Skip to main content Skip to main navigation menu Skip to site footer

High ratio of neutrophils to lymphocytes and high triglyceride levels in serum as risk factors for pre-eclampsia



Abstract

Background: Preeclampsia is still a concerning health problem in pregnancy which can get worse if it is supported by low patient compliance. Appropriate screening method modalities can help in predicting the possibility of worsening. Neutrophil to Lymphocyte Ratio (NLR) and serum triglycerides could be used as blood parameters in preeclampsia conditions. This study determined the high Neutrophil to Lymphocyte Ratio (NLR) and high triglyceride levels as risk factors for preeclampsia in pregnant women.

Methods: A case-control study was conducted from January to June 2022 at the Obstetrics and Gynecology Polyclinic, Prof. dr. I.G.N.G Ngoerah Hospital. This study involved pregnant women over 18 years of age with a gestational age of more than 20 weeks by consecutive purposive sampling. Neutrophil to Lymphocyte Ratio (NLR) and serum triglycerides were obtained by tracing complete blood laboratory results in the medical record. Chi-square analysis was conducted and continued by logistic regression analysis with the p-value <0.05 categorized as a significant result.

Results: High NLR levels were at risk of experiencing preeclampsia 32.2 times higher than those with low NLR (95%CI 6.8 – 151; p=0.000). Patients with high triglyceride levels had a risk of experiencing preeclampsia 23.1 times higher than those with low triglycerides (95%CI 5.45 – 97.26; p=0.000). NLR, serum triglycerides, and maternal age were independent risk factors for preeclampsia after controlling for parity variables (p<0.05).

Conclusion: Neutrophil to Lymphocyte Ratio (NLR) and high triglyceride levels are risk factors for preeclampsia.

Keywords: preeclampsia Neutrophil to Lymphocyte Ratio triglyceride pregnancy risk

