Kından Aziz, Kurt Dilara Sarikaya, Nalbantçılar Dilruba Ravza, Ulusoy Can Ozan, Yücel Kadriye Yakut
Department of Obstetrics and Gynecology, Etlik City Hospital, Ankara, Turkey, Varlık Neighborhood, Halil Sezai Erkut Street, Yenimahalle.
Sci Rep. 2025 Jul 1;15(1):22125. doi: 10.1038/s41598-025-01797-3.
Objective To evaluate the role of inflammatory and albumin-related indices in the diagnosis and prognosis of HELLP syndrome, with a focus on parameters such as NLR, NPAR, CAR, and FAR. Materials and methods This retrospective study analyzed 126 pregnant women, including 58 with HELLP syndrome and 68 healthy controls, admitted to the Perinatology Department of Etlik City Hospital between January 2023 and September 2024. Demographic and clinical data, including age, gestational week, and laboratory parameters, were collected. Specific inflammatory indices, including Neutrophil-to-Lymphocyte Ratio (NLR), Hemoglobin-Albumin-Lymphocyte-Platelet Score (HALP), Neutrophil Percentage-to-Albumin Ratio (NPAR), C-Reactive Protein-to-Albumin Ratio (CAR) and Fibrinogen-to-Albumin Ratio (FAR) were calculated and compared between the groups. Receiver Operating Characteristic (ROC) analysis was performed to assess the diagnostic performance of these indices. Statistical analyses were conducted with a confidence level of 95%, and p-values less than 0.05 were considered significant. Results Significant differences were observed between the HELLP group and healthy controls in terms of inflammatory and nutritional indices. NLR, NPAR, CAR, and FAR were significantly higher in the HELLP group compared to controls (p < 0.001 for all). ROC analysis revealed good diagnostic performance for CAR (AUC = 0.88, p < 0.001) and NPAR (AUC = 0.84, p < 0.001), while FAR also demonstrated high sensitivity and specificity (AUC = 0.82, p < 0.001). Additionally, PLR values were significantly lower in the HELLP group (p = 0.004), indicating its potential diagnostic relevance. PIV demonstrated the highest diagnostic performance among the markers evaluated (AUC = 0.790, sensitivity = 78%, specificity = 68%), followed by SII (AUC = 0.746). PLR and NAR showed moderate diagnostic accuracy with AUC values of 0.704 and 0.700, respectively. Conclusion Inflammatory and albumin-related indices, particularly CAR, NPAR, and FAR, show good diagnostic accuracy in identifying HELLP syndrome. These parameters may be valuable tools for early diagnosis and effective management of HELLP syndrome by enabling clinicians to identify patients at higher risk of complications, initiate timely interventions, and monitor disease progression more accurately, thus potentially improving maternal and fetal outcomes.
目的 评估炎症和白蛋白相关指标在HELLP综合征诊断和预后中的作用,重点关注中性粒细胞与淋巴细胞比值(NLR)、中性粒细胞百分比与白蛋白比值(NPAR)、C反应蛋白与白蛋白比值(CAR)和纤维蛋白原与白蛋白比值(FAR)等参数。材料与方法 本回顾性研究分析了2023年1月至2024年9月期间入住埃特利克市医院围产医学科的126名孕妇,其中包括58例HELLP综合征患者和68名健康对照。收集了人口统计学和临床数据,包括年龄、孕周和实验室参数。计算并比较了两组之间的特定炎症指标,包括中性粒细胞与淋巴细胞比值(NLR)、血红蛋白 - 白蛋白 - 淋巴细胞 - 血小板评分(HALP)、中性粒细胞百分比与白蛋白比值(NPAR)、C反应蛋白与白蛋白比值(CAR)和纤维蛋白原与白蛋白比值(FAR)。进行受试者工作特征(ROC)分析以评估这些指标的诊断性能。统计分析的置信水平为95%,p值小于0.05被认为具有统计学意义。结果 HELLP组与健康对照组在炎症和营养指标方面存在显著差异。与对照组相比,HELLP组的NLR、NPAR、CAR和FAR显著更高(所有p均<0.001)。ROC分析显示CAR(AUC = 0.88,p < 0.001)和NPAR(AUC = 0.84,p < 0.001)具有良好的诊断性能,而FAR也表现出高敏感性和特异性(AUC = 0.82,p < 0.001)。此外,HELLP组的血小板与淋巴细胞比值(PLR)值显著更低(p = 0.004),表明其潜在的诊断相关性。在评估的标志物中,血小板炎症指数(PIV)表现出最高的诊断性能(AUC = 0.790,敏感性 = 78%,特异性 = 68%),其次是全身炎症反应指数(SII,AUC = 0.746)。PLR和中性粒细胞与白蛋白比值(NAR)的诊断准确性中等,AUC值分别为0.704和0.700。结论 炎症和白蛋白相关指标,特别是CAR、NPAR和FAR,在识别HELLP综合征方面具有良好的诊断准确性。这些参数可能是早期诊断和有效管理HELLP综合征的有价值工具,使临床医生能够识别并发症风险较高的患者,及时启动干预措施,并更准确地监测疾病进展,从而有可能改善母婴结局。