Şiddetli preeklampside bileşik biyobelirteçler olarak transaminaz kompleks-platelet oranı (TACPR) ve platelet-albümin oranının (PAR) değerlendirilmesi

Abstract

Amaç: Şiddetli preeklampsi (PE) tanılı gebelerde, obstetrik ve perinatal sonuçları öngörmede transaminaz kompleks-platelet oranı (TACPR) ve platelet-albümin oranının (PAR) klinik önemini değerlendirmektir. Gereç ve Yöntemler: Ankara Bilkent Şehir Hastanesinde, şiddetli PE tanısı alan 60 gebe ve gebelik yaşı eşleştirilmiş 120 sağlıklı kadını içeren kontrol grubuyla retrospektif bir çalışma yapılmıştır. Bileşik biyobelirteçlerden TACPR, (AST×ALT) /PLT sayısı olarak, PAR ise PLT/Albümin olarak hesaplandı. Gruplar arasında klinik, laboratuvar ve perinatal sonuçlar karşılaştırıldı. TACPR'nin preterm doğum için öngörü performansını değerlendirmek için ROC eğrisi analizi kullanıldı. Proteinüri şiddetine göre (spot idrar <+2 vs. ≥+2) alt grup analizleri yapıldı. Bulgular: Demografik verilerde gruplar arasında anlamlı farklar gözlenmedi (p > 0,05). TACPR, şiddetli PE vakalarında anlamlı olarak yükselirken (p < 0,05), PAR arasında anlamlı fark gözlenmedi (p > 0,05). Şiddetli PE, preterm doğum, düşük doğum ağırlığı (DDA) ve YBÜ'ye yatış oranlarında anlamlı olarak daha yüksek oranlarla ilişkiliydi (p < 0,001). ROC analizi, preterm doğumun tahmininde 0,86'lık bir TACPR kesme noktası belirlemiştir (AUC = 0,701, duyarlılık %63,6, özgüllük %63,2). Şiddetli PE hastaları arasında, ≥+2 proteinüri olanlar, preterm doğum ve DDA oranlarının artmasıyla birlikte daha yüksek kan basıncı, kreatinin ve albümin düzeyleri sergilemiştir. Ancak, TACPR ve PAR, proteinüri düzeyleri arasında önemli bir fark göstermemiştir. Sonuç: TACPR, şiddetli PE'de olumsuz perinatal sonuçlarla ilişkili yeni ve erişilebilir bir bileşik biyobelirteçtir. Klinik değerlendirmeye dahil edilmesi, risk sınıflandırmasını iyileştirebilir. PAR, obstetrik ve perinatal sonuçların tahmininde sınırlı yarara sahiptir. Yine de bu konuda büyük popülasyona sahip çok merkezli prospektif çalışmalara ihtiyaç vardır.

Keywords

• şiddetli preeklampsi
• TACPR
• PAR
• perinatal sonuçlar
• bileşik biyobelirteçler

Assessing the transaminase complex-platelet ratio (TACPR) and the platelet-albumin ratio (PAR) as composite biomarkers in severe preeclampsia

Abstract

Aim: To evaluate the clinical significance of the transaminase complex-platelet ratio (TACPR) and the platelet-albumin ratio (PAR) in predicting obstetric and perinatal outcomes among women with severe preeclampsia (PE). Material and Methods: A retrospective study was conducted at Ankara Bilkent City Hospital, including 60 pregnant women diagnosed with severe PE and 120 gestational age-matched healthy controls. TACPR was calculated as (AST×ALT)/PLT count, and PAR as PLT/Albumin. Clinical, laboratory, and perinatal outcomes were compared between groups. ROC curve analysis was used to assess the predictive performance of TACPR for preterm birth. Subgroup analysis was performed based on proteinuria severity (spot urine <+2 vs. ≥+2). Results: No significant differences were observed between groups in demographic data (p > 0.05). TACPR was significantly elevated in severe PE cases (p < 0.05), while PAR did not differ significantly (p > 0.05). Severe PE was associated with significantly higher rates of preterm birth, low birth weight (LBW), and NICU admission (p < 0.001). ROC analysis identified a TACPR cut-off of 0.86 for predicting preterm birth (AUC = 0.701, sensitivity 63.6%, specificity 63.2%). Among severe PE patients, those with ≥+2 proteinuria exhibited higher blood pressures, creatinine, and albumin levels, along with increased rates of preterm birth and LBW. However, TACPR and PAR did not significantly differ across proteinuria levels. Conclusion: TACPR is a novel and accessible composite biomarker that correlates with adverse perinatal outcomes in severe PE. Its integration into clinical assessment could enhance risk stratification. PAR showed limited utility near delivery. Further multicenter prospective studies are warranted.

Keywords

• severe preeclampsia
• TACPR
• PAR
• perinatal outcomes
• composite biomarkers

Supporting Institution

Ankara Bilkent City Hospital

Ethical Statement

Institutional review board approval was obtained from the Ethics Committee of the Republic of Turkey Ministry of Health Ankara City Hospital (Approval number: TABED 2-25-1117). All stages of the study adhered to the principles of the Declaration of Helsinki.

