Subscribe to RSS
Can Derived Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, and Delta Neutrophil Index Predict Spontaneous Abortion?
Objective To evaluate the efficacy of complete blood count indices for the prediction of miscarriage.
Materials and Methods A retrospective case-control study was conducted in a tertiary hospital. This study consisted of 389 cases (32 elective and 193 spontaneous abortions, 164 healthy pregnancies). Maternal demographic characteristics, complete blood cell (CBC) parameters, neutrophil-lymphocyte ratio (NLR), derived NLR, systemic inflammatory immune index (SII), platelet-to-lymphocyte ratio (PLR), and delta neutrophil index (DNI) that were in the routine first trimester CBC were compared between groups.
Results There were no significant differences among groups in terms of demographic and obstetric characteristics. Statistically significant differences were observed for Hb, white blood cell (WBC), lymphocyte (L), NLR, SII, and PLR between the subgroups (p=0.003, p=0.045, p=0.000, p=0.002, p=0.043, p=0.010, respectively). There were no significant differences among groups in terms of the remaining parameters. When healthy pregnancies and spontaneous abortions were compared, statistically significant differences were detected for NLR, SII, PLR (p=0.001, p=0.039, and p=0.000, respectively). Moreover, when healthy pregnancies and elective abortions were compared, only NLR was found as statistically different (p=0.050). Area under curve (AUC) was calculated for PLR as 0.659 (%95 CI: 0.582–0.735) and a cut-off value of 158.1 was found with highest sensitivity and specificity (60.6 % and 61.6%, respectively) according to the results obtained from Youden’s index. AUC was calculated for NLR as 0.591 (%95 CI: 0.507–0.675) and a cut-off value of 3.135 was found with highest sensitivity and specificity (56% and 54.5%) according to the results obtained from Youden’s index.
Conclusion In conclusion, decreased PLR and NLR levels may be used as practical and cost-effective markers for the prediction of miscarriages.
Received: 10 October 2020
Accepted after revision: 07 January 2021
02 February 2021 (online)
© 2021. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
- 1 Griebel CP, Halvorsen J, Golemon TB. et al. Management of spontaneous abortion. Am Fam Physician 2005; 72: 1243-1250
- 2 Steer C, Campbell S, Davies M. et al. Spontaneous abortion rates after natural and assisted conception. Br Med J 1989; 299: 1317
- 3 Hussein SK. The role of maternal stress, cortisol and interleukin 12 in cases of missed abortion in the first trimester of pregnancy in Saudi women. AJAP 2019; 2: 6
- 4 Harris LK, Benagiano M, D’Elios MM. et al. Placental bed research: 2. Functional and immunological investigations of the placental bed. Am J Obs Gynecol 2019; 221: 457-469
- 5 Larsen EC, Christiansen OB, Kolte AM. et al. New insights into mechanisms behind miscarriage. BMC Med 2013; 11: 154
- 6 Jurkovic D, Overton C, Bender-Atik R. Diagnosis and management of first trimester miscarriage. BMJ 2013; 346: f3676
- 7 Eskiizmir G, Uz U, Onur E. et al. The evaluation of pretreatment neutrophil-lymphocyte ratio and derived neutrophil-lymphocyte ratio in patients with laryngeal neoplasms. Braz J Otorhinolaryngol 2019; 85: 578-587
- 8 Furuncuoğlu Y, Tulgar S, Dogan AN. et al. How obesity affects the neutrophil/lymphocyte and platelet/lymphocyte ratio, systemic immune-inflammatory index and platelet indices: a retrospective study. Eur Rev Med Pharmacol Sci 2016; 20: 1300-1306
- 9 Kirbas A, Biberoglu E, Daglar K. et al. Neutrophil-to-lymphocyte ratio as a diagnostic marker of intrahepatic cholestasis of pregnancy. Eur J Obstet Gynecol Reprod Biol 2014; 180: 12-15
- 10 Yavuzcan A, Cağlar M, Ustün Y. et al. Mean platelet volume, neutrophil-lymphocyte ratio and platelet-lymphocyte ratio in severe preeclampsia. Ginekol Pol 2014; 85: 197-203
- 11 Song JE, Lee KY, Son GH. Prognostic significance of neutrophil-to-lymphocyte ratio for repeat cerclage in women with prolapsed membranes. Biomed Res Int 2018; 2018: 1507398
- 12 Budak YS, Polat M, Huysan K. The use of platelet indices, plateletcrit, mean platelet volume and platelet distribution width in emergency non-traumatic abdominal surgery: a systematic review. Biochem Med (Zagreb) 2016; 26: 178-193
- 13 Akın MN, Kasap B, Yuvacı HU. et al. Association between platelet indices and first trimester miscarriage. Blood Coagul Fibrinolysis 2016; 27: 526-530
- 14 Baş FY, Tola EN, Sak S. et al. The role of complete blood inflammation markers in the prediction of spontaneous abortion. Pak J Med Sci 2018; 34: 1381-1385
- 15 Calleja-Agius J, Jauniaux E, Pizzey AR. et al. Investigation of systemic inflammatory response in first trimester pregnancy failure. Hum Reprod 2012; 27: 349-357
- 16 Hustin J. Histological study of the materno-embryonic interface in spontaneous abortion. Placenta 1990; 11: 477-486
- 17 Aynıoglu O, Işık H, Sahbaz A. et al. Can plateletcrit be a marker for recurrent pregnancy loss?. Clin Appl Thromb Hemost 2016; 22: 447-452
- 18 Duan J, Pan L, Yang M. Preoperative elevated neutrophil-to-lymphocyte ratio (NLR) and derived NLR are associated with poor prognosis in patients with breast cancer. Medicine 2018; 97: e13340
- 19 Kurtoglu E, Kokcu A, Celik H. et al. May ratio of neutrophil-to-lymphocyte be useful in predicting the risk of developing preeclampsia? A pilot study. J Matern Fetal Neonatal Med 2015; 28: 97-99
- 20 Yücel B, Ustun B. Neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, mean platelet volume, red cell distribution width and plateletcrit in preeclampsia. Pregn Hypertension: An International Journal of Women’s Cardiovascular Health 2017; 7: 29-32
- 21 Ata N, Kulhan M, Kulhan NG. et al. Can neutrophil-lymphocyte and platelet-lymphocyte ratios predict threatened abortion and early pregnancy loss?. Ginecolia Polska 2020; 91: 210-215
- 22 Tian C, Song W, Tian X. et al. Prognostic significance of platelet-to-lymphocyte ratio in patients with ovarian cancer: a meta-analysis. Eur J Clin Invest 2018; 48: e12917
- 23 Gasparyan AY, Ayvazhan L, Mukanova U. et al. The platelet-to-lymphocyte ratio as an inflammatory marker in rheumatic diseases. Ann Lab Med 2019; 39: 345-357
- 24 Telo S, Kuluöztürk M, Deveci F. et al. The relationship between platelet-to-lymphocyte ratio and pulmonary embolism severity in acute pulmonary embolism. Int Angiol 2019; 38: 4-9
- 25 Cakiroglu Y, Vural F, Vural B. The inflammatory markers in polycystic ovary syndrome: association with obesity and IVF outcomes. J Endocrinal Invest 2016; 39: 899-907
- 26 Yılmaz M, Delibaş IB, Isaoğlu U. et al. Relationship between mean platelet volume and recurrent miscarriage: a preliminary study. Arch Med Sci 2005; 11: 989-993
- 27 Tola EN. The association between in vitro fertilization outcome and the inflammatory markers of complete blood count among nonobese unexplained infertile couples. Taiwan J Obstet Gynecol 2018; 57: 289-294