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Year : 2017  |  Volume : 3  |  Issue : 2  |  Page : 79-83

Diagnostic accuracy of neutrophil to lymphocyte ratio in prediction of nonsevere preeclampsia and severe preeclampsia

1 Department of Obstetrics and Gynaecology, King George's Medical University, Lucknow, Uttar Pradesh, India
2 Department of Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
3 Department of Physiology, Career Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
4 Department of Anesthesiology, King George's Medical University, Lucknow, Uttar Pradesh, India

Correspondence Address:
Prof. Rekha Sachan
Department of Obstetrics and Gynaecology, King George's Medical University, C-28, Sec-J Aliganj, Lucknow - 226 024, Uttar Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jcrsm.jcrsm_27_17

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Background: Preeclampsia (PE) is a pregnancy specific syndrome characterized by hypertension and proteinuria after 20 weeks of gestation. There is inadequate placentation due to a deficiency in trophoblastic invasion which causes placental hypoxia leading to pro-inflammatory cytokine secretion, neutrophil activation, and endothelial dysfunction. Material and Methods: This prospective case–control study was carried out over a period of 1 year after informed consent and ethical clearance. Total 543 pregnant women were recruited and 43 women were lost to follow up, so 500 pregnant women followed upto 6 weeks after delivery. Out of these 51 women developed hypertensive disorders of pregnancy. 1 subject excluded during analysis since she developed Eclampsia. Thus study comprised of total 50 cases [Group 1(nonsevere PE)-34 cases and Group 2 (severe PE)-16 cases] and 51 healthy pregnant women who were controls. 5 ml venous blood samples were obtained from all the cases and controls. Samples were collected 2 times; first during the enrollment and second sample was collected after the development of disease. Neutrophil, and lymphocyte levels were measured by Medonic M 20, automated cell counter which gives the reading of cell counts, when microlitres of blood pass through it, NL ratio was obtained after reading. Results: Those women who developed PE during follow-up (Groups 1 and 2) had higher neutrophil to lymphocyte ratio (NLR) than that of the healthy pregnant women even at early gestation. The receiver operating curve showed significant diagnostic accuracy of NLR between controls and nonsevere PE (NSPE) cases (area under the curve [AUC] = 0.75, P = 0.01) at cutoff value of >3.35%, 52.9% sensitivity, and 74.5% specificity. It also showed significant diagnostic accuracy (AUC = 0.894, P = 0.005) between NSPE and severe PE, at a cutoff value of 3.42 with a sensitivity of 81.3% and specificity of 64.7%. Conclusion: NLR is a promising marker for the prediction of PE and in the detection of severe PE too.

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