Thanks

Special thanks to all the health care staff of our hospital who work devotedly for the health of our community.

References

1. Poon LC, Shennan A, Hyett JA, Kapur A, Hadar E, Divakar H et al. The International Federation of Gynecology and Obstetrics (FIGO) initiative on pre-eclampsia: A pragmatic guide for first-trimester screening and prevention. Int J Gynaecol Obstet 2019; 145(S1): 1-33.
2. Turpin CA, Sakyi SA, Owiredu WKBA, Ephraim RKD, Anto EO. Association between adverse pregnancy outcome and imbalance in angiogenic regulators and oxidative stress biomarkers in gestational hypertension and preeclampsia. BMC Pregnancy Childbirth 2015; 15: 189.
3. Emeruwa UN, Gyamfi-Bannerman C, Laurent LC. Biomarkers and the Risk of Preeclampsia. JAMA. 2023; 329: 539-41.
4. Giannini EG, Testa R, Savarino V. Liver enzyme alteration: a guide for clinicians. CMAJ 2005; 172: 367.
5. Pratt DS, Kaplan MM. Evaluation of abnormal liver-enzyme results in asymptomatic patients. N Engl J Med 2000; 342: 1266-71.
6. Woldeamanuel GG, Tlaye KG, Wu L, Poon LC, Wang CC. Platelet count in preeclampsia: a systematic review and meta-analysis. Am J Obstet Gynecol MFM 2023; 5: 100979.
7. AlSheeha MA, Alaboudi RS, Alghasham MA, Iqbal J, Adam I. Platelet count and platelet indices in women with preeclampsia. Vasc Health Risk Manag 2016; 12: 477-80.
8. Al Ghazali B, Al-Taie AA-H, Hameed RJ. Study of the clinical significance of serum albumin level in preeclampsia and in the detection of its severity. Am J BioMed 2014; 2: 964-74.

9. Cao S-L, Guo-Qing Z, Jing L, Li B, Xiao-Mei L, Quan-Peng J et al. Platelet-to-Albumin Ratio is a Potential Biomarker for Predicting Diabetic Nephropathy in Patients with Type 2 Diabetes. Biomarkers in Medi 2023; 17: 841-8.
10. Hao P, Feng S, Suo M, Wang S, Wu X. Platelet to albumin ratio: A risk factor related to prognosis in patients with non-ST-segment elevation acute coronary syndrome undergoing percutaneous coronary intervention. Int J Cardiol 2024; 395: 131588.
11. Tan J, Song G, Wang S, Dong L, Liu X, Jiang Z et al. Platelet-to-Albumin Ratio: A Novel IgA Nephropathy Prognosis Predictor. Front Immunol 2022; 13: 842362.
12. Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222. Obstet Gynecol 2020; 135: e237-e60.
13. Magee LA, Brown MA, Hall DR, Gupte S, Hennessy A, Karumanchi SA et al. The 2021 International Society for the Study of Hypertension in Pregnancy classification, diagnosis & management recommendations for international practice. Pregnancy Hypertens 2022; 27: 148-69.
14. Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. Lancet 2008; 371: 75-84.
15. Cutland CL, Lackritz EM, Mallett-Moore T, Bardají A, Chandrasekaran R, Lahariya C, et al. Low birth weight: Case definition & guidelines for data collection, analysis, and presentation of maternal immunization safety data. Vaccine 2017; 35: 6492-500.
16. Al-Jameil N, Aziz Khan F, Fareed Khan M, Tabassum H. A brief overview of preeclampsia. J Clin Med Res 2014; 6: 1-7.
17. Danielli M. Role of perivascular biomarkers at the fetal-maternal interface in hypertensive disorders of pregnancy: University of Leicester; Thesis submitted for the Degree of Doctor of Philosophy 2022.
18. Shi JM, Yang Z, Li FQ, Wang GJ. Preliminary study of human serum albumin level in early warning onset of preeclampsia]. Zhonghua Fu Chan Ke Za Zhi 2020; 55: 29-35.
19. Klajnbard A, Szecsi PB, Colov NP, Andersen MR, Jørgensen M, Bjørngaard B et al. Laboratory reference intervals during pregnancy, delivery and the early postpartum period. Clin Chem Lab Med 2010; 48: 237-48.
20. İpek G, Tanaçan A, Ağaoğlu Z, Gülçin Baştemur A, Gülen Yıldız E, Şahin D. The role of aspartate aminotransferase to platelet ratio index (APRI) in the first trimester for the prediction of superimposed preeclampsia: A case-control study from a tertiary center. Pregnancy Hypertens 2024; 37: 101132.
21. Xiao J, Fan W, Zhu Q, Shi Z. Diagnosis of proteinuria using a random urine protein-creatinine ratio and its correlation with adverse outcomes in pregnancy with preeclampsia characterized by renal damage. J Clin Hypertens (Greenwich) 2022; 24: 652-9.