Evaluation of Red Cell Distribution Width and Neutrophil Lymphocyte Ratio as prognostic factors in Hypertensive Disease of Pregnancy

Abstract

Background: Preeclampsia (PET) is characterized by hypertension and proteinuria starting from 20 weeks of gestational age or more with previous normal blood pressure. There are wide varieties of theories causing preeclampsia. The most unbreakable theory is the change of immunological system leading to increased inflammation response. Aim of the work:To compare red cell distribution width(RDW) and neutrophil lymphocyte ratio(NLR)in normal pregnant women and in women with pregnancy hypertensive disease (PHD) to evaluate whether these parameters have a prognostic significance in diagnosing and determining the severity of PHD. Patients and methods: A case-control retrospective study was carried out on a total of 536 pregnant women who have met the inclusion criteria with 300 normotensive women (55.97%) as control and 236 women with PHD (44.03%) as cases which subdivided into 3 subgroups: de-novo gestational hypertension(G.HTN) (n=100),mild preeclampsia(PET)(n=50),severe PET and/or eclampsia(n=86). Results: The mean RDW-coefficient of variation (CV) in the control group was13.83±0.87, where in PHD group was15.91±1.44with a pvalue of<0.001. Also, in the subgroup analysis, there was a difference in mean RDW-CV between women with G.HTN (15.47±1.21), mild PET (15.63±1.18) and severe PET (16.47±1.63) with a p-value of<0.001. By analyzing cutoff value 14.8%, RDW-CV had a sensitivity 78.07% and specificity 88.67% as a marker for PHD. Also, the mean NLR in the control group was 3.92±1.83 where in PHD group was 4.09±189 with a p-value of 0.025. By analyzing cutoff value 5.05, NLR had a sensitivity 33.33% and specificity 84.67% as a marker for PHD. Accidentally, it was found that platelet distribution width (PDW) has a considerable significance with a mean of 13.98±2.72 in the normotensive group versus 14.82±2.52 in the PHD group with a p-value of<0.001. Also, in the subgroup analysis, there were significant differences between women with G.HTN (14.04±2.58), mild PET (14.92±1.73) and severe PET (15.6±2.61) with a p-value of<0.001. Conclusion: RDW, NLR and PDW can be used as simple, applied, noninvasive and inexpensive parameter for prediction and prognosis of PHD.

Study of Some Hematological Markers of Systemic Inflammatory Response in Preeclampsia

“…AUC of the neutrophil, MPV, NLR and PLR for severe preeclampsia were 0.632, 0.564, 0.534 and 0.588, with p-value 0.001, 0.064, 0.689 and 0.19 respectively. Saad et al [17] had used ROC curve analysis. For predicting of preeclampsia, it showed reliable diagnostic significance of RDW with area under the curve AUC 0.89 and P-value<0.001 at cutoff value 14.8, with sensitivity 78.07% and specificity 88.67%.…”

“…1) History taking: Personal history:-include name, age, marital status, parity, address, occupation and special habits Complaint: was taken in patients' own words; however, normal cases as well as mild preeclampsia may have no complaint [17], other than coming for routine antenatal care. Present history:-analysis of the complaint and patient was asked for other complaints related to preeclampsia such as headache, blurring of vision, epigastria pain, edema and fits.…”