Neutrophil to Lymphocyte ratio versus Monocyte to Lymphocyte ratio in predicting hypertensive diseases of pregnancy

Abstract

Background: The neutrophil to lymphocyte ratio (NLR) and the monocyte to lymphocyte ratio (MLR) are two systemic inflammatory indices with promising prognostic and predictive abilities for HDP. The study aimed to determine the abilities of the NLR and MLR in predicting HDP among pregnant women in Ghana. Methods: This was a case-control study that was carried out between September 2015 and May 2016 at the Bolgatanga regional hospital. The study involved 50 pregnant women of whom 60% (30/50) had normotensive pregnancies (controls) and 40% (20/50) were confirmed to have HDP (cases). The cases were compared with the controls in terms of their socio-demographic characteristics, full blood count parameters, NLR and MLR. Probability value <0.05 was considered statistically significant. Results: The chances of developing HDP is more likely when lymphocyte count is increased [OR:1.126(95%CI:1.028-1.233)] but less likely with increased NLR [OR: 0.776(95%CI:0.651-0.926)] and MLR [OR: 0.039(95%CI: 0.003-0.469)]. There was no significant difference in the area under the curve (AUC) between NLR and MLR (0.77 vs 0.76, p>0.05). The sensitivities of NLR and MLR were 95.0% and 70.0%, while their specificities were 56.7% and 73.3%, respectively. The positive likelihood ratio (+LR) of MLR was higher than that of NLR (2.6 vs. 2.2). Conclusion: Both the NLR and MLR have moderate predictive ability for hypertensive diseases of pregnancy (HDP). However, the MLR will be a better predictor for HDP than the NLR. We recommend the addition of NLR and MLR when reporting full blood count results for pregnant women.