Pregestasyonel Diabetus Mellitus Tanılı Gebe Hastaların Sistemik İnflamatuvar İndeks, Sistemik İnflamatuvar Yanıt İndeks, Toplam Sistemik İnflamatuvar İndekslerinin Değerlendirilmesi. Bir tersiyer merkez vaka -kontrol çalışması

Öz

Amaç: Bu çalışmanın amacı Pregestasyonel diyabetes mellitus(Pre-GDM) tanılı hastaların Sistemik İnflamatuvar İndeks (Sİİ), Sistemik İnflamatuvar yanıt İndeks(SİRİ), toplam sistemik inflamatuvar indeks (AİSİ)’lerinin sağlıklı gebelerle karşılaştırılması, pre-GDM’li hastalarda Sİİ, SİRİ ve AİSİ sonuçlarının olumsuz sonuçları öngörmedeki rolünü incelemektir. Yöntemler: Bu çalışma tek merkezli, üçüncü basamak bir merkezde retrospektif olarak vaka kontrol olacak şekilde tasarlandı. Çalışmaya Şubat 2023 ile Şubat 2025 tarihleri arasında Pre-GDM tanılı 85 gebe hasta ve Pre-GDM tanılı olmayan 85 gebe hasta toplamda 170 gebe hasta dahil edildi. Çalışmaya dahil edilen hastalar pre-GDM tanısı olan çalışma grubu (grup1) ve pre-GDM tanısı olmayan kontrol grubu (grup 2) şeklinde 2 gruba ayrıldı. Çalışma ve kontrol grubu arasında maternal laboratuvar sonuçları, laboratuvar sonuçları sonrası oluşturulan Sİİ, SİRİ ve AİSİ sonuçları karşılaştırıldı. Ayrıca Pre-GDM tanılı hastalarda yenidoğan yoğun bakım (NICU)’a gidiş, birleşik olumsuz gebelik sonuçları (CAPO), preterm doğum (PTD)’ u öngörü etkinliği incelendi. Bulgular: Çalışma grubunda vücut kitle indeksi(VKİ)(p<0.001), sezaryen(c/s)(p<0.001), NICU’a gidiş (0.030), CAPO(p<0.001), PTD(p<0.001) daha yüksek izlenirken, doğum haftası (p<0.001), 1.dk apgar (p=0.005) ve 5. dk apgar (p<0.001) skorları, umblikal kord PH düzeyi (p=0.004) daha düşük izlendi. Gruplar arasında 1.trimester(tr) Nötrofil/lenfosit ratio(NLR)(p=0.037), Trombosit/Lenfosit ratio (PLR)(p=0.045), Trombosit/Nötrofil ratio(PNR)(p=0.020), Sİİ(p=0.031), 3.tr NLR(p=0.017), PLR(p=0.046), PNR(p=0.020), Monosit/Lenfosit ratio(MLR)(P=0.002), Sİİ(p=0.004), SİRİ(p<0.001), AİSİ(p<0.001) açısından anlamlı farklılık izlendi. Pre-GDM grubunda PTD, CAPO, NICU’yu öngörü için yapılan alıcı işletim sistemi (ROC) eğri grafiklerinde sonuçlar anlamlı olarak izlenmedi. Sonuç: Bu çalışmada pre-GDM’li hastalarda 1.tr NLR, PLR, Sİİ ve 3.tr NLR, PLR, Sİİ, SİRİ, AİSİ sonuçlarının kontrol grubuna göre anlamlı ve daha yüksek çıktığını gördük. Ayrıca pre-GDM grubunda Sİİ, SİRİ, AİSİ’nin PTD, NICU, CAPO gibi olumsuz sonuçları öngörü etkinliğinin ROC eğri grafikleri yardımıyla olmadığı sonucuna vardık. Pre-GDM’de Sİİ, SİRİ, AİSİ gibi İnflamatuar indeksler faydalı olabilirler ancak tek başına öngörücü olarak kullanılmaması gerektiğini düşünmekteyiz. Bununla birlikte bu indekslerin birlikte kullanılabileceği ve bu indeksleri daha anlamlı kılabilecek çok parametreli modellere dahil edilebilirler. Bu çalışmanın pre-GDM’li hastalarda inflamatuvar indekslerin çalışıldığı çok az olan literatüre katkı sunacağını düşünmekteyiz

