Neutrophil- Lymphocyte Ratio (NLR) and Platelet- Lymphocyte Ratio (PLR) as Inflammatory Markers in Preterm Birth

Muthiah Nurul Izzah; Herman Sumawan; Eppy Darmadi Achmad

doi:10.24198/obgynia.v7i2.671

Neutrophil- Lymphocyte Ratio (NLR) and Platelet- Lymphocyte Ratio (PLR) as Inflammatory Markers in Preterm Birth

Muthiah Nurul Izzah, Herman Sumawan, Eppy Darmadi Achmad

Abstract

Introduction: Preterm births make up roughly 16–18% of all live births in Indonesia. One of the factors that contribute to preterm birth is inflammation. The study aimed to assess the role of platelet/lymphocyte ratio (PLR) and neutrophil/lymphocyte ratio (NLR) as inflammatory markers in preterm birth.
Method: This is a cross-sectional retrospective Study. Data were collected from medical records at Margono Soekarjo Hospital, January 2022-February 2023. The cohort comprised 150 participants with singleton pregnancies, ranging from 28 to less than 37 weeks of gestation, divided into three groups: preterm birth without preterm premature rupture of membranes (PPROM), preterm birth with PPROM, and threatened preterm labor (TPL). Multivariate ANOVA tests were employed for data analysis.
Result: There was a statistically significant difference NLR values , notably in preterm births without PPROM compared to other groups (p value < 0.005), whereas the only difference noted in PLR values was noted between preterm births with and without PPROM. Our finding differs from that of previous studies, which indicated higher NLR values in preterm births with PPROM.
Conclusion: NLR and PLR have the potential to be used as inflammatory markers indicative of heightened risk of preterm birth.

Rasio Neutrofil-Limfosit (RNL) dan Rasio Platelet-Limfosit (RPL) sebagai Penanda Inflamasi pada Persalinan Prematur

Abstrak
Pendahuluan: Angka kejadian persalinan prematur di Indonesia mencakup 16-18% dari semua kelahiran hidup. Inflamasi atau infeksi dianggap sebagai salah satu penyebab persalinan prematur. Penelitian ini bertujuan untuk menilai peran rasio trombosit/limfosit (PLR) dan rasio neutrofil/limfosit (NLR) sebagai penanda inflamasi pada kelahiran premature.
Metode: Penelitian merupakan studi retrospektif cross-sectional. Data dikumpulkan dari rekam medis RSUD Margono Soekarjo periode Januari 2022 - Februari 2023. Didapatkan 150 pasien hamil tunggal dengan rentang usia kehamilan 28 hingga kurang dari 37 minggu yang terbagi dalam tiga kelompok: kelahiran prematur tanpa ketuban pecah dini (KPD), kelahiran prematur dengan KPD, dan ancaman persalinan prematur. Tes ANOVA multivariat digunakan untuk analisis data.
Hasil: Terdapat perbedaan nilai NLR yang signifikan secara statistik, terutama pada kelahiran prematur tanpa KPD dibandingkan dengan kelompok lain (nilai p <0,005), sedangkan perbedaan nilai PLR hanya terdapat pada kelahiran prematur dengan dan tanpa KPD. Temuan kami berbeda dengan penelitian sebelumnya yang menunjukkan nilai NLR lebih tinggi pada kelahiran prematur dengan KPD.
Kesimpulan: NLR dan PLR berpotensi digunakan sebagai penanda inflamasi yang mengindikasikan peningkatan risiko kelahiran prematur.

Kata kunci: NLR, PLR, persalinan prematur

Keywords

NLR, PLR, preterm birth

Full Text:

PDF

References

Tim Fakultas Kedokteran Universitas Padjadjaran. Obstetri Patologi. 3 ed. Jakarta: Penerbit Buku Kedokteran EGC; 2017.

World Health Organization. WHO Fact Sheet: Preterm Birth 10 May 2023. Available from: https://www.who.int/en/news-room/fact-sheets/detail/preterm-birth.