References

  1. Shiozaki A, Saito S. Risk Factors for Preeclampsia [Internet]. Preeclampsia. Springer Singapore; 2018. p. 3–25. Available from: http://dx.doi.org/10.1007/978-981-10-5891-2_1
  2. Hanprasertpong T, Hanprasertpong J. Pregnancy outcomes in Southeast Asian migrant workers at Southern Thailand. J Obstet Gynaecol (Lahore). 2014;35(6):565–9. Available from: http://dx.doi.org/10.3109/01443615.2014.987113
  3. Arianti IS, Djannah SN. Gambaran Epidemiologi Kejadian Preeklampsia/eklampsia di RSU PKU Muhammadiyah Yogyakarta Tahun 2007–2009. Bul Penelit Sist Kesehat. 2010;13(4).
  4. Vincent NTF, Darmayasa IM, Suardika A. Risk factors of preeclampsia and eclampsia in Sanglah General Hospital from March 2016 to March 2017. Intisari Sains Medis. 2018;9(2). Available from: http://dx.doi.org/10.15562/ism.v9i2.162
  5. Lidapraja H., Manoe IM., Surya I. Profil penderita Hipertensi dalam kehamilan di Rumah Sakit Umum Pusat Sanglah Denpasar dan Rumah Sakit dr. Wahidin Sudirohusodo Makassar tahun 2009-2010. Indones J Obstet Gynecol. 2011;35:82.
  6. Belay Tolu L, Yigezu E, Urgie T, Feyissa GT. Maternal and perinatal outcome of preeclampsia without severe feature among pregnant women managed at a tertiary referral hospital in urban Ethiopia. PLoS One. 2020;15(4):e0230638–e0230638. Available from: https://pubmed.ncbi.nlm.nih.gov/32271787
  7. Murmu S, Dwivedi J. Second-Trimester Maternal Serum Beta-Human Chorionic Gonadotropin and Lipid Profile as a Predictor of Gestational Hypertension, Preeclampsia, and Eclampsia: A Prospective Observational Study. Int J Appl basic Med Res. 2020/01/03. 2020;10(1):49–53. Available from: https://pubmed.ncbi.nlm.nih.gov/32002386
  8. Hai L, Hu Z-D. The clinical utility of neutrophil to lymphocyte ratio in pregnancy related complications: a mini-review. J Lab Precis Med. 2020;5:1. Available from: http://dx.doi.org/10.21037/jlpm.2019.10.03
  9. Islam NAF, Chowdhury MAR, Kibria GM, Akhter S. Study Of Serum Lipid Profile In Pre-Eclampsia And Eclampsia. Faridpur Med Coll J. 1970;5(2):56–9. Available from: http://dx.doi.org/10.3329/fmcj.v5i2.6823
  10. Gogoi P, Sinha P, Gupta B, Firmal P, Rajaram S. Neutrophil-to-lymphocyte ratio and platelet indices in pre-eclampsia. Int J Gynecol & Obstet. 2018;144(1):16–20. Available from: http://dx.doi.org/10.1002/ijgo.12701
  11. Bishnoi L. Correlation of serum uric acid with lipid profile in pre-eclamptic patients. J Med Sci Clin Res. 2019;7(9). Available from: http://dx.doi.org/10.18535/jmscr/v7i9.106
  12. Panwar M, Kumari A, HP A, Arora R, Singh V, Bansiwal R. Raised neutrophil lymphocyte ratio and serum beta hCG level in early second trimester of pregnancy as predictors for development and severity of preeclampsia. Drug Discov & Ther. 2019;13(1):34–7. Available from: http://dx.doi.org/10.5582/ddt.2019.01006
  13. Ephraim R, Doe P, Amoah S, Antoh E. Lipid Profile and High Maternal Body Mass Index is Associated with Preeclampsia: A Case-Control Study of the Cape Coast Metropolis. Ann Med Health Sci Res. 2014;4(5):746–50. Available from: https://pubmed.ncbi.nlm.nih.gov/25328787
  14. Ujan Y., Kusuma AAN., Mayura, I.G.P.M Mahayasa P. Kadar low density lipoprotein sebagai faktor risiko terjadinya preeklampsia : Studi kasus kontrol. Universitas Udayana; 2012.
  15. American Congress of Obstetricians and Gynecologists (ACOG) [Internet]. The Grants Register 2019. Palgrave Macmillan UK; 2018. p. 45–7. Available from: http://dx.doi.org/10.1007/978-1-349-95810-8_62
  16. Spracklen CN, Smith CJ, Saftlas AF, Robinson JG, Ryckman KK. Maternal hyperlipidemia and the risk of preeclampsia: a meta-analysis. Am J Epidemiol. 2014/07/02. 2014;180(4):346–58. Available from: https://pubmed.ncbi.nlm.nih.gov/24989239
  17. Tessema GA, Tekeste A, Ayele TA. Preeclampsia and associated factors among pregnant women attending antenatal care in Dessie referral hospital, Northeast Ethiopia: a hospital-based study. BMC Pregnancy Childbirth. 2015;15:73. Available from: https://pubmed.ncbi.nlm.nih.gov/25880924
  18. Shan D, Qiu P-Y, Wu Y-X, Chen Q, Li A-L, Ramadoss S, et al. Pregnancy Outcomes in Women of Advanced Maternal Age: a Retrospective Cohort Study from China. Sci Rep. 2018;8(1):12239. Available from: https://pubmed.ncbi.nlm.nih.gov/30115949
