Clinical characteristics and inflammatory–endothelial biomarkers associated with posterior reversible encephalopathy syndrome in eclampsia

Posterior reversible encephalopathy syndrome (PRES) is an acute neurological syndrome characterized by seizures, headache, visual disturbances, and altered consciousness, and is frequently associated with vasogenic cerebral edema. Eclampsia is one of the most common obstetric conditions associated with PRES due to severe hypertension, endothelial dysfunction, and systemic inflammation. However, data regarding easily accessible inflammatory and endothelial dysfunction biomarkers associated with PRES in patients with eclampsia remain limited. The aim of this study was to evaluate the clinical characteristics, laboratory parameters, and inflammatory indices associated with PRES in patients diagnosed with eclampsia. This retrospective observational study included a total of 62 patients diagnosed with eclampsia and followed in the intensive care unit (ICU) between January 2015 and December 2024. Patients were divided into two groups according to the presence or absence of PRES based on neurological findings and brain magnetic resonance imaging (MRI) results. Demographic, obstetric, clinical, and laboratory data were obtained from electronic medical records. Inflammatory biomarkers, including C-reactive protein (CRP), albumin, magnesium, C-reactive protein/albumin ratio (CAR), CRP/lymphocyte ratio (CRP/L), neutrophil/lymphocyte ratio (NLR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI), were analyzed. Receiver operating characteristic (ROC) analysis and multivariable logistic regression analysis were performed. PRES was identified in 25 patients (40.3%). Parity and gravidity were significantly lower in patients with PRES. CRP, CAR, and CRP/L levels were significantly higher in the PRES group, whereas albumin and serum magnesium levels were significantly lower. Parieto-occipital involvement was the most common MRI finding. In ROC analysis, CAR (AUC: 0.852), CRP (AUC: 0.847), and serum magnesium (AUC: 0.808) demonstrated good discriminative ability between patients with and without PRES. In the parsimonious multivariable logistic regression analysis, higher CAR levels and lower serum magnesium levels and parity remained independently associated with the presence of PRES. The presence of PRES in patients with eclampsia was associated with lower parity, increased inflammatory burden, and markers of endothelial dysfunction. These findings add to the limited evidence regarding inflammation-related biomarkers in obstetric PRES and suggest that inflammation-related biomarkers may provide complementary information when interpreted alongside established clinical and radiological findings. Further prospective multicenter studies are warranted to confirm these exploratory findings.