The Clinical Utility of Neutrophil-Based Inflammatory Indices (PIV, DNI, and NPAR) in the Early Prediction of Cesarean Scar Pregnancy

Objectives: To assess the clinical utility of neutrophil-based inflammatory indices—pan-immune inflammation value (PIV), delta neutrophil index (DNI), and neutrophil percentage-to-albumin ratio (NPAR)—in the early prediction of cesarean scar pregnancy (CSP). Methods: This retrospective case-control study was conducted at Ankara Bilkent City Hospital between January 2023 and March 2025. Thirty-six women diagnosed with CSP and sixty gestational age-matched women undergoing elective termination of early pregnancy were included. Inflammatory markers, including complete blood count parameters, DNI, NPAR, and PIV, were evaluated. Group comparisons were performed using appropriate statistical tests. Receiver operating characteristic (ROC) analysis was used to determine optimal cut-off values for predictive markers. Results: CSP cases demonstrated significantly higher white blood cell (WBC) counts, neutrophil percentages (NEU%), DNI, and PIV values, along with significantly lower lymphocyte counts compared to controls (p < 0.05). No significant difference was observed in NPAR values (p = 0.591). ROC analysis indicated moderate predictive performance for WBC (AUC = 0.707), NEU (%) (AUC = 0.647), and PIV (AUC = 0.647) in predicting CSP. Conclusion: Elevated inflammatory indices such as WBC, NEU (%), DNI, and PIV may serve as adjunctive, accessible biomarkers for early CSP detection. Their integration with imaging modalities could enhance diagnostic accuracy, particularly in settings with limited access to advanced imaging. Larger prospective multicenter studies are warranted to validate these findings and explore their utility in clinical practice.