Abstract
Introduction
To determine a cut-off value for systemic immune-inflammation index (SII) (neutrophil × platelet/lymphocyte) in the prediction of fetal growth restriction (FGR).
Materials and methods
This case–control study was conducted retrospectively at the Obstetrics-Gynecology and Perinatology Clinics of Etlik Zubeyde Hanim Women’s Health Education and Training Hospital. Singleton pregnant women with late-onset FGR who were followed up in outpatient clinics or hospitalized and whose pregnancy resulted at our hospital were included in the study group (group I). Healthy early and full-term singleton pregnant women with spontaneous labor who were followed up in the same hospital and whose pregnancy resulted at the same hospital were included in the control group (group II). Receiver-operating characteristic curves were used to assess the performance of SII value in predicting FGR.
Results
We recruited 79 cases (pregnant with late-onset fetal growth restriction) and 79 controls (healthy pregnant), matched for age, body mass index, and parity. ΔSII was statistically significantly higher in the pregnant with late-onset FGR compared with healthy pregnant (123 vs − 65; p = 0.039). The values in ROC curves with the best balance of sensitivity/specificity were > 152 109/L (49% sensitivity, 70% specificity) and > 586 109/L (27% sensitivity, 90% specificity) for late-onset FGR.
Discussion
Higher ΔSII levels in maternal blood indicate an inflammatory process causing FGR. The cut-off value for ΔSII (> 586 109/L) at 90% specificity can be used as a screening test. In the presence of ΔSII levels > 586 109/L (27% sensitivity and 90% specificity), the physicians should be more cautious about risk for FGR. Therefore, pregnant women at risk for FGR should be checked more frequently and monitored closely. However, further studies are needed to confirm our findings.
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Data availability
The data that support the findings of this study are avaible from the corresponding author upon reasonable request.
References
Fetal Growth Restriction (2021) ACOG practice bulletin, number 227. Obstet Gynecol 137(2):e16–e28
Maulik D (2006) Fetal growth restriction: the etiology. Clin Obstet Gynecol 49:228–235
American College of Obstetricians and Gynecologists (2012) Antiphospholipid syndrome: ACOG practice bulletin number 132. Obstet Gynecol 120:1514–1521
Bada HS, Das A, Bauer CR, Shankaran S, Lester BM, Gard CC et al (2005) Low birth weight and preterm births: etiologic fraction attributable to prenatal drug exposure. J Perinatol 25:631–637
Laurini R, Laurin J, Marsal K (1994) Placental histology and fetal blood flow in intrauterine growth retardation. Acta Obstet Gynecol Scand 73:529–534
Wilkins-Haug L, Roberts DJ, Morton CC (1995) Confined placental mosaicism and intrauterine growth retardation: a case-control analysis of placentas at delivery. Am J Obstet Gynecol 172:44–50
Harper LM, Odibo AO, Macones GA, Crane JP, Cahill AG (2010) Effect of placenta previa on fetal growth. Am J Obstet Gynecol 203:330.e1-e5
Cetin I, Mandò C, Parisi F (2017) Maternal characteristics predisposing to fetal growth restriction. In: Rajendram R, Preedy V, Patel V (eds) Diet, nutrition, and fetal programming. nutrition and health. Humana Press, Cham
Lausten-Thomsen U, Olsen M, Greisen G, Schmiegelow K (2014) Inflammatory markers in umbilical cord blood from small-for-gestational-age newborns. Fetal Pediatr Pathol 33(2):114–118
Bartha JL, Romero-Carmona R, Comino-Delgado R (2003) Inflammatory cytokines in intrauterine growth retardation. Acta Obstet Gynecol Scand 82(12):1099–1102
Andrikos A, Andrikos D, Schmidt B, Birdir C, Kimmig R, Gellhaus A, Köninger A (2022) Course of the sFlt-1/PlGF ratio in fetal growth restriction and correlation with biometric measurements, feto-maternal Doppler parameters and time to delivery. Arch Gynecol Obstet 305(3):597–605
Orgul G, Agbal T, Celen S, Caglar AT (2021) Neuroprotective magnesium sulfate administration increases maternal neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and systemic immune-inflammation index. Arch Gynecol Obstet 303(6):1433–1437
Hu B, Yang XR, Xu Y, Sun YF, Sun C, Guo W, Zhang X, Wang WM, Qiu SJ, Zhou J, Fan J (2014) Systemic immune-inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma. Clin Cancer Res 20(23):6212–6222
