The Accuracy of Neutrophil/Lymphocyte Ratio in Prediction of Preeclampsia in Low Risk Population

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).