Diagnostic performance of platelet-lymphocyte ratio in preterm premature rupture of membranes
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20261594Keywords:
Preterm premature rupture of membranes, Platelet-to-lymphocyte ratio, Preterm birth, Inflammatory markersAbstract
Background: Preterm premature rupture of membranes (PPROM) is a significant contributor to preterm birth and is associated with considerable maternal and neonatal morbidity, with diagnosis often challenging due to nonspecific clinical presentation and limited reliable markers. Therefore, the present study aimed to evaluate the diagnostic performance of platelet-to-lymphocyte ratio (PLR) in PPROM.
Methods: This cross-sectional study was conducted in the Department of Obstetrics and Gynaecology, Dhaka Medical College Hospital, Bangladesh (June 2022-May 2023). Sixty pregnant women (30 PPROM, 30 controls) at 28–36⁺⁶ weeks’ gestation were enrolled to evaluate PLR in PPROM. Exclusions included multiple gestations, systemic disorders, malignancy, fetal anomalies, and pregnancy complications (GDM, preeclampsia). Data were analyzed using SPSS v26, with p<0.05 considered significant.
Results: A total of 60 participants (30 per group) were included with comparable baseline characteristics (mean age: 27.57±5.14 vs. 28.33±5.02 years; p=0.561). No significant differences were observed in parity or ANC status. Platelet count (269.63±63.40 vs. 207.43±46.50×10³/mm³; p<0.001) and PLR (123.15±27.73 vs. 104.48±26.09; p=0.009) were significantly higher in Group A, while lymphocyte count was not significant. ROC analysis showed AUC 0.697 with cut-off ≥117.7, sensitivity 53.3%, specificity 76.7%, and accuracy 65%.
Conclusions: PLR shows moderate diagnostic utility as a supportive biomarker in PPROM.
References
Walani SR. Global burden of preterm birth. Int J Gynecol Obstet. 2020;150(1):31-3.
Guduru R, Manjareeka M, Panda J, Pattanayak S. Hematologic Ratios as Early Biomarkers for Preterm Premature Rupture of Membranes: A Prospective Cohort Study. Cureus. 2026;18:3.
Jena BH, Biks GA, Gete YK, Gelaye KA. Incidence of preterm premature rupture of membranes and its association with inter-pregnancy interval: a prospective cohort study. Scientific Rep. 2022;12(1):5714.
Kabir A, Akter L, Ripon A. Association of maternal platelet-to-lymphocyte ratio with preterm prelabour rupture of membranes. Int J Clin Obstet Gynaecol. 2025;9(1):185-91.
Ozel A, Alici Davutoglu E, Yurtkal A, Madazli R. How do platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio change in women with preterm premature rupture of membranes, and threaten preterm labour? J Obstet Gynaecol. 2020;40(2):195-9.
Goya M, Bernabeu A, García N, Plata J, Gonzalez F, Merced C, et al. Premature rupture of membranes before 34 weeks managed expectantly: maternal and perinatal outcomes in singletons. J Maternal-Fetal Neonatal Med. 2013;26(3):290-3.
Simhan HN, Canavan TP. Preterm premature rupture of membranes: diagnosis, evaluation and management strategies. BJOG. 2005;112:32-7.
Celik IH, Hanna M, Canpolat FE, Pammi M. Diagnosis of neonatal sepsis: the past, present and future. Pediatric Res. 2022;91(2):337-50.
Li T, Dong G, Zhang M, Xu Z, Hu Y, Xie B, et al. Association of neutrophil-lymphocyte ratio and the presence of neonatal sepsis. J Immunol Res. 2020;2020(1):7650713.
Ghafoor S. Current and emerging strategies for prediction and diagnosis of prelabour rupture of the membranes: a narrative review. Malaysian J Med Sci. 2021;28(3):5.
