Association between first trimester platelet to lymphocyte ratio and stillbirth.

BACKGROUND: Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) have been investigated as inflammatory markers of malignancies, cardiovascular and autoimmune diseases. We explored the association between NLR, PRL, measured during pregnancy, and stillbirth (SB). METHODS: We conducted a retrospective case control study at a tertiary hospital center in New York City from May 2015 to July 2018. Cases were defined as SB pregnancies and controls as uncomplicated pregnancies. We calculated NLR and PLR using the complete blood count components routinely collected during prenatal care in the first trimester. The groups were matched by age, parity, body mass index (BMI) and race. We used receiver operating characteristic (ROC) curve analysis to evaluate the association of NLR and PLR to SB. RESULTS: We identified 28 patients with SB pregnancies and matched them with 28 controls. Age, parity, BMI, and race were equally distributed between the groups. The median gestational age of SB was 30 weeks (22-34). In the first trimester PLR was significantly lower in SB cases compared to controls (124.8 vs. 153.4, P=0.044) with an area under the curve (AUC) of 0.65. A PLR value higher than 156.4 accurately excluded SB with a sensitivity of 0.50, specificity of 0.89, positive predictive value of 0.013 and a negative predictive value of 0.998. NLR did not show a significant difference in the first trimester. CONCLUSIONS: A PLR higher than 156.4 in the first trimester appears to reliably exclude the occurrence of SB later during pregnancy. Lower platelet and higher lymphocyte levels may be related to an early inflammatory process. We speculate that pregnancies in which the initial myometrial invasion by the placental cells is dysfunctional and reflected by a high level of inflammation in the peripheral maternal blood, may contribute to fetal demise. Larger studies are needed to confirm our results.

Predictors of readmission for postpartum preeclampsia.

Objective: To develop a predictive model for re-admission for postpartum preeclampsia (PPEC).Methods: A case-control study; cases were patients re-admitted for PPEC; controls were not re-admitted. Mixed linear modelling was used to develop a predictive model on the training set, then validated on the validation set.Results: Two-hundred-sixty-nine patients were readmitted, and matched to 538 controls. A risk calculator was developed and yielded a sensitivity and specificity for readmission of 80.9% and 53.5%, respectively.Conclusion: A predictive model using age, race, discharge blood pressures, and preeclampsia was able to predict re-admission for PPEC with a high level of sensitivity.

Association Between Complete Blood Count Components and Intrahepatic Cholestasis of Pregnancy.

Objective Some components of the routine complete blood count (CBC) and their ratios, such as neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been found to be sensitive biomarkers of preeclampsia and other inflammatory obstetric conditions. We wanted to evaluate whether they can be associated with intrahepatic cholestasis of pregnancy (ICP). Materials and Methods We conducted a retrospective case-control study between May 1, 2015 and July 1, 2018. Cases were considered pregnancies with ICP and control healthy pregnancies. Cases and controls were matched for age, parity, and race. We compared the levels of white blood cells (WBC), hemoglobin, neutrophils, lymphocytes, NLR, PLR, platelets, red cell distribution width (RDW), and mean platelet volume (MPV) in the first and third trimesters between cases and controls. In addition, we compared the same components in the third trimester between patients with mild (serum total bile acid (TBA) of 10 - 40 µmols/L) and severe (TBA > 40 µmols/L) ICP.  Results There were 33 patients with ICP and 33 controls. There were no significant differences between the two groups in the first trimester. WBC, neutrophil count, and NLR were decreased in women with ICP in the third trimester compared to controls. MPV was significantly higher in the third trimester of patients with ICP compared to controls. RDW was lower in mild ICP compared to severe ICP in the third trimester. Conclusion Decreased WBC, neutrophil, NLR, and MPV values are associated with ICP and may be useful additions to the diagnostic algorithm for ICP. Larger studies are needed to assess the responsible underlying molecular pathogenic mechanisms.