الفهرس 
Hypertensive Disorders of PregnancyOnly 14 pages are availabe for public view
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Abstract
Preeclampsia arises as a result of excessive maternal intravascular inflammatory response to pregnancy, which may occur because either the stimulus or the maternal response is too strong and involves both the innate and the adaptive immune system (Heyward et al., 2017).
Neutrophil activation is confined to the maternal circulation, where it may contribute to vascular damage (Regal et al., 2015). Further evidence of enhanced inflammation in PE is the uncontrolled increased activation of the complement system compared with normal pregnancy. Activation of the complement system amplifies inflammation, promotes chemotaxis of inflammatory cells and generates proteolytic fragments that enhance phagocytosis by neutrophils and monocytes (Lynch et al., 2010). Another important feature of systemic inflammation in PE is the predominance of Th1-type immunity and the absence of Th2 tendency (Pergialiotis et al., 2016; Cornelius et al., 2019; Cubro et al., 2018).
The differential white blood cell counts are an easily measurable, available and reliable parameter which can be used as a severity index of the systemic inflammatory immune response (Imtiaz et al., 2012; Balta et al., 2014).
In recent years, there was more focus on NLR as a reliable marker of low grade inflammation in various clinical conditions (Balta et al., 2016; Ozturk et al., 2015). Platelets and lymphocytes are significant blood parameters related to immune surveillance and the PLR plays an important role in cytokine-dependent immune response (Turkmen et al., 2013; Tasoglu et al., 2014).
We aimed to assess the the accuracy of neutrophil/lymphocyte ratio (NLR) in prediction of preeclampsia (PET) in low risk population.
We compared 70 Egyptian women, 35 with preeclampsia and 35 women who had normal pregnancies, for the values of neutrophil/lymphocyte ratio in all patients in three occasions before 20th week of gestation, at time of labour and the first 48 hours after delivery.
Results showed that there was no statistically significant difference between patients with PE and healthy pregnant women as regard neutrophil/lymphocyte ratio.
We used Receiver Operating characteristic (ROC) curve, The area under the curve was 0.628, standared error was 0.070 and 95% confidence interval’s lower bound was 0.491 and upper bound was 0.764 so Neutrophil/ Lymphocyte ratio cannot predict preeclampsia in low risk population.
The results are:
By comparing the age distribution between cases and controls we found that ,the mean of age in cases was 29.11±2.90 years and the mean of age in controls was 28.83±2.56 years and the p value was 0.66 which is statistically non significant.
Also, by comparing the gestational age between cases and controls we found that, The mean of gestational age in cases was 36.26±1.46and the mean of age in controls was 37.91±1.36 and the p value was <0.001 which is statistically highly significant.
Inaddition, By comparing the gravidity between cases and controls, The number of cases with gravidity 1 was 12 with percent of 34.3% of all cases, The number of controls with gravidity 1 was 12 with percent of 34.3% of all controls.The number of cases with gravidity 2 was 9 with percent of 25.7% of all cases, The number of controls with gravidity 2 was 9 with percent of 25.7% of all controls.The number of cases with gravidity 3 was 8 with percent of 22.9% of all cases, The number of controls with gravidity 3 was 7 with percent of 20.0% of all controls.The number of cases with gravidity >4was 6 with percent of 17.1% of all cases, the number of controls with gravidity >4 was 7 with percent of 20.0% of all controls.finally, After calculation of p value the result was .99 which is statistically non-significant.
By comparing the Parity between cases and controls, The number of cases with parity 0 was 14 with percent of 40% of all cases and the number of controls with parity 0 was 12 with percent of 34.3% of all controls, The number of cases with parity 1 was 12 with percent of 34.3% of all cases and the number of controls with parity 1 was 11 with percent of 31.4% of all controls, The number of cases with parity 2 was 6 with percent of 17.1% of all cases and the number of controls with parity 2 was 6 with percent of 17.1% of all controls, The number of cases with parity >3 was 3 with a percent of 8.6 % of all cases and the number of controls with parity >3 was 6 with percent of 17.1% of all controls.And finally, After calculation of p value the result was .77 which is statistically non significant.
By comparing the previous abortions between cases and controls, The number of cases with no history of previous abortions was 25 with a percent of 71.4% of all cases and with history of previous abortions was 10 with a percent of 28.6% of all cases, The number of controls with no history of previous abortions was 30 with a percent of 85.7% of all controls and with history of previous abortions was 5 with a percent of 14.3% of all controls.After calculation of p value the result was 0.15 which is statistically non-significant.
