Predictive Biomarkers of Preeclampsia Severity in a Low Resource Setting: Role of Red Blood Cell Indices, NLR, and Albumin-to-creatinine Ratio

Overview

Journal Narra J

Specialties Public Health
Tropical Medicine

Date 2024 Sep 16

PMID 39280265

Authors

Immanuel Dl Tobing

Sarma N Lumbanraja

Letta S Lintang

Rafli R Edwar

Ichwanul Adenin

Muara P Lubis

Khairani Sukatendel

Eva Suarthana

Affiliations

Soon will be listed here.

Abstract

Preeclampsia (PE), a serious medical condition with substantial maternal and perinatal implications, poses a significant challenge, particularly in high-incidence countries like Indonesia. Red blood cell (RBC) indices, neutrophil-to-lymphocyte ratio (NLR), and microalbuminuria (albumin-to-creatinine ratio (ACR)) may signal systemic inflammation and endothelial dysfunction, recently recognized as potential indicators for diagnosing and predicting disease severity. The aim of this study was to analyze RBC indices, NLR, and ACR changes in women with PE and their potential for predicting disease severity. A cross-sectional study was conducted at multi-center hospitals across Medan, Indonesia, from June 2022 to June 2023. The patients were grouped into PE cases with and without severe features. Demographic characteristics and complications were recorded while blood and urine were tested. The Chi-squared test, Fisher's exact test and Mann-Whitney test were used to determine biomarkers associated with severe PE. A total of 208 PE patients were included in the study (104 patients for each PE with and without severe features). Our data indicated that PE patients with severe features had higher red cell distribution width (18.5% vs 13.7%; <0.001), NLR (5.66% vs 4.1%; <0.001), and ACR (755.97 mg/dL vs 468.63 mg/dL; <0.001) compared to those without severe features. In contrast, the platelet count was lower in severe features than those without (21.9 × 106/μL vs 27.0 × 106/μL; =0.002). This study highlighted that PE patients with severe features predominantly had higher levels of RDW, NLR, and ACR and lower platelet counts compared to those without severe features. Therefore, basic tests such as complete blood count and urinalysis, which are inexpensive and feasible in primary care settings with limited resources, offer hope as valuable diagnostic biomarkers for pregnant women diagnosed with PE in a low resource setting.

References

McElwain C, Tuboly E, McCarthy F, McCarthy C . Mechanisms of Endothelial Dysfunction in Pre-eclampsia and Gestational Diabetes Mellitus: Windows Into Future Cardiometabolic Health?. Front Endocrinol (Lausanne). 2020; 11:655. PMC: 7516342. DOI: 10.3389/fendo.2020.00655. View

Beltran B, Paredes S, Castro D, Cotrina E, Sotomayor E, Castillo J . High Red Cell Distribution Width is an Adverse Predictive and Prognostic Factor in Patients With Diffuse Large B-Cell Lymphoma Treated With Chemoimmunotherapy. Clin Lymphoma Myeloma Leuk. 2019; 19(9):e551-e557. DOI: 10.1016/j.clml.2019.06.005. View

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

Say L, Chou D, Gemmill A, Tuncalp O, Moller A, Daniels J . Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014; 2(6):e323-33. DOI: 10.1016/S2214-109X(14)70227-X. View

Ying H, Deng Q, He B, Pan Y, Wang F, Sun H . The prognostic value of preoperative NLR, d-NLR, PLR and LMR for predicting clinical outcome in surgical colorectal cancer patients. Med Oncol. 2014; 31(12):305. DOI: 10.1007/s12032-014-0305-0. View

Kurt R, Aras Z, Silfeler D, Kunt C, Islimye M, Kosar O . Relationship of red cell distribution width with the presence and severity of preeclampsia. Clin Appl Thromb Hemost. 2013; 21(2):128-31. DOI: 10.1177/1076029613490827. View

Bulbul M, Uckardes F, Karacor T, Nacar M, Kaplan S, Kirici P . Can complete blood count parameters that change according to trimester in pregnancy be used to predict severe preeclampsia?. J Obstet Gynaecol. 2021; 41(8):1192-1198. DOI: 10.1080/01443615.2020.1854697. View

Adam I, Mutabingwa T, Malik E . Red cell distribution width and preeclampsia: a systematic review and meta-analysis. Clin Hypertens. 2019; 25:15. PMC: 6628484. DOI: 10.1186/s40885-019-0119-7. View

Freitas M, da Costa A, Medeiros L, Cunha L, Coutinho Filho U, Garrote Filho M . The role of the erythrocyte in the outcome of pregnancy with preeclampsia. PLoS One. 2019; 14(3):e0212763. PMC: 6402648. DOI: 10.1371/journal.pone.0212763. View

10.

