Systemic Immune-Inflammation Index and Other Inflammation Biomarkers in the Diagnosis of Gestational Diabetes Mellitus

Abstract

Aims: Gestational diabetes mellitus (GDM) emerges during pregnancy due to physiological shifts, resulting in an adverse intrauterine environment characterized by insulin resistance and hyperglycemia, with inflammation believed to play a significant role. While inflammation typically protects the body, it can also have adverse effects. Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and lymphocyte-to-monocyte ratio (LMR) are recognized as biomarkers of inflammation. Methods: This retrospective cohort study took place between January 2022 and December 2023 at a tertiary training and research hospital. A total of 567 patients were included in the study. A comparison of inflammation markers was conducted between patients with and without GDM. Results: A significant difference was observed in the mean SII values between the groups, with group A (Control group) exhibiting 1144 ± 400 and group B (Patients with GDM) showing 1280 ± 496 (p = .002). Another significant difference observed between groups for NLR (p= .001). Conclusion: The significant differences observed in SII values between patient groups, coupled with the discriminative abilities of SII and NLR in diagnosing GDM, underscore the potential clinical relevance of these markers.

Keywords

• Systemic Immune Inflammation Index
• Gestational Diabetes
• Inflammation Markers
• Neutrophile Lymphocyte Ratio

Gestasyonel Diyabet Mellitus Tanısında Sistemik İmmün-İnflamasyon İndeksi ve Diğer İnflamasyon Biyobelirteçleri

Abstract

Amaç: Gestasyonel diyabet mellitus (GDM), gebelik sırasında fizyolojik değişiklikler sonucu ortaya çıkar ve insülin direnci ile hiperglisemiyle karakterize olumsuz bir intrauterin ortam oluşturur. İnflamasyonun bu süreçte önemli bir rol oynadığı düşünülmektedir. İnflamasyon genellikle vücudu korurken, aynı zamanda olumsuz etkiler de gösterebilir. Nötrofil-lenfosit oranı (NLR), trombosit-lenfosit oranı (PLR), sistemik immün-inflamasyon indeksi (SII) ve lenfosit-monosit oranı (LMR), inflamasyonun biyobelirteçleri olarak kabul edilmektedir. Yöntemler: Bu retrospektif kohort çalışması, Ocak 2022 ile Aralık 2023 tarihleri arasında üçüncü basamak bir eğitim ve araştırma hastanesinde gerçekleştirildi. Çalışmaya toplam 567 hasta dahil edildi. İnflamasyon belirteçleri, GDM'li ve GDM'siz hastalar arasında karşılaştırıldı. Bulgular: Gruplar arasında ortalama SII değerlerinde anlamlı bir fark gözlemlendi. A grubu (Kontrol grubu) 1144 ± 400 değerine sahipken, B grubu (GDM'li hastalar) 1280 ± 496 değeri gösterdi (p = .002). Ayrıca, gruplar arasında NLR için de anlamlı bir fark tespit edildi (p = .001). Sonuç: Hasta grupları arasında gözlemlenen SII değerlerindeki anlamlı farklar, SII ve NLR'nin GDM tanısındaki ayırt edici yetenekleriyle birleştiğinde, bu belirteçlerin potansiyel klinik önemini vurgulamaktadır.

Keywords

• Sistemik İmmün-İnflamasyon İndeksi
• Gestasyonel Diyabet
• İnflamasyon Belirteçleri
• Nötrofil Lenfosit Oranı

References

1. Kim C. Gestational diabetes: risks, management, and treatment options. Int J Womens Health. 2010;2:339-51. doi:10.2147/ijwh.S13333
2. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2014;37 Suppl 1:S81-S90. doi:10.2337/dc14-S081
3. ACOG Practice Bulletin No. 190 Summary: Gestational Diabetes Mellitus. Obstet Gynecol. 2018;131(2):406-408. doi:10.1097/AOG.0000000000002498
4. Pietzner M, Kaul A, Henning AK, et al. Comprehensive metabolic profiling of chronic low-grade inflammation among generally healthy individuals. BMC Med. 2017;15(1):210. doi:10.1186/s12916-017-0974-6
5. Daglar HK, Kirbas A, Kaya B, Kilincoglu F. The value of complete blood count parameters in predicting preterm delivery. Eur Rev Med Pharmacol Sci. 2016;20(5):801-5.
6. Örgül G, Aydın Haklı D, Özten G, Fadiloğlu E, Tanacan A, Beksaç MS. First trimester complete blood cell indices in early and late onset preeclampsia. Turk J Obstet Gynecol. 2019;16(2):112-117. doi:10.4274/tjod.galenos.2019.93708
7. Lainampetch J, Panprathip P, Phosat C, et al. Association of Tumor Necrosis Factor Alpha, Interleukin 6, and C-Reactive Protein with the Risk of Developing Type 2 Diabetes: A Retrospective Cohort Study of Rural Thais. J Diabetes Res. 2019;2019:9051929. doi:10.1155/2019/9051929
8. Pordzik J, Jakubik D, Jarosz-Popek J, et al. Significance of circulating microRNAs in diabetes mellitus type 2 and platelet reactivity: bioinformatic analysis and review. Cardiovasc Diabetol. 2019;18(1):113. doi:10.1186/s12933-019-0918-x

