Do serum Delta-Neutrophil Index and Neutrophil-to-Lymphocyte ratio predict fetal growth restriction?

Aim: To investigate the prognostic significance of delta-neutrophil index (DNI) and neutrophil/lymphocyte ratio (NLR) in women with intrauterine growth retardation (IUGR) and normal pregnant women.

Methods: Normal pregnant women who delivered at Health Sciences University Etlik Zübeyde Hanim Women's Health Training and Research Hospital between January 2015 and July 2020 and pregnant women with IUGR were included in the study. 486 pregnant women and 400 normally pregnant women diagnosed with IUGR according to Delphi criteria were included in the analysis. Data available at presentation for delivery or within four weeks before delivery were used for analysis of DNI and other laboratory values in both the patient and control groups.

Results: The mean age of study group was 28.3±4.6 and control group was 27.2±5.6 years. There were significant differences between the study and control groups regarding maternal age, prepregnancy BMI, BMI at delivery and gestational age at admission and delivery, hemoglobin(Hb) levels, hematocrit (Hct) values, WBC values, lymphocyte, monocyte, neutrophile, thrombocyte counts, NLRs, DNI values, between the two groups. The median NLRs were 4.6 (range, 1.54±44.29), the mean DNI value of IUGR was --0.26±3.4 and the mean DNI value of control group was -3.7±5.8 (p<0.001, p<0.001, respectively). The NLR and DNI levels are significantly higher in the IUGR group. The optimal cut-off value for NLR was 3.84, with a sensitivity of 70.6% a specificity of 70.5%, and an area under the receiver operating characteristic curve of 0.780. The optimal cutoff value for DNI was -1.18, with a sensitivity of 53.9%, a specificity of 52%, and an area under the ROC curve of 0.692. The Odds Ratio of the DNI was 1.2, and NLR was 5.7.

Conclusion: Considering its sensitivity and specificity, the NLR value shows that inflammatory events are much more effective in pregnant women with IUGR than we thought.