NLR predictive index for liver and coagulation dysfunction in preeclampsia patients

A new study in BMC Pregnancy and Childbirth, reveals that neutrophil to lymphocyte ratios (NLR) could be used as an independent predictor of liver and coagulation dysfunction in Pre-eclampsia (PE) patients. PE is related to an enhanced immune response hence immune cell characteristics such as neutrophil or monocyte to lymphocyte ratios (NLR, MLR) are known to be related to kidney and liver dysfunction in hypertensive patients hence can be evaluated for the same.

PE is a serious complications of pregnancy with growing rate of 3–3.5% from 20 weeks into pregnancy. The clinical manifestations of PE are hypertension, proteinuria, HELLP syndrome (hemolysis, elevated liver enzymes, and thrombocytopenia), maternal pulmonary edema, cerebral palsy, and cerebrovascular accidents in severe cases.

Hui Xing Cui and team aimed to analyze the correlations between NLR, MLR and platelet to lymphocyte ratio (PLR) and liver, renal and coagulation functional parameters and the impacts of these immune cell profiles to the prognostic significance in PE patients.

A total of 320 first-time pregnant women with pre-delivery hematological and biochemical parameters analyzed retrospectively. Patients were divided into normal pregnancy (normal, n = 161), mild PE (mPE, n = 28) and severe PE (sPE, n = 131) groups according to diagnostic criteria. Pearson correlation analysis were performed and area under the curve (AUC) were conducted for the diagnostic values of NLR, MLR and PLR. Results were validated with data from the Department of Obstetrics and Gynecology of Seoul National University Hospital (SNUH).

The key findings of the study are:

• Kidney functional indexes were adversative in mPE and sPE and liver and coagulation indexes were worse in sPE compared to normal groups.

• Among immune cells, lymphocytes were increased in mPE and sPE patients, resulted in reduced NLR, MLR and PLR in PE groups, more significant difference were shown in sPE.

• NLR and PLR were associated with CREA and/or BUN negatively and positive associations were observed with total protein (TP) and albumin (ALB) in sPE.

• Only NLR showed positive associations with coagulation indexes (PT and APTT) in sPE. AUC analysis for NLR, MLR and PLR were 0.700, 0.656, 0.643, respectively, and NLR < 3.7 predicted hypertension (95% CI in all participants: 0.647–0.749, p < 0.001).

• Blood pressure, liver, kidney and coagulation indexes were worse at cut off value (NLR < 3.7), and this was validated with the data from SNUH.

Hui Xing Cui and team concluded that NLR could be used as an independent predictor of liver and coagulation dysfunction in PE patients. Their results may provide non-invasive and efficient way of the risk assessment among PE patients.

Reference: Cui, H.X., Chen, C., Jung, Y.M. et al. Neutrophil-to-lymphocyte ratio (NLR) as a predictive index for liver and coagulation dysfunction in preeclampsia patients. BMC Pregnancy Childbirth 23, 4 (2023). https://doi.org/10.1186/s12884-022-05335-1.