Seyhanli Zeynep, Bayraktar Burak, Karabay Gulsan, Filiz Ahmet Arif, Bucak Mevlut, Agaoglu Recep Taha, Ulusoy Can Ozan, Kolomuc Tugba, Yucel Kadriye Yakut, Yilmaz Zehra Vural
Department of Perinatology, Ankara Etlik City Hospital, Ankara, Turkey.
Department of Obstetrics and Gynecology, Ankara Etlik City Hospital, Ankara, Turkey.
BMC Pregnancy Childbirth. 2024 Oct 1;24(1):620. doi: 10.1186/s12884-024-06811-6.
The aim of this study was to evaluate the potential of immunonutritional markers, specifically the hemoglobin, albumin, lymphocyte, and platelet (HALP) score and the prognostic nutritional index (PNI), in predicting late-onset fetal growth restriction (LO-FGR) during the first trimester.
This retrospective study was conducted at a tertiary care center between October 2022 and August 2023. The study included a total of 213 singleton pregnancies, with 99 women in the LO-FGR group and 114 in the healthy control group, matched by maternal age and gestational age at delivery. All blood samples were collected between 11 and 14 weeks of gestation (during the first-trimester screening test). We analyzed first-trimester laboratory parameters, specifically focusing on hemoglobin levels, white blood cells (WBCs), lymphocytes, platelets, and albumin levels. Afterwards, we calculated the HALP score and PNI, and then compared the values of both groups.
Both HALP score (3.58 ± 1.31 vs. 4.19 ± 1.8, p = 0.012) and PNI (36.75 ± 2.9 vs. 39.37 ± 3.96, p < 0.001) were significantly lower in the FGR group than in the control group. The HALP score cut-off value of < 3.43 in predicting FGR had a sensitivity of 62.3% and specificity of 54.5% (AUC = 0.600, 95% CI: 0.528-0.672, p = 0.012). The PNI cut-off value of < 37.9 in predicting FGR had a sensitivity of 65.8% and specificity of 62.9% (AUC = 0.707, 95% CI: 0.632-0.778, p < 0.001). While the HALP score was not a significant predictor of composite adverse neonatal outcomes in the FGR group, PNI showed a cut-off value of < 37.7 with a sensitivity of 60.9% and specificity of 59.7% (AUC = 0.657, 95% CI: 0.581-0.733, p < 0.001).
The HALP score and PNI are valuable prognostic tools for predicting the risk of FGR in the first trimester. Low PNI values are also associated with composite adverse neonatal outcomes in pregnancies complicated by FGR.
本研究旨在评估免疫营养标志物，特别是血红蛋白、白蛋白、淋巴细胞和血小板（HALP）评分以及预后营养指数（PNI）在孕早期预测晚发性胎儿生长受限（LO-FGR）的潜力。
本回顾性研究于2022年10月至2023年8月在一家三级医疗中心进行。该研究共纳入213例单胎妊娠，其中LO-FGR组99例女性，健康对照组114例，两组按产妇年龄和分娩时孕周进行匹配。所有血样均在妊娠11至14周（孕早期筛查试验期间）采集。我们分析了孕早期的实验室参数，特别关注血红蛋白水平、白细胞（WBC）、淋巴细胞、血小板和白蛋白水平。之后，我们计算了HALP评分和PNI，然后比较了两组的值。
FGR组的HALP评分（3.58±1.31 vs. 4.19±1.8，p = 0.012）和PNI（36.75±2.9 vs. 39.37±3.96，p < 0.001）均显著低于对照组。预测FGR时HALP评分临界值<3.43的敏感度为62.3%，特异度为54.5%（AUC = 0.600，95%CI：0.528 - 0.672，p = 0.012）。预测FGR时PNI临界值<37.9的敏感度为65.8%，特异度为62.9%（AUC = 0.707，95%CI：0.632 - 0.778，p < 0.001）。虽然HALP评分不是FGR组综合不良新生儿结局的显著预测指标，但PNI显示临界值<37.7时，敏感度为60.9%，特异度为59.7%（AUC = 0.657，95%CI：0.581 - 0.733，p < 0.001）。
HALP评分和PNI是预测孕早期FGR风险的有价值的预后工具。低PNI值也与FGR合并妊娠的综合不良新生儿结局相关。
