Neutrophil–lymphocyte ratio for the prediction of histological chorioamnionitis in cases of preterm premature rupture of membranes: a case-control study

Abstract

Background The neutrophil-lymphocyte ratio (NLR) is easily calculated blood test parameter, which can be used as marker to predict many inflammatory disorders. The aim of this study was to assess and compare the NLR in maternal blood with the white blood cell (WBC) count and C-reactive protein (CRP) concentration for the prediction of histological chorioamnionitis. Methods This was a case-control study of 137 woman with preterm premature rupture of membranes (PPROM) at a gestational age between 22+ 0 and 34+ 6 weeks. Blood samples, collected less than 48 h before delivery and at least 48 h after the administration of corticosteroids, were selected for the analysis. The NLR was calculated by dividing the number of neutrophils by the number of lymphocytes. Chorioamnionitis was diagnosed by the histopathological evaluation of placental membranes and chorionic plate. Results Patients with diagnosed histological chorioamnionitis (HCA) had significantly higher levels of WBC, CRP and NLR (p-value < 0.001). Levels of WBC, CRP and NLR predicted HCA with an area under the curve (AUC) of 0.81, 0.81 and 0.89, respectively. NLR had statistically significantly higher AUC than WBC, but no significant difference was found between AUCs of NLR and CRP. The cut-off level of NLR was found to be 5,97, which had a sensitivity of 77 % and a specificity of 95 %. Conclusion NLR has a good predictive value for HCA and could be used as an additional diagnostic marker for predicting histological chorioamnionitis in cases with preterm premature rupture of membranes before 34 weeks of gestation.

Plasma E‐selectin and kallistatin as predictive markers of histologic chorioamnionitis in women with preterm premature rupture of membranes

“…In the context of PPROM, several studies have suggested that patients with acute HCA have increased WBC counts, NLR, and CRP levels compared with those without HCA 58–61 . In line with these findings, 58–61 our results revealed independent associations of elevated levels of CRP, WBC counts, and NLR in maternal blood with acute HCA. The main advantages of these widely used laboratory tests are that they can provide a fast, simple, easy, and inexpensive way of assessing acute HCA; however, they are not sufficiently specific or sensitive when applied alone.…”

“…In the context of PPROM, several studies have suggested that patients with acute HCA have increased WBC counts, NLR, and CRP levels compared with those without HCA 58–61 . In line with these findings, 58–61 our results revealed independent associations of elevated levels of CRP, WBC counts, and NLR in maternal blood with acute HCA.…”

Non‐invasive prediction of histologic chorioamnionitis using maternal serum markers in women with preterm prelabour rupture of membranes

“…38 Although lymphocytes may also be predictors of HCA, we found NLR to be of higher value. By evaluating the predictive value of NLR in patients with PPROM and HCA, a recent study by Balciuniene et al 39 found that NLR also had a good predictive value, which was not significantly different from that of CRP.…”

Plasma IGFBP‐1, Fas, kallistatin, and P‐selectin as predictive biomarkers of histologic chorioamnionitis and associated intra‐amniotic infection in women with preterm labor

“…CRP levels and NLR, as indicators of systemic inflammation, have many advantages in the clinical setting, such as low cost, fast performance, and simplicity when assessing acute HCA; however, they are not sufficiently sensitive or specific to detect inflammation in the body. In the context of PPROM, previous studies showed that increased CRP levels and NLR in maternal blood would be useful to identify patients at risk of acute HCA 69–71 . However, to date, little information is available on whether these two blood markers, which are the most commonly used in the clinic, are also useful for detecting acute HCA in PTL patients.…”

“…In the context of PPROM, previous studies showed that increased CRP levels and NLR in maternal blood would be useful to identify patients at risk of acute HCA. [69][70][71] However, to date, little information is available on whether these two blood markers, which are the most commonly used in the clinic, are also useful for detecting acute HCA in PTL patients. Indeed, most studies have been conducted in mixed patient populations, including both PTL and PPROM patients, 72,73 In the present study, which only included patients with PTL, we did not find independent associations of increased blood levels of CRP or NLR with acute or microbial-associated HCA, although these associations were significant in univariate analyses.…”