Anahtar Kelimeler

• Diabetes mellitus
• tip 2
• nötrofil
• lenfosit
• trombosit
• yeni doğan yoğun bakım

Evaluation of Systemic Immune-Inflammation Index, Systemic Inflammation Response Index, and Aggregate Index of Systemic Inflammation in Pregestational Diabetes Mellitus Patients: A Tertiary Center Case-Control Study

Öz

Objective: This study aimed to compare the Systemic Immune-Inflammation Index (SII), Systemic Inflammation Response Index (SIRI), and Aggregate Index of Systemic Inflammation (AISI) between pregnant women with Pregestational Diabetes Mellitus (Pre-GDM) and healthy controls, and to evaluate the predictive role of these indices for adverse pregnancy outcomes. Methods: This study was designed as a retrospective, case–control study conducted at a single tertiary care center. A total of 170 pregnant women who delivered between February 2023 and February 2025 were included: 85 with Pre-GDM and 85 without Pre-GDM. The participants were divided into two groups, with the study group consisting of patients diagnosed with pregestational diabetes mellitus (Group 1) and the control group including women without a pre-GDM diagnosis (Group 2). Maternal demographic and laboratory results, as well as inflammation indices (SII, SIRI, and AISI), were compared between the groups. In addition, the predictive performance of these indices for neonatal intensive care unit (NICU) admission, composite adverse pregnancy outcomes (CAPO), and preterm delivery (PTD) in patients with Pre-GDM was evaluated. Results: Body mass index (BMI) (p<0.001), cesarean delivery rate(p<0.001), NICU (p<0.030), CAPO(p<0.001) and PTD(p<0.001) were significantly higher in the Pre-GDM group, while gestational age at delivery (p<0.001), 1st (p<0.005) and 5th minute Apgar scores (p<0.001), and umbilical cord pH levels (p=0.004) were significantly lower. Significant differences were observed between groups for first-trimester (tr) Neutrophil/ Lymphocyte (NLR) (p=0.037), Platelet/ Lymphocyte (PLR) (p=0.045), Platelet/ Neutrophil (PNR) (p=0.020), and SII (p=0.031); and for third-tr NLR (p=0.017), PLR (p=0.046), PNR (p=0.020), Monocyte/ Lymphocyte (MLR) (p=0.002), SII (p=0.004), SIRI (p<0.001), and AISI (p<0.001). Receiver Operating Characteristic (ROC) curve analyses for predicting PTD, CAPO, and NICU admission in the Pre-GDM group revealed no statistically significant predictive power. Conclusion: In this study, we observed that first-trimester NLR, PLR, and SII, as well as third-trimester NLR, PLR, SII, SIRI, and AISI values, were significantly higher in patients with pre-GDM compared with the control group. Additionally, ROC curve analyses demonstrated that SII, SIRI, and AISI did not have sufficient predictive ability for adverse outcomes such as PTD, NICU admission, or CAPO in the pre-GDM group. Although inflammatory indices such as SII, SIRI, and AISI may provide useful information regarding the inflammatory burden in pre-GDM, we believe that they should not be used as standalone predictive markers. However, these indices may be incorporated into multiparametric predictive models, in which their combined use could enhance diagnostic and prognostic performance. We believe that this study will contribute to the limited body of literature examining inflammatory indices in patients with pre-GDM.

Anahtar Kelimeler

• Diabetes Mellitus
• Type 2
• Neutrophil
• Lymphocyte
• Platelet
• Neonatal Intensive Care Unit.

Kaynakça

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