Inflammatory and fibrosis indices (UA/Alb, Fib/UA, UA/Cr, Cr/BW, AST/PLT, AST/ALT, FIB-4, and FIB-5) as predictors of preeclampsia-associated systemic dysfunction

Abstract Objective This study aimed to evaluate the clinical and prognostic value of various inflammatory and metabolic indices in identifying of early-onset (EO-PE) and late-onset preeclampsia (LO-PE) and in predicting composite adverse maternal outcomes (CAMO), composite adverse perinatal outcomes (CANO), and disease severity. Methods This retrospective cohort study included 625 singleton pregnant women followed at a tertiary center between January 1, 2023, and January 1, 2025. The study group comprised 320 preeclamptic women (170 EO-PE < 34 weeks, 150 LO-PE ≥ 34 weeks), while 305 gestational age-matched healthy pregnancies served as controls (155 early controls, 150 late controls). Preeclampsia cases were further classified into 155 severe and 165 mild cases. The indices analyzed included uric acid/albumin ratio (UA/Alb), fibrinogen/uric acid ratio (Fib/UA), uric acid/creatinine ratio (UA/Cr), creatinine/body weight ratio (Cr/BW), AST/platelet ratio (AST/PLT), AST/ALT ratio, and fibrosis indices (FIB-4 and FIB-5). Composite adverse maternal outcomes (CAMO) include the presence of at least one of the following maternal outcomes: thrombocytopenia, renal dysfunction, hepatic dysfunction, HELLP syndrome (hemolysis, elevated liver enzymes, low platelet count), disseminated intravascular coagulation (DIC), pulmonary edema, eclampsia, and admission to the maternal intensive care unit (ICU). Composite adverse neonatal outcomes (CANO) include the presence of at least one of the following adverse outcomes: transient tachypnea of the newborn, respiratory distress syndrome, need for continuous positive airway pressure, need for mechanical ventilation, need for phototherapy, neonatal hypoglycemia, intraventricular hemorrhage, necrotizing enterocolitis, neonatal sepsis, 5th minute APGAR score < 7, neonatal intensive care unit (NICU) admission, placental abruption, and preterm birth. Results The UA/Alb ratio and Fib/UA ratio were the most strongly associated with EO-PE and LO-PE, with high discriminative accuracy (AUC = 0.831 and 0.888, respectively). These indices also showed strong associations with CAMO, CANO, and disease severity. In contrast, the AST/ALT ratio was not significantly associated with PE discrimination, severity, CAMO, or CANO. The AST/PLT ratio and FIB-4 were significantly associated with both EO-PE and LO-PE, while FIB-5 was only associated with EO-PE. Both FIB-4 and FIB-5 were significantly linked to CAMO and CANO in EO-PE cases, but not in LO-PE. Both indices were also associated with severe preeclampsia. Although the Cr/BW ratio was associated with disease severity, it showed limited value in distinguishing EO-PE or LO-PE from the control group and was only related to CAMO and CANO in EO-PE. Conclusion Our study identified UA/Alb and Fib/UA ratios as the most informative indices for classifying EO-PE and LO-PE, assessing CAMO and CANO risk, and evaluating disease severity. The high AUC values support their potential clinical applicability. Conversely, the AST/ALT ratio was not significantly associated with preeclampsia diagnosis, disease severity, differentiation of CAMO or CANO.