Relationship Between Inflammation-Nutrition Composite Indices and Ovarian Endometrioma: A Retrospective Observational Study

Yan Zhang,1 Ni Mei Zeng,1 Jing Yi Fan,1 Jian Ping Qiu,2 Fang Da Jiang,3 Yun Wang1 1Physical Examination Center, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, People’s Republic of China; 2Gynecological Department, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, People’s Republic of China; 3Internal Medicine Department, Aurora Oshkosh Medical Center, Oshkosh, Wisconsin, USACorrespondence: Yun Wang, Physical Examination Center, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, No. 242, Guang Ji Road, Suzhou, 215008, People’s Republic of China, Email [email protected]: Endometriosis is a chronic inflammatory disease with impacts on reproduction, health and quality of life, yet its diagnosis is often delayed. Ovarian endometrioma (OMA) is the most common subtype of endometriosis. The establishment of simple predictive indicators could screen women at high risk of OMA, thereby potentially facilitating the early diagnosis and management of endometriosis. This study aimed to comprehensively evaluate the predictive performance of inflammation and inflammation-nutrition composite indices for ovarian endometrioma (OMA) among women of reproductive age in China.Methods: A total of 333 women with diagnosed OMA and 506 controls were included in this study. Inflammation indices including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune inflammation index (SII) and inflammation-nutrition composite indices including neutrophil percentage‑to‑albumin ratio (NPAR), NLR/AGR, PLR/AGR, SII/AGR and neutrophil percentage/AGR(NP/AGR) were calculated. Multivariate logistic regressions were used to assess the associations of indices with OMA. Receiver operating characteristic (ROC) curves and areas under the curve (AUCs) were used to evaluate the predictive value of indices for OMA.Results: Compared with women without OMA, inflammation indices (NLR, PLR, SII) and inflammation-nutrition composite indices (NPAR, NLR/AGR, PLR/AGR, SII/AGR, NP/AGR) in patients with OMA showed a significant increase. Subjects in the higher tertile of these indices had a significantly increased risk of OMA compared with those in the lower tertile (P < 0.01). NP/AGR had the greatest total AUC (AUC = 0.799) in the ROC curve analysis.Conclusion: NPAR, NLR/AGR, PLR/AGR, SII/AGR and NP/AGR could provide additional clinical diagnostic value for OMA as non-invasive and cost-effective tests, and are better than inflammation indices (NLR, PLR, SII) alone. Among them, NP/AGR might be the best predictor.Keywords: neutrophil-to-lymphocyte ratio, NLR, platelet-to-lymphocyte ratio, PLR, systemic immune inflammation index, SII, neutrophil-percentage-to-albumin ratio