Tanacan A, Uyanik E, Unal C, Beksac MS (2020) A cut-off value for systemic immune-inflammation index in the prediction of adverse neonatal outcomes in preterm premature rupture of the membranes. J Obstet Gynaecol Res 46(8):1333–1341
Gordijn SJ, Beune IM, Thilaganathan B, Papageorghiou A, Baschat AA, Baker PN, Silver RM, Wynia K, Ganzevoort W (2016) Consensus definition of fetal growth restriction: a Delphi procedure. Ultrasound Obstet Gynecol 48(3):333–339
Faul F, Erdfelder E, Buchner A, Lang AG (2009) Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods 41(4):1149–1160
Affero General Public License v3; published 2011. RStudio for Linux, version v2021.09.4+403.pro3 Ghost Orchid; September 19, 2022; developed by Posit, PBC
Watson J, Round A, Hamilton W (2012) Raised inflammatory markers. BMJ 3(344):e454
Chen JH, Zhai ET, Yuan YJ, Wu KM, Xu JB, Peng JJ, Chen CQ, He YL, Cai SR (2017) Systemic immune-inflammation index for predicting prognosis of colorectal cancer. World J Gastroenterol 23(34):6261–6272
Biswas T, Kang KH, Gawdi R, Bajor D, Machtay M, Jindal C, Efird JT (2020) Using the systemic immune-inflammation index (SII) as a mid-treatment marker for survival among patients with stage-III locally advanced non-small cell lung cancer (NSCLC). Int J Environ Res Public Health 17(21):7995
Shang J, Han X, Zha H, Tao H, Li X, Yuan F, Chen G, Wang L, Ma J, Hu Y (2021) Systemic immune-inflammation index and changes of neutrophil-lymphocyte ratio as prognostic biomarkers for patients with pancreatic cancer treated with immune checkpoint blockade. Front Oncol 24(11):585271
Genc MR, Ford CE (2010) The clinical use of inflammatory markers during pregnancy. Curr Opin Obstet Gynecol 22(2):116–121
Alissa EM, Algarni SA, Khaffji AJ, Al Mansouri NM (2021) Role of inflammatory markers in polycystic ovaries syndrome: In relation to insulin resistance. J Obstet Gynaecol Res 47(4):1409–1415
Zhu Y, Zhou S, Liu Y, Zhai L, Sun X (2018) Prognostic value of systemic inflammatory markers in ovarian cancer: a PRISMA-compliant meta-analysis and systematic review. BMC Cancer 18(1):443
Turgut E, Yildirim M, Sakcak B, Ayhan SG, Tekin OM, Sahin D (2022) Predicting miscarriage using systemic immune-inflammation index. J Obstet Gynaecol Res 48(3):587–592
D’Ambrosi F, Ruggiero M, Cesano N, Di Maso M, Cetera GE, Tassis B, Carbone IF, Ferrazzi E (2023) Risk of stillbirth in singleton fetuses with advancing gestational age at term: a 10-year experience of late third trimester prenatal screenings of 50,000 deliveries in a referral center in northern Italy. PLoS ONE 18(2):e0277262
Kim ET, Singh K, Moran A, Armbruster D, Kozuki N (2018) Obstetric ultrasound use in low and middle income countries: a narrative review. Reprod Health 15(1):129
Cotechini T, Komisarenko M, Sperou A, Macdonald-Goodfellow S, Adams MA, Graham CH (2014) Inflammation in rat pregnancy inhibits spiral artery remodeling leading to fetal growth restriction and features of preeclampsia. J Exp Med 211(1):165–179
Acknowledgements
The authors are grateful to all participants and their families who spent their precious time and participated in this research program. The authors are also thankful for the tireless efforts of the research team members.
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FBF, ST, MLD, and YAR drafted the manuscript and collected data related to the subject. STS analyzed data to identify patterns. FBF, STS, and KYY were involved in drafting the manuscript and in the critical revision of the draft. ES and SO made a substantial contribution to the conception and design of the study. MLD, SC, and ATC participated in the design of the manuscript and the coordination of the study. All authors read and approved the final manuscript.
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All patients and controls provided written informed consents and this study was approved by the Committee on Ethics of Etlik Zubeyde Hanim Women’s Health Education and Training Hospital.
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Firatligil, F.B., Sucu, S.T., Tuncdemir, S. et al. Evaluation of systemic immune-inflammation index for predicting late-onset fetal growth restriction. Arch Gynecol Obstet (2024). https://doi.org/10.1007/s00404-024-07453-x
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DOI: https://doi.org/10.1007/s00404-024-07453-x