  19. Ogawa K, Urayama KY, Tanigaki S, Sago H, Sato S, Saito S, et al. Association between very advanced maternal age and adverse pregnancy outcomes: a cross sectional Japanese study. BMC Pregnancy Childbirth. 2017;17(1):349. Available from: https://pubmed.ncbi.nlm.nih.gov/29017467
  20. Mostello D, Kallogjeri D, Tungsiripat R, Leet T. Recurrence of preeclampsia: effects of gestational age at delivery of the first pregnancy, body mass index, paternity, and interval between births. Am J Obstet Gynecol. 2008;199(1):55.e1-55.e7. Available from: http://dx.doi.org/10.1016/j.ajog.2007.11.058
  21. Lisonkova S, Joseph KS. Incidence of preeclampsia: risk factors and outcomes associated with early- versus late-onset disease. Am J Obstet Gynecol. 2013;209(6):544.e1-544.e12. Available from: http://dx.doi.org/10.1016/j.ajog.2013.08.019
  22. Luo Z-C, An N, Xu H-R, Larante A, Audibert F, Fraser WD. The effects and mechanisms of primiparity on the risk of pre-eclampsia: a systematic review. Paediatr Perinat Epidemiol. 2007;21(s1):36–45. Available from: http://dx.doi.org/10.1111/j.1365-3016.2007.00836.x
  23. Mbah AK, Kornosky JL, Kristensen S, August EM, Alio AP, Marty PJ, et al. Super-obesity and risk for early and late pre-eclampsia. BJOG An Int J Obstet & Gynaecol. 2010;117(8):997–1004. Available from: http://dx.doi.org/10.1111/j.1471-0528.2010.02593.x
  24. Hunkapiller NM, Gasperowicz M, Kapidzic M, Plaks V, Maltepe E, Kitajewski J, et al. A role for Notch signaling in trophoblast endovascular invasion and in the pathogenesis of pre-eclampsia. Development. 2011;138(14):2987–98. Available from: https://pubmed.ncbi.nlm.nih.gov/21693515
  25. Kao CK, Morton JS, Quon AL, Reyes LM, Lopez-Jaramillo P, Davidge ST. Mechanism of vascular dysfunction due to circulating factors in women with pre-eclampsia. Clin Sci. 2016;130(7):539–49. Available from: http://dx.doi.org/10.1042/cs20150678
  26. Oylumlu M, Ozler A, Yildiz A, Oylumlu M, Acet H, Polat N, et al. New inflammatory markers in pre-eclampsia: echocardiographic epicardial fat thickness and neutrophil to lymphocyte ratio. Clin Exp Hypertens. 2014;36(7):503–7. Available from: http://dx.doi.org/10.3109/10641963.2013.863324
  27. Cadden KA, Walsh SW. Neutrophils, but not lymphocytes or monocytes, infiltrate maternal systemic vasculature in women with preeclampsia. Hypertens pregnancy. 2008;27(4):396–405. Available from: https://pubmed.ncbi.nlm.nih.gov/19003640
  28. Gezer C, Ekin A, Ertas IE, Ozeren M, Solmaz U, Mat E, et al. High first-trimester neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios are indicators for early diagnosis of preeclampsia. Ginekol Pol. 2016;87(6):431–5. Available from: http://dx.doi.org/10.5603/gp.2016.0021
  29. Dahlan IS, Tahir M, Lukas E, T Chalid SM. Hypertriglyceridemia is associated with the incidence of preeclampsia. Indones J Obstet Gynecol. 2018;218–21. Available from: http://dx.doi.org/10.32771/inajog.v6i4.844
  30. Gallos ID, Sivakumar K, Kilby MD, Coomarasamy A, Thangaratinam S, Vatish M. Pre-eclampsia is associated with, and preceded by, hypertriglyceridaemia: a meta-analysis. BJOG An Int J Obstet & Gynaecol. 2013;120(11):1321–32. Available from: http://dx.doi.org/10.1111/1471-0528.12375
  31. Ray JG, Diamond P, Singh G, Bell CM. Brief overview of maternal triglycerides as a risk factor for pre-eclampsia. BJOG An Int J Obstet Gynaecol. 2006;113(4):379–86. Available from: http://dx.doi.org/10.1111/j.1471-0528.2006.00889.x

How to Cite

Anak Agung Ngurah Jaya Kusuma, Endang Sri Widiyanti, Anak Agung Gde Marvy Khrisna Pranamartha, & Adytia Theopani Bineredo Damanik. (2023). High ratio of neutrophils to lymphocytes and high triglyceride levels in serum as risk factors for pre-eclampsia. Bali Medical Journal, 12(1), 987–990. https://doi.org/10.15562/bmj.v12i1.4007
ACM ACS APA ABNT Chicago Harvard IEEE MLA Turabian Vancouver
Download Citation
Endnote/Zotero/Mendeley (RIS) BibTeX

HTML
5

Total
3

Share

Search Panel

Anak Agung Ngurah Jaya Kusuma
Google Scholar
Pubmed
BMJ Journal

Endang Sri Widiyanti
Google Scholar
Pubmed
BMJ Journal

Anak Agung Gde Marvy Khrisna Pranamartha
Google Scholar
Pubmed
BMJ Journal

Adytia Theopani Bineredo Damanik
Google Scholar
Pubmed
BMJ Journal