Evaluation of the hematologic system as a marker of subclinical inflammation in hyperemesis gravidarum: a case control study
Abstract
Objectives: Current evidence suggests that subclinical inflammation plays a significant role in the development of hyperemesis gravidarum (HEG). Simple hematological markers, such as mean platelet volume (MPV), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR), have been shown to reflect inflammatory burden and disease activity in several disorders. This study aimed to determine the diagnostic value of these hematological parameters for HEG.
Material and methods: A total of 54 HEG patients and 58 age- and gestational-age-matched control subjects were studied. NLR, MPV, PLR, platelet distribution width (PDW), and red cell distribution width (RDW) values in all patients were calculated and recorded from complete blood cell counts.
Results: For HEG patients, the median NLR was 3.2 (1.6–7.1), and the median PLR was 143.7 (78.1–334.6); for control subjects, the values were 2.1 (1.0–4.7) and 93.1 (47.3–194.7), respectively. Although both the NLR and PLR of HEG patients were found to be significantly higher than in the controls, no significant difference was found between the study groups in terms of MPV, RDW, or PDW. Correlation analysis revealed a significant correlation between NLR and CRP (r = 0.872, p < 0.001).
Conclusions: Our results show that peripheral blood NLR and PLR values can reflect inflammatory burden in HEG patients and can be used as markers for HEG.
Keywords: hyperemesis gravidarummean platelet volumeneutrophil-to-lymphocyte ratioinflammation
References
- Sandven I, Abdelnoor M, Nesheim BI, et al. Helicobacter pylori infection and hyperemesis gravidarum: a systematic review and meta-analysis of case-control studies. Acta Obstet Gynecol Scand. 2009; 88(11): 1190–1200.
- Ismail SK, Kenny L. Review on hyperemesis gravidarum. Best Pract Res Clin Gastroenterol. 2007; 21(5): 755–769.
- Kuşcu NK, Koyuncu F. Hyperemesis gravidarum: current concepts and management. Postgrad Med J. 2002; 78(916): 76–79.
- Goodwin TM. Hyperemesis gravidarum. Obstet Gynecol Clin North Am. 2008; 35(3): 401–17, viii.
- Engin-Ustun Y, Tonguç E, Var T, et al. Vaspin and C-reactive protein levels in hyperemesis gravidarum. Eur Rev Med Pharmacol Sci. 2013; 17(1): 138–140.
- Kurt RK, Güler A, Silfeler DB, et al. Relation of inflammatory markers with both presence and severity of hyperemesis gravidarum. Ginekol Pol. 2014; 85(8): 589–593.
- Kaplan PB, Gücer F, Sayin NC, et al. Maternal serum cytokine levels in women with hyperemesis gravidarum in the first trimester of pregnancy. Fertil Steril. 2003; 79(3): 498–502.
- Torun S, Tunc BD, Suvak B, et al. Assessment of neutrophil-lymphocyte ratio in ulcerative colitis: a promising marker in predicting disease severity. Clin Res Hepatol Gastroenterol. 2012; 36(5): 491–497.
- Yildirim M, Turkyilmaz E, Avsar AF. Preoperative Neutrophil-to-Lymphocyte Ratio Has a Better Predictive Capacity in Diagnosing Tubo-Ovarian Abscess. Gynecol Obstet Invest. 2015; 80(4): 234–239.
- Suvak B, Torun S, Tas A, et al. Mean platelet volume is a useful indicator of systemic inflammation in cirrhotic patients with ascitic fluid infection. Ann Hepatol. 2013; 12(2): 294–300.
- Akbas EM, Demirtas L, Ozcicek A, et al. Association of epicardial adipose tissue, neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio with diabetic nephropathy. Int J Clin Exp Med. 2014; 7(7): 1794–1801.
- Kuscu NK, Yildirim Y, Koyuncu F, et al. Interleukin-6 levels in hyperemesis gravidarum. Arch Gynecol Obstet. 2003; 269(1): 13–15.
- Wada J. Vaspin: a novel serpin with insulin-sensitizing effects. Expert Opin Investig Drugs. 2008; 17(3): 327–333.
- Walsh SR, Cook EJ, Goulder F, et al. Neutrophil-lymphocyte ratio as a prognostic factor in colorectal cancer. J Surg Oncol. 2005; 91(3): 181–184.
- Cho S, Cho H, Nam A, et al. Neutrophil-to-lymphocyte ratio as an adjunct to CA-125 for the diagnosis of endometriosis. Fertil Steril. 2008; 90(6): 2073–2079.
- Demir AK, Demirtas A, Kaya SU, et al. The relationship between the neutrophil-lymphocyte ratio and disease activity in patients with ulcerative colitis. Kaohsiung J Med Sci. 2015; 31(11): 585–590.
- Kim EY, Lee JW, Yoo HMo, et al. The Platelet-to-Lymphocyte Ratio Versus Neutrophil-to-Lymphocyte Ratio: Which is Better as a Prognostic Factor in Gastric Cancer? Ann Surg Oncol. 2015; 22(13): 4363–4370.
- Aktar F, Tekin R, Bektaş MS, et al. Diagnostic role of inflammatory markers in pediatric Brucella arthritis. Ital J Pediatr. 2016; 42: 3.
- Caglayan EK, Engin-Ustun Y, Gocmen AY, et al. Is there any relationship between serum sirtuin-1 level and neutrophil-lymphocyte ratio in hyperemesis gravidarum? J Perinat Med. 2016; 44(3): 315–320.
- Huczek Z, Filipiak KJ, Kochman J, et al. Baseline platelet size is increased in patients with acute coronary syndromes developing early stent thrombosis and predicts future residual platelet reactivity. A case-control study. Thromb Res. 2010; 125(5): 406–412.
- Ulucan Ş, Keser A, Kaya Z, et al. Association between PDW and Long Term Major Adverse Cardiac Events in Patients with Acute Coronary Syndrome. Heart Lung Circ. 2016; 25(1): 29–34.
- Sandhaus LM, Meyer P. How useful are CBC and reticulocyte reports to clinicians? Am J Clin Pathol. 2002; 118(5): 787–793.
- Bath PM, Butterworth RJ. Platelet size: measurement, physiology and vascular disease. Blood Coagul Fibrinolysis. 1996; 7(2): 157–161.
- Kisacik B, Tufan A, Kalyoncu U, et al. Mean platelet volume (MPV) as an inflammatory marker in ankylosing spondylitis and rheumatoid arthritis. Joint Bone Spine. 2008; 75(3): 291–294.
- Sahin S, Senel S, Ataseven H, et al. Does mean platelet volume influence the attack or attack-free period in the patients with Familial Mediterranean fever? Platelets. 2013; 24(4): 320–323.
- Özer S, Yılmaz R, Sönmezgöz E, et al. Simple markers for subclinical inflammation in patients with Familial Mediterranean Fever. Med Sci Monit. 2015; 21: 298–303.
- Weiss G, Goodnough LT. Anemia of chronic disease. N Engl J Med. 2005; 352(10): 1011–1023.
