Neutrophil Lymphocyte Ratio (NLR) as a Bio Inflammatory Marker in Pre-eclampsia

Abstract

Introduction: Pre-eclampsia, a systemic disease unique to pregnancy, affects 3-14% of pregnant women. The aim of the present study was to evaluate Neutrophil Lymphocyte Ratio (NLR) as a bio inflammatory marker of pre-eclampsia (PE), a hypertensive disorder of pregnancy characterized by hypertension and proteinuria after 20 weeks of gestation. Material and Methods: This case control study was carried out over a period of 10 months after informed consent and ethical clearance. The study population included 70 pregnant women (35 pre-eclampsia cases and 35 normotensive pregnant subjects as controls). 3 ml venous blood samples were obtained from both the cases and controls. Complete blood count was done using semi-automated three part haematology analyser which gives the reading of cell counts, NLR was calculated manually. Results: The case group (subjects with pre-eclampsia) were found to have higher neutrophil to lymphocyte ratio (NLR) than that of the control group. This difference was statistically significant (p<0.001). The receiver operating curve (ROC) analysis showed significant diagnostic accuracy of NLR to discriminate cases and controls (area under the curve [AUC] = 0.73, P < 0.001) at cutoff value of >= 4.86, 68.6% sensitivity and 80% specificity. Conclusion: Unlike many other inflammatory markers, NLR proves to be an inexpensive and readily available biomarkers, obtained from routinely done complete blood counts that may be useful for prediction and diagnosis of pre-eclampsia.

Description of Neutrophil-to-lymphocyte Ratio, C-reactive Protein, and Procalcitonin Levels in Pregnancy with COVID-19 at Sanglah General Hospital Period of April 2020–April 2021

“…In women with preeclampsia, neutrophils are activated in the placental circulation under hypoxic conditions which contribute to increased vascular resistance in preeclampsia. 15 Neutrophilto-lymphocyte ratio in preeclamptic patients was significantly higher compared to those without preeclampsia. 15 Preeclampsia is characterized by antiangiogenetic and inflammation, thus increasing in proinflammatory cytokines, such as interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α), which ultimately causes the expression of the acute phase protein CRP.…”

“…15 Neutrophilto-lymphocyte ratio in preeclamptic patients was significantly higher compared to those without preeclampsia. 15 Preeclampsia is characterized by antiangiogenetic and inflammation, thus increasing in proinflammatory cytokines, such as interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α), which ultimately causes the expression of the acute phase protein CRP. 16 In preeclampsia, there is also an increase in procalcitonin, which is associated with systemic inflammation, and increases in other proinflammatory cytokines and cytotoxic activity on hepatocytes and endothelium.…”

Comparison of neutrophil lymphocyte ratio (NLR), mean platelet volume (MPV) and platelet lymphocyte ratio (PLR) in preeclampsia and normotensive pregnancies

“…Therefore, the NLR is considered as a provider of diagnostic and prognostic value in preeclampsia. [18][19][20][21][22] Mannaerts et al 10 reported that patients with preeclampsia have NLR value higher than normotensive pregnancies, although it is not significantly different. In contrast, some studies reported that the NLR value of patients with preeclampsia is significantly different compare with normotensive pregnancies.…”

“…19 The cut-off value for NLR in predicting preeclampsia have been proposed by some authors. Singhal et al 20 found that the NLR has a cutt-off value of ≥ 4.86 with a sensitivity of 68.6% and a specificity of 80.0% in predicting preeclampsia. Prasetyo et al 22 found that the NLR is associated with preeclampsia with cut-off values between 3.5-5.6 in different sensitivity and specificity.…”

“…11,13,14,18 Neutrophils from women with preeclampsia expressed more cyclooxygenase-2 than pregnancies without preeclampsia or in women who were not pregnant. 20,21 However, the mechanism behind this modulation of the immune system has not been elucidated. Another study showed that neutrophil activation occurs in the hypoxic placental circulation so that it infiltrates the systemic vascular tissue in women with preeclampsia which causes vascular inflammation.…”