martinez A, Garcia-Caceres E. Difference between preeclampsia, HELLP syndrome and eclampsia, maternal evaluation. Ginecologia y obstetricia de Mexico. 1996;64:377–82.
• 10. Benedetto C, Marozio L, Tancredi A, Picardo E, Nardolillo P, Maria Tavella A, et al. Biochemistry of HELLP syndrome. Advances in clinical chemistry. 2011;53:85.
• 11. Gezer C, Ekin A, Ertas IE, Ozeren M, Solmaz U, Mat E, et al. High first-trimester neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios are indicators for early diagnosis of preeclampsia. Ginekologia polska. 2016;87:431–5.
• 12. Mannaerts D, Heyvaert S, De Cordt C, Macken C, Loos C, Jacquemyn Y. Are neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and/or mean platelet volume (MPV) clinically useful as predictive parameters for preeclampsia? The Journal of Maternal-Fetal & Neonatal Medicine. 2019;32:1412–9.
• 13. Gogoi P, Sinha P, Gupta B, Firmal P, Rajaram S. Neutrophil‐to‐lymphocyte ratio and platelet indices in pre‐eclampsia. International Journal of Gynecology & Obstetrics. 2019;144:16–20.
• 14. Martin Jr JN, Rinehart BK, May WL, Magann EF, Terrone DA, Blake PG. The spectrum of severe preeclampsia: comparative analysis by HELLP (hemolysis, elevated liver enzyme levels, and low platelet count) syndrome classification. American journal of obstetrics and gynecology. 1999;180:1373–84.
• 15. Stone JH. HELLP syndrome: hemolysis, elevated liver enzymes, and low platelets. Jama. 1998;280:559–62.
• 16. Karaşin SS, Çift T. The role of ischemia-modified albumin as a biomarker in preeclampsia. Revista Brasileira de Ginecologia e Obstetrícia. 2020;42:133–9.
• 17. Sachan R, Patel ML, Sachan P, Shyam R. Diagnostic accuracy of neutrophil to lymphocyte ratio in prediction of nonsevere preeclampsia and severe preeclampsia. Journal of Current Research in Scientific Medicine. 2017;3:79.
• 18. Sisti G, Faraci A, Silva J, Upadhyay R. Neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and complete blood count components in the first trimester do not predict HELLP syndrome. Medicina. 2019;55:219.
• 19. Imtiaz F, Shafique K, Mirza SS, Ayoob Z, Vart P, Rao S. Neutrophil lymphocyte ratio as a measure of systemic inflammation in prevalent chronic diseases in Asian population. International archives of medicine. 2012;5:1–6.
• 20. Garciéa RG, Celedón J, Sierra-Laguado J, Alarcón MA, Luengas C, Silva F, et al. Raised C-reactive protein and impaired flow-mediated vasodilation precede the development of preeclampsia. American journal of hypertension. 2007;20:98–103.
• 21. Kurt RK, Aras Z, Silfeler DB, Kunt C, Islimye M, Kosar O. Relationship of red cell distribution width with the presence and severity of preeclampsia. Clinical and Applied Thrombosis/Hemostasis. 2015;21:128–31.