Predication of Preeclampsia Severity by NLR and PLR

Background & Objective: We aimed to assess the Neutrophil Lymphocyte Ratio (NLR) and the Platelet Lymphocyte Ratio (PLR) in pregnant women with Severe Preeclampsia (SPE) compared with Non-Severe Preeclampsia (NSPE) and Non Preeclamptic (NPE) controls to evaluate whether there is an association between these hematologic parameters and severity of preeclampsia (PE). Methods: Demographic data and laboratory results of 148 pregnant women (age range:15-43 years; mean age:30 years), with SPE, NSPE and NPE were retrospectively evaluated in this cohort study during 2019-2021. Three groups were evaluated in terms of demographic characteristics and the hematological parameters of first trimester including Neutrophil, Lymphocyte, Platelet, NLR and PLR. Receiver Operating Characteristic curve (ROC) analysis was also performed to identify the optimal levels of NLR and PLR to predict PE. Results: In the present study, of 148 pregnant women, 47(31.7%) were SPE, 46(~31.1%) were NSPE and the remaining 55 (~37.2%) were NPE. According to the Kolmogorov-Smirnov Test, variables don’t have normal distribution between groups (p<0.05). According to the Kruskal-Wallis Test, there was not a statistically significant difference between NLR and PLR in these three groups (p<0.05); however, the median of PLR in SPE group was higher than the two other groups. In the hematological parameters after Generalized Estimating Equation (GEE) analysis, NLR (p=0.000, β=-0.405) and PLR (p=0.001, β=15.5) levels in the SPE group were higher than the NSPE group. Also NLR (p=0.000, β=0.529) and PLR (p=0.000, β=-39.03) levels in the SPE group were higher than the control group. In the ROC analysis, for both NLR and PLR, the area under the curve was <0.07. The cut-off values of NLR>2.13 and PLR>81 predicted PE between NSPE and NPE groups with the sensitivity of 73% and 60% and specificity of 43% and 48% respectively. The cut-off values of NLR>2.03 and PLR>85 predicted PE between SPE and NSPE groups with the sensitivity of 70% and 60% and the specificity of 27% and 46.7% respectively. Conclusion: NLR and PLR cannot be used as a marker. in predicting of subsequent PE or its severity.