Bilal A, Farooq J, Kiani I, Assad S, Ghazanfar H, Ahmed I . Importance of Mean Red Cell Distribution Width in Hypertensive Patients. Cureus. 2017; 8(11):e902. PMC: 5208582. DOI: 10.7759/cureus.902. View

11.

Jung E, Romero R, Yeo L, Gomez-Lopez N, Chaemsaithong P, Jaovisidha A . The etiology of preeclampsia. Am J Obstet Gynecol. 2022; 226(2S):S844-S866. PMC: 8988238. DOI: 10.1016/j.ajog.2021.11.1356. View

12.

Seckin K, Karsli M, Yucel B, Bestel M, Yildirim D, Canaz E . The utility of tumor markers and neutrophil lymphocyte ratio in patients with an intraoperative diagnosis of mucinous borderline ovarian tumor. Eur J Obstet Gynecol Reprod Biol. 2015; 196:60-3. DOI: 10.1016/j.ejogrb.2015.10.025. View

13.

Robillard P, Dekker G, Scioscia M, Saito S . Progress in the understanding of the pathophysiology of immunologic maladaptation related to early-onset preeclampsia and metabolic syndrome related to late-onset preeclampsia. Am J Obstet Gynecol. 2022; 226(2S):S867-S875. DOI: 10.1016/j.ajog.2021.11.019. View

14.

Bujak K, Wasilewski J, Osadnik T, Jonczyk S, Kolodziejska A, Gierlotka M . The Prognostic Role of Red Blood Cell Distribution Width in Coronary Artery Disease: A Review of the Pathophysiology. Dis Markers. 2015; 2015:824624. PMC: 4563066. DOI: 10.1155/2015/824624. View

15.

Morikawa M, Mayama M, Noshiro K, Saito Y, Nakagawa-Akabane K, Umazume T . Earlier onset of proteinuria or hypertension is a predictor of progression from gestational hypertension or gestational proteinuria to preeclampsia. Sci Rep. 2021; 11(1):12708. PMC: 8209055. DOI: 10.1038/s41598-021-92189-w. View

16.

Okamoto T, Watanabe K, Banno T, Saitou T, Sugiura K, Iwasaki A . Amount of proteinuria as associated with severity classification of pregnant women with preeclampsia. Pregnancy Hypertens. 2022; 29:30-35. DOI: 10.1016/j.preghy.2022.05.009. View

17.

Wong T, Groen H, Faas M, van Pampus M . Clinical risk factors for gestational hypertensive disorders in pregnant women at high risk for developing preeclampsia. Pregnancy Hypertens. 2015; 3(4):248-53. DOI: 10.1016/j.preghy.2013.07.003. View

18.

Serin S, Avci F, Ercan O, Kostu B, Bakacak M, Kiran H . Is neutrophil/lymphocyte ratio a useful marker to predict the severity of pre-eclampsia?. Pregnancy Hypertens. 2016; 6(1):22-5. DOI: 10.1016/j.preghy.2016.01.005. View

19.

Kang Q, Li W, Yu N, Fan L, Zhang Y, Sha M . Predictive role of neutrophil-to-lymphocyte ratio in preeclampsia: A meta-analysis including 3982 patients. Pregnancy Hypertens. 2020; 20:111-118. DOI: 10.1016/j.preghy.2020.03.009. View

20.

Paliogiannis P, Zinellu A, Mangoni A, Capobianco G, Dessole S, Cherchi P . Red blood cell distribution width in pregnancy: a systematic review. Biochem Med (Zagreb). 2018; 28(3):030502. PMC: 6214699. DOI: 10.11613/BM.2018.030502. View