By comparing the weight between cases and controls, The mean of weight in cases was 74.20±8.98 Kg and the mean of weight in controls was 75.09±8.43 Kg and the p value was 0.67which is statistically non significant.While By comparing the height between cases and controls, The mean of height in cases was 162.57±5.36 cm and the mean of height in controls was 163.71±6.40 cm and the p value was 0.42 which is statistically non significant.Also, By comparing the BMI between cases and controls, The mean of BMI in cases was 28.20±3.97 Kg/m2 and the mean of BMI in controls was 27.99 ±2.73 Kg/m2 and the p value was 0.80 which is statistically non significant.
Regarding to systolic blood pressure between cases and controls, The mean of SBP in cases was 142.43±12.62 mmHg and the mean of SBP in controls was 109.71±11.24 mmHg and the p value was <0.001 which is statistically highly significant.Also, By comparing the diastolic blood pressure between cases and controls, The mean of DBP in cases was 96.00±8.98 mmHg and the mean of DBP in controls was 69.57±7.71 mmHg and the p value was <0.001 which is statistically highly significant.
By comparing the proteinurea between cases and controls we found that the mean of proteinurea in cases was 2745.31±619.59 mg/dl 24hour and the mean of proteinurea in controls was 132.18±15.68 mg/dl 24hour and the p value was <0.001 which is statistically highly significant.
By comparing the platelet count between cases and controls we found that the mean of platelet count in cases was 239.74±80.53(10*3/UL) and the mean of platelet count in controls was 247.60±91.30 (10*3/UL) and the p value was 0.70 which is statistically non-significant.Also, by comparing the haemoglobin level between cases and controls, The mean of HB in cases was 11.01±1.24 mg/dl and the mean of HB in controls was 10.68±1.32 mg/dl and the p value was 0.35 which is statistically non-significant.
By comparing the ALT level between cases and controls we found that the mean in cases was 40.86±33.91 and the mean in controls was 16.00±11.10 and the p value was <0.001 which is statistically highly significant.Also, By comparing the the AST level between cases and controls, the mean in cases was 31.71±22.20 and the mean in controls was 30.54±16.05 and the p value was 0.80 which is statistically non-significant.
By comparing the serum creatinine level between cases and controls, the mean in cases was 0.70±0.21 and the mean in controls was 0.59±0.17 and the p value was 0.03 which is statistically significant.
By comparing the Neutrophils1 level between cases and controls we found that the mean in cases was 70.83±9.11 and the mean in controls was 75.91±4.05 and the p value was 0.001 which is statistically highly significant and by comparing the lymphocytes1 level between cases and controls, the mean in cases was 19.77±6.38 and the mean in controls was 21.21±2.75 and the p value was 0.22 which is statistically non-significant.
By comparing the Neutrophils2 level between cases and controls we found that the mean in cases was 72.02±7.63 and the mean in controls was 75.67±4.02 and the p value was 0.02 which is statistically significant and by comparing the lymphocytes 2 level between cases and controls, the mean in cases was 18.97±5.97 and the mean in controls was 20.88±2.73 and the p value was 0.09 which is statistically non-significant.
Finally by comparing the Neutrophil/lymphocyte ratio 1”before labour” between cases and controls we found that the mean was 4.01±1.53 and the mean in controls was 3.62±0.33 and the p value was 0.14 which is statistically non-significant and by comparing the Neutrophil lymphocyte ratio 2”after labour” between cases and controls, The mean in cases was 4.22±1.51 and the mean in controls was 3.66±0.35 and the p value was 0.04 which is statistically significant.After doing the ROC curve, the area under the curve was 0.565, standared error was 0.076 and 95% confidence interval’s lower bound was .416 and upper bound was 0.713. So the N/L ratio cannot discriminate between cases and controls.
By comparing the neutrophils 3 level”taken from their files and measured in the early pregnancy, before 20th week of pregnancy” between cases and controls we found that the mean in cases was 71.67±4.48 and the mean in controls was 74.49±2.57 and the p value was 0.002 which is statistically highly significant while by comparing the lymphocytes 3 ”taken from their files and measured in the early pregnancy, before 20th week of pregnancy” level between cases and controls, the mean in cases was 21.61±4.79 and the mean in controls was 24.47±10.00 and the p value was 0.13 which is statistically non significant.
After comparing between neutrophil/lymphocyte ratio 3 between cases and controls, the mean was 3.46±0.71and the mean in controls was 3.25±.57 and the p value was .17 which is statistically non significant and after doing the ROC curve, The area under the curve was 0.628, standared error was 0.070 and 95% confidence interval’s lower bound was .491 and upper bound was 0.764.So the net result is that N/L ratio cannot predict preeclampsia.