Correlation Between WBC,PLT,NLR,PLR And CRP And Preterm Premature Rupture Of Membranes

Objective:Analysis of white blood cell count（WBC）,platelet count（PLT）,neutrophils/lymphocytes（NLR）,platelet/lymphocytes（PLR）,c-reactive protein（CRP）and the risk of preterm premature rupture of membranes and adverse outcomes in neonates,discuss its possible predictive value for PPROM and neonatal complications.By analyzing the changes of the above indexes in the serum of pregnant women,PPROM and the adverse outcomes of its neonates can be found early and the outcomes of mothers and infants can be improved.Methods:Retrospective analysis is the study methods of this.A total of 828 pregnant women with PPROM admitted to the Department of Obstetrics of the Second Hospital of Jilin University from January 2019to October 2021 were collected.A total of 308 pregnant women with PPROM were included in the observation group（group A）according to the inclusion and exclusion criteria,and 300 normal pregnant women who visited the outpatient department of our hospital during the same period,selecting them as the control group（group B）.A total of 608 subjects were included.Group A according to gestational age was divided into 28-31+6 weeks group（group Aa）in 68cases,32-33⁺⁶weeks group（group Ab）in 58 cases and 34-36⁺⁶weeks group（group Ac）in 182 cases.Group B according to gestational age was divided into 28-31+6 weeks group（group Ba）in 89 cases,32-33+6 weeks group（group Bb）in 50 cases and 34-36+6weeks group（group Bc）in 161 cases.Group A according to the outcome of each gestational group,the neonates were divided into subgroups:good outcome group（Aa₁group,Ab₁group,Ac₁group）,neonatal complications group（Aa₂group,Ab₂group,Ac₂group）.The neonatal complications group included at least one of the following:neonatal respiratory distress syndrome（NRDS）,neonatal bronchopulmonary dysplasia（BPD）,neonatal intracranial hemorrhage,neonatal white matter injury and neonatal infection.Collecting general clinical data,including age,gestational age,number of pregnancies and number of births.Before treatment with glucocorticoids and antibiotics,pregnant women with PPROM received fasting blood test,and then immediately sent for testing.Blood cell count,platelet parameters and C-reactive protein were detected,and NLR and PLR values were calculated（calculation method:NLR=NEU/LYM,PLR=PLT/LYM）.All normal pregnant women in outpatient clinic took blood on an empty stomach for test,and then immediately sent for test to detect blood cell count and platelet parameters,and calculate the ratio of NLR and PLR.The included indexes were statistically processed,and the logistic regression model was established for analysis.Through the data analysis,the changes of various indexes in PPROM and different neonatal outcomes were discussed to explore their predictive value for PPROM and adverse neonatal outcomes,and obtain-ing the ideal cut-off value.Result:1.There was no significant difference in general clinical data between PPROM group and normal delivery group（P>0.05）.2.Comparison between PPROM group（group A）and normal delivery group（group B）:In 28-31⁺⁶weeks（group a）,the WBC of group Aa was（12.66±4.19）x10~9/L,the WBC of group Ba was（8.93±1.99）x 109/L;the PLT of group Aa was（242.34±58.82）x109/L,the PLT of group Ba was（214.42±52.00）x109/L;the NLR of group Aa was5.79（4.87,8.63）,the NLR of group Ba was 4.03（3.09,4.84）;the PLR of group Aa was149.31（121.67,196.06）,the PLR of group Ba was 132.64（109.08,163.17）.In 32-33⁺⁶weeks（group b）,the WBC of group Ab was（11.71±3.27）x109/L,the WBC of group Bb was（8.92±1.70）x 109/L;the PLT of group Ab was（241.15±61.70）x109/L,the PLT of group Bb was（218.37±36.48）x10~9/L;the NLR of group Ab was 6.23（4.51,7.94）,the NLR of group Bb was 3.98（3.11,5.63）;the PLR of group Ab was 152.88（129.42,196.57）,the PLR of group Bb was 135.83（111.31,182.77）.In 34-36+6 weeks（group c）,the WBC of group Ac was（10.64±2.58）x10~9/L,the WBC of group Bc was（8.89±1.78）x 10~9/L;the PLT of group Ac was（225.78±59.71）x109/L,the PLT of group Bc was（197.29±39.55）x10~9/L;the NLR of group Ac was 4.72（3.94,5.71）,the NLR of group Bc was 4.09（3.30,4.97）;the PLR of group Ac was 134.31（106.69,178.37）,the PLR of group Bc was124.55（104.69,153.05）.In three gestational age groups,group A compared with group B,the WBC,PLT,NLR,PLR were significantly elevated,and P<0.05,the differences were statistically significant.3.Comparison between the neonatal complication group and the neonatal good outcome group:In 28-31⁺⁶weeks（group a）,WBC,PLT,NLR,PLR and CRP changed in varying degrees,but all P>0.05,the difference was not statistically significant.In32-33⁺⁶weeks（group b）,compare the good neonatal outcome group（group Ab₁）with the neonatal complications group（group Ab₂）:WBC of group Ab₁was（10.19±2.60）×10~9/L,WBC of group