The prognostic value of neutrophile/lymphocyte ratio and serum chemerin to predict maternal-fetal complications in pregnant systemic lupus erythematosus patients.

Autor: Medina G; Translational Research Unit, Hospital de Especialidades Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico.; Universidad Nacional Autónoma de México, Mexico City, Mexico., González-Cortés FR; Facultad de Medicina, Universidad Veracruzana, Xalapa, Mexico., Sánchez-González A; Rheumatology Department, Hospital de Especialidades Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico., Vázquez-Rodríguez JG; Intensive Care Unit, Hospital de Gineco-Obstetricia No. 3, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico., Ordoñez-González I; Hospital Infantil de México Federico Gómez, Mexico City, Mexico., Jiménez-Arellano MP; Hospital de Gineco-Obstetricia No. 3, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico., García-Collinot G; Hospital de Gineco-Obstetricia No. 3, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico., Morales-Montalvo SI; Unidad de Medicina Familiar No. 66, IMSS, Xalapa-Enriquez, Mexico., Florez-Durante OI; Translational Research Unit, Hospital de Especialidades Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico., Cruz-Domínguez MP; Universidad Nacional Autónoma de México, Mexico City, Mexico.; Direction of Education and Research, Hospital de Especialidades Centro Médico Nacional La Raza 'Dr Antonio Fraga Mouret,' Instituto Mexicano del Seguro Social, Mexico City, Mexico., Colorado-Cruz MF; Facultad de Medicina, Universidad Veracruzana, Veracruz, Mexico., Zurita-Muñoz MA; Unidad de Medicina Familiar No. 20, Instituto Mexicano del Seguro Social, Mexico City, Mexico., Cruz-Arteaga G; Unidad de Medicina Familiar No. 20, Instituto Mexicano del Seguro Social, Mexico City, Mexico., Sánchez-Enriquez C; Unidad de Medicina Familiar No. 20, Instituto Mexicano del Seguro Social, Mexico City, Mexico., Jara LJ; Division of Rheumatology, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico., Saavedra MÁ; Research Division, Instituto Mexicano del Seguro Social, Hospital de Especialidades Centro Médico Nacional La Raza, Mexico City, Mexico.
Jazyk: angličtina
Zdroj: Lupus [Lupus] 2023 Oct; Vol. 32 (12), pp. 1409-1417. Date of Electronic Publication: 2023 Oct 16.
DOI: 10.1177/09612033231206446
Abstrakt: Background: Pregnancy in SLE continues to be a challenge. The neutrophil-to-lymphocyte ratio (NLR) and chemerin are predictors of preeclampsia in the general population; however, their role as predictors of maternal-fetal complications in pregnant SLE patients has not been analyzed.
Objective: To investigate the prognostic value of NLR and serum chemerin, to predict maternal-fetal complications in pregnant SLE patients, and compare both biomarkers among three study groups.
Methods: Design: Analytical cross-sectional study of cases and controls with the following study groups: systemic lupus erythematosus (SLE), preeclampsia, and healthy. NLR and chemerin serum were determined between 20 and 25 weeks of gestation. Patients were evaluated every 4-6 weeks until pregnancy resolution. Maternal and fetal outcomes were registered. We employed Receiver Operating Characteristic (ROC) curves to validate prognostic values.
Results: Seventy pregnant patients were included: 20 with SLE, 20 with preeclampsia, and 30 healthy pregnant women; NLR values were 4 (2.3-5.6) in SLE, 6 (4.6-9.2) in preeclampsia, and 2.8 (2.1-2.9) in the group of healthy women ( p = .0001). Chemerin levels were: 26 (15.3-56.2) in SLE, 96 (37.3-146.2) in preeclampsia, and 24.6 ng/mL (15.3-47.4) in the healthy group ( p = .007) Maternal complications were observed in 11 (55%), 20 (100%), and 8 (26%) per group, respectively. Thrombocytopenia was the most frequent complication in all pregnant women, followed by hypertensive disorders. Fetal complications were registered in 12 (60%), 16 (80%), and 2 (6.7%), respectively. Congenital malformations and prematurity were the most frequent fetal complications. NLR had good diagnostic accuracy in predicting maternal-fetal complications (AUROC 0.715) p = .015, CI 95% 0.56-0.86, cut-off point level: 2.9, sensitivity 61%, specificity 78%, positive predictive value (PPV) 65%, negative predictive value (NPV) 75%. Regarding chemerin, a cut-off point level >43 ng/mL had a sensitivity of 75%, specificity of 72% AUROC 0.75, p = .001, CI 95% 0.61-0.89, PPV 51.7% NPV 87.8%, meaning that 51.7% of patients with chemerin levels >43 ng/mL have or will have preeclampsia.
Conclusion: The NLR may help predict maternal-fetal complications in SLE pregnancy, constituting a marker of subclinical inflammation. Chemerin levels may be associated with preeclampsia. These biomarkers could improve the care of SLE patients with timely intervention of potential complications during pregnancy.
Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Databáze: MEDLINE
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