The Effect of Preoperative Neutrophil-To-Lymphocyte Ratio and Platelet-To-Lymphocyte Ratio on Predicting Rupture Risk in Tubal Ectopic Pregnancies

Abstract

Background: Consecutive measurements of β-hCG levels and sonographic evaluation of adnexae are critical for choosing the optimal management in ampullar tubal ectopic pregnancies (EP). To select suitable patients for conservative approach, there is a need for an affordable and reliable marker for determining rupture risk. Evaluation of systemic inflammatory markers in combination with serum β-hCG levels and ultrasound might help to decide the appropriate treatment option. Objective: The purpose of the present study was to evaluate the diagnostic value of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in determining the rupture risk in ampullar tubal EPs and to compare with intraoperative findings. Methods: A total of 142 patients who underwent surgery for tubal EP were included. Seventy-two patients were in the intraoperatively diagnosed tubal rupture group and 70 patients without rupture findings were included in the control group. Both groups were compared for inflammation markers, β-hCG levels, and sonographic findings. Results: Both NLR and PLR levels were found to be significantly higher in the tubal rupture group (4.62 ± 3.13 vs. 2.67 ± 1.43, 162.94 ± 63.61 vs. 115.84 ± 41.15, p < 0.01, respectively). According to the receiver operating characteristic analysis performed for the diagnostic performance of tubal diameter measurement, β-hCG, NLR, and PLR levels were significantly associated with histopathologically confirmed tubal rupture (p < 0.01). Conclusion: Systemic inflammatory markers are feasible and affordable tools for predicting tubal rupture risk in ampullar EPs and might be useful for determining surgery decision especially in low resource settings.

Association Between White Blood Cells at Baseline and Treatment Failure of MTX for Ectopic Pregnancy

“…Cekmez et al (11) report that MPV and NLR levels were higher in a successful MTX treatment group than in a failure group, suggesting that higher MPV and NLR are protective factors for success with singledose MTX treatment. Kanmaz et al (9) report that NLR could be used to evaluate the success of single-dose MTX administration in treating EP. Another study (9) found that both the levels of NLR and PLR were significantly higher in an FT rupture group compared with the levels of NLR and PLR in a non-rupture EP group, which suggests that inflammation markers are predictors for the risk of FT rupture.…”

“…Some studies have also found an association between inflammation-related indicators and treatment. Several inflammation-related indicators can be related to the efficacy of MTX, such as neutrophil-lymphocyte ratio (NLR), plateletlymphocyte ratio (PLR), platelet distribution width (PDW), platelet mean volume (MPV), and platelet count (PLT) (9)(10)(11). White blood cell (WBC) count, as the most common and important test index for evaluating inflammation in clinical practice, is often measured for each patient on the first day of admission.…”

The benefits of higher LMR for early threatened abortion: A retrospective cohort study

“…The evidence obtained from experimental studies has suggested that inflammation is involved in the whole pregnancy evolution [12,13,14]. In addition, the clinical studies have found that inflammationrelated parameters are strongly correlated with the pregnancy complications [15,16]. However, the evidence of the link between inflammation and miscarriage in women with early threatened abortion is limited.…”

Can Inflammatory Hematological Parameters be a Guide to Late-onset Fetal Growth Restriction?

“…Neutrophils are undoubtedly major effectors of acute inflammation, however several results reported in different studies have indicated that they also contribute to chronic inflammatory conditions and adaptive immune responses [12]. Ratios that have been recently investigated in many diseases including the neutrophil-lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) are affordable, sensitive, and useful inflammation markers [13]. Studies have indicated that these markers have prognostic value in coronary artery disease, diabetes, inflammatory arthritis, hyperemesis gravidarum, and preeclampsia [14,15].…”