Purisch SE, Gyamfi-Bannerman C. Epidemiology of preterm birth. Semin Perinatol. 2017;41(7):387-91.

Simmons LE, Rubens CE, Darmstadt GL, Gravett MG. Preventing preterm birth and neonatal mortality: exploring the epidemiology, causes, and interventions. Semin Perinatol. 2010;34(6):408-15.

Aziz MA. Strategi pencegahan kelahiran preterm: suplementasi vitamin D, tantangan dan harapannya ke depan. Bandung: KSM/Departemen Obstetri dan Ginekologi Fakultas Kedokteran UNPAD RSUP Dr. Hasan Sadikin Bandung; 2019.

Toprak E, Bozkurt M, Dinçgez Çakmak B, Özçimen EE, Silahlı M, Ender Yumru A, et al. Platelet-to-lymphocyte ratio: A new inflammatory marker for the diagnosis of preterm premature rupture of membranes. J Turk Ger Gynecol Assoc. 2017;18(3):122-6.

Xiao WK, Chen D, Li SQ, Fu SJ, Peng BG, Liang LJ. Prognostic significance of neutrophil-lymphocyte ratio in hepatocellular carcinoma: a meta-analysis. BMC Cancer. 2014;14:117.

Hershko Klement A, Hadi E, Asali A, Shavit T, Wiser A, Haikin E, et al. Neutrophils to lymphocytes ratio and platelets to lymphocytes ratio in pregnancy: A population study. PLoS One. 2018;13(5):e0196706.

Kim MA, Lee YS, Seo K. Assessment of predictive markers for placental inflammatory response in preterm births. PLoS One. 2014;9(10):e107880.

Esercan A, Demir I. Neutrophil/Lymphocyte and Platelet/Lymphocyte Ratio in Preterm Premature Rupture of Membranes. Cureus. 2023;15(5):e38664.

Kurtoglu E, Kokcu A, Celik H, Tosun M, Malatyalioglu E. May ratio of neutrophil to lymphocyte be useful in predicting the risk of developing preeclampsia? A pilot study. J Matern Fetal Neonatal Med. 2015;28(1):97-9.

Sahbaz A, Cicekler H, Aynioglu O, Isik H, Ozmen U. Comparison of the predictive value of plateletcrit with various other blood parameters in gestational diabetes development. J Obstet Gynaecol. 2016;36(5):589-93.

Kirbas A, Biberoglu E, Daglar K, İskender C, Erkaya S, Dede H, et al. Neutrophil-to- lymphocyte ratio as a diagnostic marker of intrahepatic cholestasis of pregnancy. Eur J Obstet Gynecol Reprod Biol. 2014;180:12-5.

Akgun N, Namli Kalem M, Yuce E, Kalem Z, Aktas H. Correlations of maternal neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) with birth weight. J Matern Fetal Neonatal Med. 2017;30(17):2086-91.

Yavuzcan A, Cağlar M, Ustün Y, Dilbaz S, Ozdemir I, Yildiz E, et al. Mean platelet volume, neutrophil-lymphocyte ratio and platelet-lymphocyte ratio in severe preeclampsia. Ginekol Pol. 2014;85(3):197-203.

Peng LP, Li J, Li XF. Prognostic value of neutrophil/lymphocyte, platelet/lymphocyte, lymphocyte/monocyte ratios and Glasgow prognostic score in osteosarcoma: A meta- analysis. World J Clin Cases. 2022;10(7):2194-205.

Conti N, Torricelli M, Voltolini C, Vannuccini S, Clifton VL, Bloise E, et al. Term histologic chorioamnionitis: a heterogeneous condition. Eur J Obstet Gynecol Reprod Biol. 2015;188:34-8.

Jain V, Das V, Agarwal A, Pandey A. Asymptomatic bacteriuria & obstetric outcome following treatment in early versus late pregnancy in north Indian women. Indian J Med Res. 2013;137(4):

DOI: http://dx.doi.org/10.24198/obgynia.v7i2.671