Day 4 and day 0 neutrophil‐to‐lymphocyte ratios as predictors of treatment failure with single‐dose methotrexate for ectopic pregnancies

Abstract

ObjectiveTo evaluate changes in the neutrophil‐to‐lymphocyte ratio (NLR) between day 4 and day 0 in ectopic pregnancy (EP) patients treated with single‐dose methotrexate (MTX) and investigate its predictive value for treatment outcome.MethodsA total of 406 EP patients receiving single‐dose MTX therapy at Shanghai First Maternity and Infant Hospital from January 10, 2013 to September 30, 2019 were studied. A multivariate model was constructed to predict treatment outcome.ResultsAmong the 406 patients, 281 were treated successfully. Treatment success declined significantly when NLR decreased by less than 23% (74.8% vs 58.5%, P = 0.004). Multivariate regression analysis identified NLR reduction of less than 23% on day 4 (odds ratio [OR] 2.09, 95% confidence interval [CI] 1.27–3.44), a human chorionic gonadotropin (hCG) decrease of 15% or less (OR 3.17, 95% CI 1.62–6.34), and an hCG increase of more than 15% on day 4 (OR 5.47, 95% CI 3.05–10.22) as independent risk factors for single‐dose MTX treatment failure. The final predictive model had a sensitivity of 0.768 and a specificity of 0.569, using a cut‐off value of 3. The area under the receiver operating characteristic curve was 0.712. Patients with a predictive score of ≥3 were more likely to fail single‐dose MTX therapy.ConclusionThe present study concluded that an NLR decrease of less than 23% on day 4, a plateau or increase in serum hCG on day 4, and an hCG value greater than 1000 mIU/mL on day 0 were predictors of single‐dose MTX treatment failure in EP patients.