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Clinical and Experimental Obstetrics & Gynecology  2020, Vol. 47 Issue (2): 183-188    DOI: 10.31083/j.ceog.2020.02.5229
Original Research Previous articles | Next articles
Prediction of severity of preeclampsia in Egyptian patients: role of neutrophil/lymphocyte ratio, platelet/lymphocyte ratio and C-reactive protein
A. E. Kholeif1, *(), M. Y. Khamis1, S. Eltabakh2, R. S. Swilam3, A. Elhabashy1, R. EISherif1
1Departments of Obstetrics & Gynecology
2Medical Biochemistry
3Clinical Pathology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Abstract  Objective: In this study, the authors aimed to compare and correlate neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and C-reactive protein (CRP) levels in Egyptian patients with different degrees of preeclampsia (PE). Materials and Methods: The authors recruited 105 Egyptian pregnant women with gestational age ≥ 34 weeks. They were divided into 35 normotensive pregnant and 70 PE women, further subdivided into 35 mild and 35 severe PE cases according to ACOG criteria. Results: There was no statistically significant difference between patients with PE and healthy pregnant women as regards to NLR. PLR showed statistically significant difference between the control and severe PE cases and between mild and severe PE cases. CRP levels showed a statistically significant difference between the control and mild PE cases and between the control and severe PE cases. Conclusion: CRP was more sensitive and specific than PLR to predict PE in pregnant females, hence it can be used in prediction of PE. PLR was more sensitive but less specific than CRP to predict severity of PE in pregnant females, therefore PLR can be used for early prediction of severity. NLR cannot be used as a marker for prediction of PE or its severity.
Key words:  Preeclampsia      Neutrophil/lymphocyte ratio (NLR)      platelet/lymphocyte ratio (PLR)      C-reactive protein (CRP)     
Published:  15 April 2020     
*Corresponding Author(s):  A. E. Kholeif     E-mail:  alykholeif@yahoo.com

Cite this article: 

A. E. Kholeif, M. Y. Khamis, S. Eltabakh, R. S. Swilam, A. Elhabashy, R. EISherif. Prediction of severity of preeclampsia in Egyptian patients: role of neutrophil/lymphocyte ratio, platelet/lymphocyte ratio and C-reactive protein. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(2): 183-188.

URL: 

https://ceog.imrpress.com/EN/10.31083/j.ceog.2020.02.5229     OR     https://ceog.imrpress.com/EN/Y2020/V47/I2/183

