Hematological Parameters to Predict the Severity of Hyperemesis Gravidarum and Ketonuria

Abstract

Objective Hyperemesis gravidarum (HG) is a pregnancy complication that can progress with persistent nausea and vomiting. The aim of the present study is to evaluate the relationship between hematological parameters and HG. Method A total of 532 pregnant women with HG who were admitted to the Department of Obstetrics and Gynecology between March 2019 and February 2021, and 534 healthy pregnant women with characteristics similar to those of the case group were included in the study. The hematological parameters of both groups were compared. In addition, the hematological parametersof patients with HG according to the severity of ketonuria were compared. Results The mean age of the HG group (n = 532) was 26.3 ± 4.1 years, and that of the control group (n = 534) was 25.9 ± 4.8 years. Among patients with HG, 46% (n = 249) had ketone (+), 33% (n = 174), ketone (++), and 21% (n = 109), ketone (++ + ). The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were higher in the HG group than in the control group: 3.8 (2.8–5.8)/3.2 (2.6–4.0); p < 0.001; and 135.2 ± 30.4/108.9 ± 62.2; p < 0.001 respectively. The neutrophil count, NLR, and PLR were higher in the group with ketone (++ + ) than in the groups with ketone (+) or ketone (++): 7.6 ± 1.9/5.5 ± 2.4; p < 0.001; 3.8(2.8–4.6)/2.9(2.3–3.6); p < 0.001; and 149.9 ± 48.0/135.9 ± 65.7; p < 0.001 respectively. The mean corpuscular hemoglobin (MCH) level, the NLR, and the PLR were identified as independent predictors of the presence of HG and the level of ketone positivity in HG patients. Conclusion The NLR and PLR were high in patients with HG, suggesting the its inflammatory activity. They may be important markers associated with the presence and severity of HG.

The predictive value of HALP score and systemic immune inflammation (SII) index in hyperemesis gravidarum

“…18 Another study defined the mean corpuscular hemoglobin (MCH), NLR, and PLR levels as independent predictors of the presence of HG and level of ketone positivity. 19 Soysal et al classified the severity of ketonuria into four groups and found a positive correlation between ketonuria levels and inflammatory markers (PLR, MLR, and NLR levels) in patients with HG. 20 In our study, NLR, PLR, and PCT counts were found to be significantly higher in the HG group than in the control group.…”

“…They also stated that dehydration and the inflammatory process parallel to the severity of HG were responsible for this increase, and they suggested that PLR and PCT were important independent discriminators for HG 18 . Another study defined the mean corpuscular hemoglobin (MCH), NLR, and PLR levels as independent predictors of the presence of HG and level of ketone positivity 19 . Soysal et al classified the severity of ketonuria into four groups and found a positive correlation between ketonuria levels and inflammatory markers (PLR, MLR, and NLR levels) in patients with HG 20 .…”

The role of systemic inflammatory indices in predicting nausea and vomiting in pregnancy and the need for hospitalization

“…The modi ed pregnancy-unique quanti cation of emesis and nausea (PUQE) index, which consists of the assessment of three components, including the duration of nausea in hours, the number of vomiting episodes, and retching within a day, was used to assess the severity of NVP [13]. The severity of nausea and/or vomiting in pregnancy is categorized using the PUQE score: mild (4-6), moderate (7)(8)(9)(10)(11)(12) and severe, also known as HG (≥ 13). The patients with moderate NVP and HG, who were almost always treated as inpatients, were de ned as patients requiring 'inpatient treatment'.…”

“…The severity of nausea and/or vomiting in pregnancy is categorized using the PUQE score: mild (4-6), moderate (7)(8)(9)(10)(11)(12) and severe, also known as HG (≥ 13). The patients with moderate NVP and HG, who were almost always treated as inpatients, were de ned as patients requiring 'inpatient treatment'.…”

“…Since these biomarkers cannot be used universally due to the high cost and di culty of integrating them into clinical practice, in ammatory markers derived from a simple complete blood count (CBC) appear to be more attractive for predicting diseases and/or their prognosis where altered in ammation plays an important role in pathogenesis. In addition, the relationship between CBC-derived in ammatory parameters, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and monocyte-to-lymphocyte ratio (MLR), and ketonuria and the severity of HG has already been investigated [11,12]. Research in this area continues to search for more relevant, useful, and easily applicable predictive tools at a reasonable cost for predicting NVP and its severity.…”