Predictive Value Of PLR And NLR In Combination With Thromboelastography In Individuals With Combined Thrombocytopenia Of Pregnancy In Predicting Adverse Maternal And Infant Outcomes

Objective:Retrospective clinical data of patients with combined thrombocytopenia in pregnancy were analyzed to determine the predictive value of platelet/lymphocyte ratio(PLR)and neutrophil/lymphocyte ratio(NLR)combined with thromboelastography(TEG)in maternal postpartum hemorrhage and adverse perinatal outcomes in patients with combined thrombocytopenia in pregnancy.Methods:According to the inclusion and exclusion criteria,180 pregnant patients with thrombocytopenia who were admitted to the obstetrics section of the Second Hospital of Lanzhou University between January 2017 and April 2022 were chosen as the observation group.According to the existence or absence of postpartum hemorrhage,the observation groups were split into a postpartum hemorrhage group and a nonpostpartum hemorrhage group,and according to the perinatal outcome,into groups with excellent perinatal outcomes and those with poor perinatal outcomes(presence or absence of neonatal thrombocytopenia,neonatal hemorrhage,neonatal preterm birth,low birth weight infant,neonatal asphyxia,and neonatal transfer).The control group consisted of 145 healthy late-pregnant women who gave birth at the Second Hospital of Lanzhou University during the same time frame.To compare the differences in clinical data between the control group and the subgroups,including age,gestational week,delivery,days in the hospital,body mass index(BMI),method of delivery,and PLR,NLR,and TEG;Spearman’s correlation analysis was used to investigate the relationships between PLR,NLR,TEG,and platelet levels in the monitoring group as well as the relationships between TEG parameters and PLR;Using subject receiver operating characteristic(ROC)curves,it was determined how well PLR,NLR,and TEG measures predicted mother postpartum hemorrhage and unfavorable perinatal outcomes in patients with combined thrombocytopenia of pregnancy.Results:1.There were no statistically significant differences in age,pregnancy,delivery,and BMI between the groups(P > 0.05);there were statistically significant differences in gestational weeks,hospital days,and method of delivery(P < 0.05).2.There were statistically significant differences between groups in PLR,NLR,and TEG(P < 0.05).PLT,PLR,α-angle,MA,and CI in the postpartum hemorrhage and poor perinatal outcome groups were smaller than those in the other groups,and R and K were larger than those in the other groups.In comparison to the other groups,the postpartum hemorrhage groups’ NLR was smaller,the NLR between the normal pregnancy group,the good perinatal outcome group,and the poor perinatal outcome group were statistically significant.3.In the pregnancy combined with the thrombocytopenia group,PLR,α-angle,MA,LY30,EPL,and CI were positively correlated with platelet levels,while R and K were negatively correlated.Similarly,α-angle,MA,LY30,EPL,and CI were positively correlated with PLR,while R and K were negatively correlated with PLR.4.The ROC curve was used to evaluate the predictive value of the R,K,α-angle,MA,CI,and TEG parameters for maternal postpartum hemorrhage.The results showed that the space under the curve for the R,K,α-angle,MA,and CI ranged from0.680 to 0.779;the sensitivity ranged from 66.67% to 81.82%;the specificity ranged from 48.30% to 84.35%;The area under the curve of TEG was 0.843,the sensitivity was 72.73%,and the specificity was 82.99%.In comparison to other factors,the combined TEG index had a larger area under the curve.The ROC curve was used to evaluate the predictive value of the PLR,NLR,and TEG parameters for postpartum hemorrhage.The results showed that the PLR,NLR,and TEG parameters had an area under the curve between 0.674 and 0.843,a sensitivity between 72.73% and 81.82%,and a specificity between 57.14% and 82.99%.The area under the curve of the combined index was 0.873,with a sensitivity of 87.88% and specificity of 74.83%.The combined index had a larger area under the curve and higher sensitivity for predicting postpartum hemorrhage.5.The ROC curve was used to evaluate the predictive value of R,K,α-angle,MA,CI,and TEG parameters for adverse perinatal outcomes.The results showed that the area under the curve for R,K,α-angle,MA,and CI ranged from 0.740 to 0.793;the sensitivity ranged from 56.41%-97.44%;and the specificity ranged from 50.35%-85.11%.The area under the curve of TEG was 0.829,the sensitivity of 94.87%,and the specificity of 65.96%.The area under the curve of the TEG combined index for predicting adverse perinatal outcomes was larger.The ROC curve evaluated the predictive value of PLR,NLR,and TEG parameters for adverse perinatal outcomes,and the results showed that the area under the curve for PLR,NLR,and TEG ranged from 0.742-0.829;the sensitivity ranged from 51.28%-94.87%;and the specificity ranged from 65.96%-90.78%.The area under the curve for the combined index was0.863,with a sensitivity of 79.49% and specificity of 85.82%.The area under the curve for the combined index to predict adverse perinatal outcomes was greater.Conclusions:1.Patients with pregnancy complicated with thrombocytopenia accompanied by postpartum hemorrhage and perinatal adverse outcomes have small gestational weeks,long hospital stays,and a high cesarean section rate.2.Patients with pregnancy complicated with thrombocytopenia accompanied by postpartum hemorrhage and perinatal adverse outcomes,the level of a coagulation factor and coagulation function is creased,and the risk of low-coagulation hemorrhage is significantly increased.3.In individuals with combined thrombocytopenia in pregnancy,there was a link between PLR,R,K,α-angle,MA,and CI and platelet counts,as well as between PLR and R,K,α-angle,MA,and CI.4.In patients with combined thrombocytopenia in pregnancy,PLR,NLR,and TEG metric has some utility in predicting maternal postpartum hemorrhage and poor perinatal outcomes;however,the composite index of these parameters has a larger predictive value.