Table 1  — Comparison among the three studied groups according to fetal outcome.
Group I (n = 35) Group II (n = 35) Group III (n = 35) Test of Sig. p
No. % No. % No. %
Neonatal birth weight (Kg)
Min. - Max. 1.30 - 4.0 1.30 - 4.20 1.10 - 3.60 F= 11.293* <0.001*
Mean ± SD. 2.98 ± 0.45 2.85 ± 0.63 2.32 ± 0.73
Median 3.0 2.90 2.45
Sig.bet.Grps p1=0.373, p2<0.001*, p3=0.001*
Apgar 1 min.
Min. - Max. 4.0 - 7.0 5.0 - 7.0 2.0 - 8.0 H= 10.710* 0.005*
Mean ± SD. 6.83 ± 0.57 6.86 ± 0.49 6.26 ± 1.27
Median 7.0 7.0 7.0
Sig.bet.Grps p1=0.808, p2=0.007*, p3=0.003*
Apgar 5 min.
Min. - Max. 8.0 - 9.0 7.0 - 9.0 6.0 - 9.0 H= 15.996* <0.001*
Mean ± SD. 8.97 ± 0.17 8.86 ± 0.43 8.40 ± 0.95
Median 9.0 9.0 9.0
Sig.bet.Grps p1=0.350, p2<0.001*, p3=0.004*
Admission to NICU
No 33 94.3 32 91.4 22 62.9 χ2= 14.885* 0.001*
Yes 2 5.7 3 8.6 13 37.1
Sig.bet.Grps FE p1=1.000, p2=0.001*, p3=0.004*
Table 2  — Comparison among the three studied groups according to different CBC parameters.
CBC Group I (n = 35) Group II (n = 35) Group III (n = 35) F p
Hemoglobin (g/dl)
Min. - Max. 7.90 - 14.30 8.0 - 13.50 5.40 - 16.10 4.018* 0.021*
Mean ± SD. 11.17 ± 1.23 11.17 ± 1.35 12.05 ± 1.83
Median 11.10 11.20 11.90
Sig. bet. grps. p1=0.987, p2=0.016*, p3=0.015*
WBCs (103/μL)
Min. - Max. 5.99 - 13.10 5.40 - 17.10 5.12 - 26.67 1.939 0.149
Mean ± SD. 9.58 ± 2.19 10.85 ± 3.14 11.35 ± 5.51
Median 8.70 10.91 10.90
Platelets (103/μL)
Min. - Max. 120.0 - 447.0 108.0 - 393.0 52.0 - 400.0 8.852* <0.001*
Mean ± SD. 230.17 ± 69.41 242.37 ± 73.36 171.69 ± 82.07
Median 218.0 247.0 159.0
Sig. bet. grps. p1=0.499, p2=0.002*, p3<0.001*
Table 3  — Comparison among the three studied groups according to neutrophils and lymphocytes.
Group 1 (n = 35) Group 2 (n = 35) Group 3 (n = 35) Test of Sig. p
Neutrophils (103/μL)
Min. - Max. 3.22 - 11.10 3.30 - 15.20 3.60 - 24.76 F = 2.353 0.100
Mean ± SD. 6.90 ± 2.14 8.08 ± 2.92 8.69 ± 4.88
Median 6.10 7.68 7.70
Lymphocytes (103/μL)
Min. - Max. 1.0 - 3.10 0.80 - 3.71 0.84 - 7.35 H = 3.918 0.141
Mean ± SD. 1.97 ± 0.53 2.13 ± 0.70 1.93 ± 1.12
Median 2.06 2.10 1.70
Table 4  — Comparison among the three studied groups according to NLR and PLR.
Group 1 (n = 35) Group 2 (n = 35) Group 3 (n = 35) H p
NLR 3.559 0.169
Min. - Max. 1.60 - 10.90 1.64 - 11.75 1.29 - 19.65
Mean ± SD. 3.92 ± 2.22 4.31 ± 2.58 5.28 ± 3.71
Median 3.0 3.43 4.08
PLR 7.386* 0.025*
Min. - Max. 46.15 - 260.53 56.84 - 287.69 16.15 - 292.10
Mean ± SD. 125.88 ± 52.42 126.37 ± 61.16 98.43 ± 59.11
Median 108.70 113.67 82.94
Sig.bet.Grps p1=0.784, p2=0.012*, p3=0.030*
Table 5  — Comparison among the three studied groups according to CRP.
Group 1 (n = 35) Group 2 (n = 35) Group 3 (n = 35) H p
CRP (mg/dL)
Min. - Max.

0.10 - 0.50

0.10 - 6.04

0.20 - 9.50

47.402*

<0.001*
Mean ± SD. 0.30 ± 0.13 1.17 ± 1.17 1.66 ± 1.73
Median 0.30 0.70 1.30
Sig.bet.Grps p1<0.001*, p2<0.001*, p3=0.645
Table 6  — Agreement (sensitivity, specificity) for PLR and CRP to predict cases (vs control).
AUC p 95% C.I Cut off Sensitivity Specificity PPV NPV
PLR 0.598 0.104 0.487 - 0.709 ≤77.5 35.71 85.71 83.3 40.0
CRP 0.905 <0.001* 0.850 - 0.961 >0.5 75.71 100.0 100.0 67.3
Table 7  — Agreement (sensitivity, specificity) for PLR and CRP to predict severe cases (vs mild).
AUC p 95% C.I Cut off Sensitivity Specificity PPV NPV
PLR 0.651* 0.030* 0.521 - 0.780 ≤101.364 65.71 62.86 63.9 64.7
CRP 0.611 0.109 0.477 - 0.746 >1 62.86 65.71 50.7 100.0
Figure 1.  — ROC curve for PLR and CRP to predict PE cases vs. control.

Figure 2.  —ROC curve for PLR and CRP to predict severe PE cases vs. mild.

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