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. 2024 Dec 15;16(12):7448-7457.
doi: 10.62347/OWXV5949. eCollection 2024.

Analysis of changes in platelet parameters and inflammatory markers in intrahepatic cholestasis of pregnancy before disease development

Cong Shen  1 , Wenshi Hu  2 , Tiantian Wu  1 , Gaigai Wang  1 , Longwei Qiao  1 , Tingting Gao  3
Affiliations

Analysis of changes in platelet parameters and inflammatory markers in intrahepatic cholestasis of pregnancy before disease development

Cong Shen et al. Am J Transl Res. .

Abstract

Background: Intrahepatic cholestasis of pregnancy (ICP) is the most common liver condition during pregnancy, associated with adverse outcomes for both mother and fetus. While inflammatory markers are important predictors in oncology and cardiovascular disease, their role in ICP remains unclear. This study investigates changes in platelet parameters and blood-derived inflammatory markers around the onset of ICP and evaluates their potential as independent risk factors.

Methods: This retrospective study analyzed inflammatory markers, including the Neutrophil-to-Lymphocyte Ratio (NLR), Derived NLR (dNLR), Monocyte-to-Lymphocyte Ratio (MLR), Neutrophil-Monocyte-to-Lymphocyte Ratio (NMLR), Systemic Inflammation Response Index (SIRI), and Systemic Immune-Inflammation Index (SII) along with variations in platelet parameters in 49 ICP patients and 250 healthy controls during late pregnancy, specifically at disease onset. Additionally, changes in these parameters were assessed among the same 49 ICP patients compared to 1439 healthy controls during early pregnancy.

Results: During an episode of ICP, individuals exhibited increased platelet parameters, including PCT, P-LCR, PDW and MPV, compared to those with uncomplicated pregnancies. The levels of WBC, NEUT, NLR, dNLR, NMLR, SIRI, and SII were also elevated in the ICP group relative to the control group. Prior to disease onset, platelet parameters such as PCT and PDW, along with inflammatory markers including NEUT, NLR, NMLR, SIRI, and SII, were significantly higher in ICP patients. Additionally, a notable increase in HGB, HCT, MCV, MCH, and RDW-CV was observed in the ICP group, while MCHC was decreased. Logistic regression analysis identified MCV, PDW and SII as risk factors for developing ICP.

Conclusions: PCT, PDW, NEUT, NLR, NMLR, SIRI, and SII levels were significantly elevated both before and during the progression of ICP. Notably, MCV, PDW, and SII were identified as independent risk factors, representing new predictive indicators for the development of ICP.

Keywords: Intrahepatic cholestasis of pregnancy (ICP); inflammatory markers; platelet parameters.

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Conflict of interest statement

None.

Figures

Figure 1
Figure 1
Differences in parameters related to routine blood tests between the ICP group and the control group in late-pregnancy. (A) PCT, (B) P-LCR, (C) MPV, (D) PDW, (E) NLR, (F) dNLR, (G) NMLR, (H) SIRI and (I) SII. ICP, Intrahepatic Cholestasis of Pregnancy; PCT, plateletcrit; P-LCR, platelet-larger cell ratio; MPV, mean platelet volume; PDW, platelet distribution width; WBC, white blood cell count; NEUT, neutrophil count; NLR, neutrophil to lymphocyte ratio; dNLR, derived neutrophil to lymphocyte ratio; NMLR, neutrophil-monocyte to lymphocyte Ratio; SIRI, systemic inflammatory response index; SII, systemic immune inflammatory index. *<0.05, **<0.01, ***<0.001.
Figure 2
Figure 2
Differences in parameters related to routine blood tests between the ICP group and the control group in early or mid-pregnancy. (A) PCT, (B) PDW, (C) NLR, (D) NMLR, (E) SIRI and (F) SII. ICP, Intrahepatic Cholestasis of Pregnancy; PCT, plateletcrit; PDW, platelet distribution width; NLR, neutrophil to lymphocyte ratio; NMLR, neutrophil-monocyte to lymphocyte Ratio; SIRI, systemic inflammatory response index; SII, systemic immune inflammatory index. *<0.05, **<0.01, ***<0.001.
Figure 3
Figure 3
Differences in parameters related to erythrocyte examination between the ICP group and the control group in early or mid-pregnancy. (A) HGB, (B) HCT, (C) MCV, (D) MCH, (E) MCHC and (F) RDW-SD. HGB, hemoglobin; HCT, hematocrit; MCV, mean corpusular volume; MCH, mean corpusular hemoglobin; MCHC, mean corpusular hemoglobin concentration; RDW, red blood cell volume distribution width. *<0.05, **<0.01, ***<0.001.
Figure 4
Figure 4
PCT, NEUT, NLR, NMLR, SIRI and SII are strongly correlated. PCT, plateletcrit; NEUT, neutrophil count; NLR, Neutrophil-to-Lymphocyte Ratio; NMLR, Neutrophil-Monocyte-to-Lymphocyte Ratio; SIRI, Systemic Inflammation Response Index; SII, Systemic Immune-Inflammation Index.
Figure 5
Figure 5
Multiple regression analysis found that MCV, PDW and SII were associated with an increased risk of ICP. ICP, Intrahepatic cholestasis of pregnancy; MPV, ean platelet volume; PDW, platelet distribution width; SII, Systemic Immune-Inflammation Index.
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