Can neutrophil‐to‐lymphocyte and monocyte‐to‐lymphocyte ratios be useful markers for predicting missed abortion in the first trimester of pregnancy?

Abstract

Aim To explore whether neutrophil‐to‐lymphocyte ratio (NLR) and monocyte‐to‐lymphocyte ratio (MLR) could predict missed abortion (MA) at 7–13 week's gestation. Methods A total of 363 women with a diagnosis of MA and 232 women with normal pregnancy at 7–13 week's gestation, who visited our hospital from June 2012 to May 2018 were retrospectively analyzed. At 7 week's gestation, total and differential leukocyte counts, NLR and MLR were compared between women with MA (n = 69) and normal controls (n = 53). The receiver operating characteristic curve was used to select the optimal indicator and its cut‐off point. The role of the optimal indicator was further assessed at 8–13 week's gestation. Results The mean white blood cell counts, the mean neutrophil counts, the median monocyte counts, the mean NLR and the median MLR in women with MA were significantly lower than those in normal controls (P < 0.05, respectively).The neutrophil counts had the highest area under the curve (AUC) value of 0.772 (95% confidence interval 0.675–0.869) with a cut‐off value of 4.870 × 109/L, and the sensitivity was 72.46%, the specificity was 69.81%, positive predictive value was 75.76%, and negative predictive value was 66.07%. In addition, the neutrophil counts were also significantly lower in MA groups than those in normal controls at 8–13 week's gestation, and all had the highest AUC values. Conclusion Neutrophil counts may predict MA in the first trimester of pregnancy, which may provide a promising marker to diagnose missed abortion as early as 7 week's gestation.

Predictivity of Platelet to Lymphocyte and Neutrophil to Lymphocyte Ratios in the First Trimester Missed Abortion:A Retrospective Case-Control Study

“…Wang et al analyzed MA cases at week 7 in terms of WBC value. 16 Contrary to our data, they reported that the risk of MA increased when this value was below 8x10 3 /μL in MA cases (84% sensitivity and 54% specificity). Wang et al further explored the effects of progesterone on the total or differential WBC value, NLR and MLR in MA cases.…”

“…2,7,29 The NLR threshold value calculated to predict MA was reported to be below 2.4 in Wang et al's study and below 5.72 in Kim's study. 16,29 The cut-off value in these studies is in the opposite direction with our results. The difference between these studies in the literature is due to 2 reasons.…”

“…However, it was revealed that progesterone treatment did not create a significant difference between the groups in terms of these parameters. 16 MPV is a specific parameter of the platelet function. Larger platelets are hemostatically more active.…”

“…2 However, Wang et al stated that, contrary to the abovementioned data, the NLR value in the MA group was low, which showed a statistically significant difference. 16 According to the ROC analysis, the best predictive marker for MA was found to be NLR. The optimal cutoff value was 4.56.…”

“…14 Based on this hypothesis, some studies have investigated markers such as NLR, PLR, and MLR in the first trimester MA cases. 2,7,15,16 There are few studies in the literature evaluating the prediction of MA cases according to CBC parameters. There are controversial cut-off values for proportional calculations.…”