Neutrophil–lymphocyte ratio for the prediction of histological chorioamnionitis in cases of preterm premature rupture of membranes: a case-control study

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Abstract

Background

The neutrophil-lymphocyte ratio (NLR) is easily calculated blood test parameter, which can be used as marker to predict many inflammatory disorders. The aim of this study was to assess and compare the NLR in maternal blood with the white blood cell (WBC) count and C-reactive protein (CRP) concentration for the prediction of histological chorioamnionitis.

Methods

This was a case-control study of 137 woman with preterm premature rupture of membranes (PPROM) at a gestational age between 22 ^+ 0 and 34 ^+ 6 weeks. Blood samples, collected less than 48 h before delivery and at least 48 h after the administration of corticosteroids, were selected for the analysis. The NLR was calculated by dividing the number of neutrophils by the number of lymphocytes. Chorioamnionitis was diagnosed by the histopathological evaluation of placental membranes and chorionic plate.

Results

Patients with diagnosed histological chorioamnionitis (HCA) had significantly higher levels of WBC, CRP and NLR (p-value < 0.001). Levels of WBC, CRP and NLR predicted HCA with an area under the curve (AUC) of 0.81, 0.81 and 0.89, respectively. NLR had statistically significantly higher AUC than WBC, but no significant difference was found between AUCs of NLR and CRP. The cut-off level of NLR was found to be 5,97, which had a sensitivity of 77 % and a specificity of 95 %.

Conclusion

NLR has a good predictive value for HCA and could be used as an additional diagnostic marker for predicting histological chorioamnionitis in cases with preterm premature rupture of membranes before 34 weeks of gestation.

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Most cited references 26

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Prevalence and diversity of microbes in the amniotic fluid, the fetal inflammatory response, and pregnancy outcome in women with preterm pre-labor rupture of membranes.

Daniel B DiGiulio, Roberto Romero, Juan Pedro Kusanovic … (2010)

The role played by microbial invasion of the amniotic cavity (MIAC) in preterm pre-labor rupture of membranes (pPROM) is inadequately characterized, in part because of reliance on cultivation-based methods. Amniotic fluid from 204 subjects with pPROM was analyzed with both cultivation and molecular methods in a retrospective cohort study. Broad-range and group-specific polymerase chain reaction (PCR) assays targeted small subunit ribosomal DNA (rDNA), or other gene sequences, from bacteria, fungi, and archaea. Results were correlated with measurements of host inflammation, as well as pregnancy and perinatal outcomes. The prevalence of MIAC was 34% (70/204) by culture, 45% (92/204) by PCR, and 50% (101/204) by both methods combined. The number of bacterial species revealed by PCR (44 species-level phylotypes) was greater than that by culture (14 species) and included as-yet uncultivated taxa. Some taxa detected by PCR have been previously associated with the gastrointestinal tract (e.g., Coprobacillus sp.), the mouth (e.g., Rothia dentocariosa), or the vagina in the setting of bacterial vaginosis (e.g., Atopobium vaginae). The relative risk for histologic chorioamnionitis was 2.1 for a positive PCR [95% confidence interval (CI), 1.4-3.0] and 2.0 for a positive culture (95% CI, 1.4-2.7). Bacterial rDNA abundance exhibited a dose relationship with gestational age at delivery (R(2) = 0.26; P < 0.01). A positive PCR was associated with lower mean birthweight, and with higher rates of respiratory distress syndrome and necrotizing enterocolitis (P < 0.05 for each outcome). MIAC in pPROM is more common than previously recognized and is associated in some cases with uncultivated taxa, some of which are typically associated with the gastrointestinal tract. The detection of MIAC by molecular methods has clinical significance.

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Glucocorticoid-induced granulocytosis: contribution of marrow release and demargination of intravascular granulocytes.