Ab₂was（12.39±3.33）×10~9/L;PLT of group Ab₁was（257.71±70.29）×109/L,WBC of group Ab₂was（233.70±56.80）×109/L;NLR was 4.79（3.53,6.39）in group Ab₁and 6.59（4.74,8.49）in group Ab₂;PLR was 147.17（125.14,187.95）in group Ab₁and 147.17（125.14,187.95）in group Ab₂;CRP was（5.05（2.02,9.36））mg/L in group Ab₁and（8.95（5.43,11.15））mg/L in group Ab₂;WBC,NLR and CRP were increased,P<0.05,the difference was statistically significant.There were differences in PLT,PLR,but P>0.05,the differences were not statistically signific-ant.In 34-36+6weeks（group c）,compare the good neonatal outcome group（group Ac₁）with the neonatal complications group（group Ac₂）:WBC was（9.66±1.89）×10~9/L in Ac₁group and（11.89±2.79）×10~9/L in Ac₂group.PLT was（225.84±64.27）×10~9/L in Ac₁group and（225.95±53.88）×10~9/L in Ac₂group.The NLR of Ac₁group was 4.40（3.64,5.30）,and Ac₂group was 5.23（4.36,7.62）.The PLR of Ac₁group was 134.17（106.83,177.90）,and Ac₂group was 134.44（106.07,179.17）.The CRP was(4.44（3.30,7.50）mg/L in Ac₁group and(7.50（5.38,9.25）mg/L in Ac₂group.WBC,NLR and CRP were increased,P<0.05,the difference was statistically significant.There were differences in PLT,PLR,but P>0.05,the differences were not statistically significant.4.Logistic regression analysis showed that the OR value of WBC in PPROM was1.294,95%CI was 1.175-1.425,P=0.000;the OR value of NLR was 1.320,95%CI was1.174-1.485,P=0.000.The results showed that WBC and NLR were risk factors of PPROM and had predictive value for the occurrence of PPROM（P<0.05）.In neonatal complications at 32-36⁺⁶weeks of gestation,the OR value of WBC was 1.210,95%CI was 1.036-1.413,P=0.016;the OR value of NLR was 1.376,95%CI was 1.138-1.664,P=0.001;the OR value of CRP was 1.213,95%CI was 1.091-1.347,P=0.000.The results showed that WBC,NLR and CRP were the risk factors of neonatal complications and had predictive value for the occurrence of neonatal complications（P<0.05）.5.The ROC curve was drawn by statistical software.The area under the curve predicted by WBC to PPROM was 0.731,P<0.05,indicating that WBC had predictive significance for the diagnosis of PPROM,the sensitivity was 0.63,the specificity was0.73,and the threshold was 9.95×10~9/L.The area under the curve of NLR prediction PPROM is 0.701,P<0.05,indicating that NLR has predictive significance for PPROM diagnosis.The sensitivity of NLR is 0.68,the specificity is 0.64,and the threshold is4.37.The area under the curve of WBC combined with NLR prediction PPROM was0.751,P<0.05,the sensitivity was 0.60,the specificity was 0.79,and the limit was9.95×109/L.The area under the curve of WBC for predicting neonatal complications was0.738（P<0.05）,indicating that WBC has predictive significance for the diagnosis of neonatal complications,with a sensitivity of 0.42,specificity of 0.93 and a threshold of12.25×10~9/L.The area under the curve of NLR for predicting neonatal complications was 0.717（P<0.05）,indicating that NLR has predictive significance for the diagnosis of neonatal complications,with a sensitivity of 0.51,specificity of 0.81 and boundary value of 5.6.The area under the curve for CRP to predict neonatal complications was0.728（P<0.05）,indicating that CRP had predictive significance in the diagnosis of neonatal complications,with a sensitivity of 0.78,specificity of 0.58 and a threshold of5.29 mg/L.The area under the curve of WBC+NLR,WBC+CRP,NLR+CRP and WBC+NLR+CRP were 0.770,0.776,0.789 and 0.805,respectively.The area under the curve of combined detection was larger than that of single detection.Especially,the area under the curve of combined detection of WBC,NLR and CRP was the largest.It has good predictive value for the occurrence of neonatal complications.6.The results of correlation analysis show that WBC and NLR are positively corre-lated in PPROM,r=0.614,P<0.05.WBC,NLR and CRP were correlated in neonatal com-plications,WBC was positively correlated with NLR,r=0.549,P<0.05;WBC was positi-vely correlated with CRP,r=0.339,P<0.05;NLR was positively correlated with CRP,r=0.225,P<0.05.Conclusion:1.WBC,NLR,PLR were correlated with PPROM.Compared with normal pregnancy,WBC,NLR,PLR were increased in PPROM.2.At 32-36+6weeks of gestation,WBC,NLR,CRP were associated with adverse neonatal outcomes after PPROM,and CRP,WBC,NLR were increased in neonatal comp-lications after PPROM.3.WBC and NLR are risk factors of PPROM and have predictive value to PPROM.The combined detection value of WBC and NLR is better than that of single detection.4.WBC,NLR and CRP are risk factors for adverse neonatal outcomes after PPROM,and have predictive value for the occurrence of neonatal complications.NLR>5.6 can be used to predict the occurrence of neonatal complications.5.WBC,NLR and CRP levels are positively correlated with each other,so the combined detection of the three should be strengthened during pregnancy.