Ekin A, Gezer C, Taner CE, Ozeren M, Uyar I, Gulhan I. Risk factors and perinatal outcomes associated with latency in preterm premature rupture of membranes between 24 and 34 weeks of gestation. Arch Gynecol Obstet. 2014;290(3):449-55.
Menon R, Richardson LS, Lappas M. Fetal membrane architecture, aging and inflammation in pregnancy and parturition. Placenta. 2019;79:40-5.
Kenyon S, Boulvain M, Neilson JP, Cochrane Pregnancy and Childbirth Group. Antibiotics for preterm rupture of membranes. Cochrane Database System Rev. 1996;2013:12.
Karampitsakos T, Mavrogianni D, Machairiotis N, Potiris A, Panagopoulos P, Stavros S, et al. The impact of amniotic fluid interleukin-6, interleukin-8, and metalloproteinase-9 on preterm Labor: A narrative review. Biomedicines. 2025;13(1):118.
Balta S, Ozturk C. The platelet-lymphocyte ratio: A simple, inexpensive and rapid prognostic marker for cardiovascular events. Platelets. 2015;26(7):680-1.
Nording HM, Seizer P, Langer HF. Platelets in inflammation and atherogenesis. Front Immunol. 2015;6:98.
Qin B, Ma N, Tang Q, Wei T, Yang M, Fu H, et al. Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) were useful markers in assessment of inflammatory response and disease activity in SLE patients. Modern Rheumatol. 2016;26(3):372-6.
Stojkovic Lalosevic M, Pavlovic Markovic A, Stankovic S, Stojkovic M, Dimitrijevic I, Radoman Vujacic I, et al. Combined diagnostic efficacy of neutrophil‐to‐lymphocyte ratio (NLR), platelet‐to‐lymphocyte ratio (PLR), and mean platelet volume (MPV) as biomarkers of systemic inflammation in the diagnosis of colorectal cancer. Dis Markers. 2019;2019(1):6036979.
Özer PT, Özer M, Oğlak SC, Budak A, İnan AH, Tosun G, et al. Evaluating the predictive potential of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in the second-trimester preterm premature rupture of membranes (PPROM): a retrospective case-control study. Clin Expe Obstet Gynecol. 2024;51(2):28.
Abebe TA, Nima DD, Mariye YF, Leminie AA. Determinants for perinatal adverse outcomes among pregnant women with preterm premature rupture of membrane: A prospective cohort study. Front Reprod Health. 2022;4:1052827.
Naher N, Faria FT. Maternal and Fetal Outcome in Women Presenting with Preterm Premature Rupture of Membranes (PPROM): A Case Series from a Tertiary Care Hospital in Bangladesh. TAJ. 2025;38(4):206-11.
Noor S, Nazar AF, Bashir R, Sultana R. Prevalance of PPROM and its outcome. J Ayub Med Coll Abbottabad. 2007;19(4):14-7.
Ağaoğlu RT, Öztürk Ö, Ulusoy CO, Günday F, Sarikaya Kurt D, Aksu M, et al. Perinatal outcomes and predictors of neonatal mortality in preterm premature rupture of membranes: a tertiary center experience. BMC pregnancy and childbirth. 2025;25(1):585.
Toprak E, Bozkurt M, Dinçgez Çakmak B, Özçimen EE, Silahlı M, Ender Yumru A, et al. Platelet-to-lymphocyte ratio: A new inflammatory marker for the diagnosis of preterm premature rupture of membranes. J Turk Ger Gynecol Assoc. 2017;18(3):122-6.
Egiz MN, Mahmoud SA, Abdel-Samea SR, Dawood RM. The Diagnostic Value of Platelet/Lymphocyte Ratio and Neutrophil/Lymphocyte Ratio in Preterm Premature Rupture of Membranes. Egypt J Hospital Med. 2023;91(1):4251-8.
Esercan A, Demir I. Neutrophil/Lymphocyte and Platelet/Lymphocyte Ratio in Preterm Premature Rupture of Membranes. Cureus. 2023;15(5):e38664.