9. Wang D, Yang JX, Cao DY, et al. Preoperative neutrophillymphocyte and platelet-lymphocyte ratios as independent predictors of cervical stromal involvement in surgically treated endometrioid adenocarcinoma. Onco Targets Ther. 2013;6:211-216. doi:10.2147/OTT.S41711
10. Celikbilek M, Dogan S, Ozbakır O, et al. Neutrophillymphocyte ratio as a predictor of disease severity in ulcerative colitis. J Clin Lab Anal. 2013;27(1):72-6. doi:10.1002/jcla.21564
11. Ergani SY, Yücel KY, Şahin B, et al. The role of inflammation in cases with gestational diabetes mellitus: Systemic immune inflammatory index according to trimesters. Am J Reprod Immunol. 2024;91(1):e13806. doi:10.1111/aji.13806
12. Kang H. Sample size determination and power analysis using the G*Power software. J Educ Eval Health Prof. 2021;18:17. doi:10.3352/jeehp.2021.18.17
13. Hershko Klement A, Hadi E, Asali A, et al. Neutrophils to lymphocytes ratio and platelets to lymphocytes ratio in pregnancy: A population study. PLoS One. 2018;13(5):e0196706. doi:10.1371/journal.pone.0196706
14. Nie Y, Zhou H, Wang J, Kan H. Association between systemic immune-inflammation index and diabetes: a population-based study from the NHANES. Front Endocrinol (Lausanne). 2023;14:1245199. doi:10.3389/fendo.2023.1245199
15. Ye YX, Wang Y, Wu P, et al. Blood Cell Parameters From Early to Middle Pregnancy and Risk of Gestational Diabetes Mellitus. J Clin Endocrinol Metab. 2023;108(12):e1702-e1711. doi:10.1210/clinem/dgad336
16. Sahin M, Oguz A, Tüzün D, et al. A new marker predicting gestational diabetes mellitus: First trimester neutrophil/lymphocyte ratio. Medicine (Baltimore). 2022;101(36):e30514. doi:10.1097/md.0000000000030511
17. Hocaoglu M, Demirer S, Loclar Karaalp I, et al. Identification of miR-16-5p and miR-155-5p microRNAs differentially expressed in circulating leukocytes of pregnant women with polycystic ovary syndrome and gestational diabetes. Gynecol Endocrinol. 2021;37(3):216-220. doi:10.1080/09513590.2020.1843620
18. Liu W, Lou X, Zhang Z, Chai Y, Yu Q. Association of neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, mean platelet volume with the risk of gestational diabetes mellitus. Gynecol Endocrinol. 2021;37(2):105-107. doi:10.1080/09513590.2020.1780579
19. Curi R, Levada-Pires AC, Silva EBD, et al. The Critical Role of Cell Metabolism for Essential Neutrophil Functions. Cell Physiol Biochem. 2020;54(4):629-647. doi:10.33594/000000245
20. Yang L, Fu M, Yu L, Wang H, Chen X, Sun H. Value of markers of systemic inflammation for the prediction of postoperative progression in patients with pancreatic neuroendocrine tumors. Front Endocrinol (Lausanne). 2024;15:1293842. doi:10.3389/fendo.2024.1293842
21. Zhang Y, Song M, Yang Z, Huang X, Lin Y, Yang H. Healthy lifestyles, systemic inflammation and breast cancer risk: a mediation analysis. BMC Cancer. 2024;24(1):208. doi:10.1186/s12885-024-11931-5