Yunting Zhuang,1,2 Yanxuan Xiao,2 Ruiyan Bai,2 Yao Song,1,2 Zeshan Lin,1 Yiqi Yu,1 Qian Chen,1 Zhijian Wang3 

1Department of Obstetrics, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China; 2School of Nursing, Southern Medical University, Guangzhou, People’s Republic of China; 3Department of Obstetrics and Gynecology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases; Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology; Guangdong-Hong Kong-Macao Greater Bay Area Higher Education Joint Laboratory of Maternal-Fetal Medicine; The Third Affiliated Hospital, Guangzhou Medical University, Guangzhou, People’s Republic of China

Correspondence: Qian Chen, Department of Obstetrics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, People’s Republic of China, Email chenqianqian430@qq.com Zhijian Wang, Department of Obstetrics and Gynecology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases; Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology; Guangdong-Hong Kong-Macao Greater Bay Area Higher Education Joint Laboratory of Maternal-Fetal Medicine; The Third Affiliated Hospital, Guangzhou Medical University, Guangzhou, 510150, People’s Republic of China, Email wzjnfyy@163.com

Background: Preeclampsia (PE) is a syndrome exclusive to pregnancy, presenting substantial risks to maternal and fetal health. Systemic immune-inflammatory response is a prominent feature of PE.
Methods: A retrospective study was conducted involving 749 pregnant women in Guangzhou, China from September 2018 to September 2024. Three hundred and seventy participants were diagnosed with PE, 166 of which had adverse pregnancy outcomes (APOs). Immuno-inflammatory markers expressed in peripheral blood were evaluated during the second-trimester. APOs included postpartum haemorrhage (PPH), premature rupture of membranes (PROM), placental abruption, fetal growth restriction, neonatal intensive care unit (NICU) transfer, and fetal distress. The relationship between immune-inflammatory markers and PE and APOs was analyzed.
Results: Women with PE were at higher risk of APOs and had higher levels of neutrophil-to-lymphocyte ratio (NLR), systemic immunoinflammatory index (SII) and systemic inflammatory response index (SIRI). The AUC values for NLR, SII, and SIRI with PE were 0.594, 0.649, and 0.646 (P < 0.001), with cut-off values of 4.389, 994.863, and 2.406, respectively. For APOs in PE, the AUC values were 0.632, 0.627 and 0.669, with cut-off values of 4.959, 1070.408 and 3.346, respectively. Analysis indicated higher SII levels with increased incidences of fetal growth restriction, NICU transfer and fetal distress, and SIRI levels with NICU transfer and fetal distress (P < 0.05).
Conclusion: Elevated levels of immune-inflammatory markers including NLR, SII, and SIRI are associated with PE and APOs. Our findings underscored the different optimal cut-off values of immune-inflammatory markers in the pregnant women between PE and the APOs.

Keywords: preeclampsia, NLR, SII, SIRI, adverse pregnancy outcomes, inflammation