Motohito Nakagawa, Takeshi Terashima, Yulia D’yachkova … (1998)

Glucocorticoid-induced granulocytosis has been attributed to enhanced release of polymorphonuclear leukocytes (PMNs) from bone marrow, delayed apoptosis, and reduced egress of PMNs into tissues. This study was designed to determine the relative contributions of PMNs released from the bone marrow and those entering the circulation from the marginated pool to the granulocytosis produced by a single dose of dexamethasone (2.0 mg/kg) in rabbits. PMN transit through the mitotic and postmitotic pools of the bone marrow and rate of release of PMNs into the circulation were measured by use of the thymidine analogue 5'-bromo-2'-deoxyuridine (BrdU) to pulse-label PMNs in the bone marrow. The shift of PMNs from the marginated to the circulating pool was measured with BrdU-labeled PMNs transferred from donor rabbits to recipients before dexamethasone was delivered. The data show that dexamethasone increased bone marrow release of PMNs and shortened their transit time through the postmitotic pool (P 0.05). Dexamethasone slowed the clearance of BrdU-labeled PMNs from the circulation (P<0.05) and lengthened their disappearance (half-life) from the circulation compared with control (half-life, 4.95 versus 9. 45 hours). At 6 hours after dexamethasone, bone marrow release contributed approximately 10%, mobilization from the marginated pool approximately 61%, and a lengthened half-life in the circulation approximately 29% to the glucocorticoid-induced granulocytosis. We conclude that a single dose of dexamethasone causes a granulocytosis primarily by a shift of PMNs from the marginated to the circulating pool, with a minor contribution from marrow release.

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Early neurodevelopmental outcomes of extremely preterm infants

Susan Hintz, Elizabeth Rogers (2016)

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Author and article information

Contributors

Diana Ramasauskaite: diana.ramasauskaite@santa.lt

Journal

Journal ID (nlm-ta): BMC Pregnancy Childbirth

Journal ID (iso-abbrev): BMC Pregnancy Childbirth

Title: BMC Pregnancy and Childbirth

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2393

Publication date (Electronic): 27 September 2021

Publication date PMC-release: 27 September 2021

Publication date Collection: 2021

Volume: 21

Electronic Location Identifier: 656

Affiliations

[1 ]GRID grid.6441.7, ISNI 0000 0001 2243 2806, Clinic of Obstetrics, and Gynecology, , Institute of Clinical Medicine, Faculty of Medicine of Vilnius University, ; M.K. Ciurlionio st. 21, 03101 Vilnius, Lithuania

[2 ]GRID grid.6441.7, ISNI 0000 0001 2243 2806, Center of Obstetrics and Gynecology, , Vilnius University Hospital Santaros Klinikos, ; Santariskiu st. 2, 08661 Vilnius, Lithuania

[3 ]GRID grid.493509.2, Department of Immunology, , State Research Institute Centre for Innovative Medicine, ; Santariskiu st. 5, 08410 Vilnius, Lithuania

Article

Publisher ID: 4101

DOI: 10.1186/s12884-021-04101-z

PMC ID: 8474740

PubMed ID: 34579660

SO-VID: ee64467e-3022-4890-93c1-9b8108cb4d16

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 9 May 2021

Date accepted : 29 August 2021

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100004504, Lietuvos Mokslo Taryba;

Award ID: S-MIP-19-57

Custom metadata

ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: chorioamnionitis,preterm premature rupture of membranes,neutrophil-lymphocyte ratio,white blood cell,c-reactive protein

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ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: chorioamnionitis, preterm premature rupture of membranes, neutrophil-lymphocyte ratio, white blood cell, c-reactive protein

Neutrophil–lymphocyte ratio for the prediction of histological chorioamnionitis in cases of preterm premature rupture of membranes: a case-control study

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Bacterial vaginosis and biofilm

Most cited references 26

Prevalence and diversity of microbes in the amniotic fluid, the fetal inflammatory response, and pregnancy outcome in women with preterm pre-labor rupture of membranes.

Glucocorticoid-induced granulocytosis: contribution of marrow release and demargination of intravascular granulocytes.

Early neurodevelopmental outcomes of extremely preterm infants

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