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CC BY-NC-ND 4.0 · J Lab Physicians 2019; 11(02): 149-153
DOI: 10.4103/JLP.JLP_151_18
Original Article

Subclinical inflammation markers in hyperemesis gravidarum and ketonuria: A case–control study

Ersin çintesun
Department of Obstetrics and Gynecology, Faculty of Medicine, Selçuk University, Selçuklu, Konya, Turkey, India
,
Serra Akar
Department of Obstetrics and Gynecology, Faculty of Medicine, Selçuk University, Selçuklu, Konya, Turkey, India
,
Ayhan Gul
Department of Obstetrics and Gynecology, Faculty of Medicine, Selçuk University, Selçuklu, Konya, Turkey, India
,
Feyza Nur Incesu Çintesun
Department of Obstetrics and Gynecology, Faculty of Medicine, Selçuk University, Selçuklu, Konya, Turkey, India
,
Gözde Sahin
Department of Obstetrics and Gynecology, Faculty of Medicine, Selçuk University, Selçuklu, Konya, Turkey, India
,
Huriye Ezveci
Department of Biochemistry, Faculty of Medicine, Selçuk University, Selçuklu, Konya, Turkey, India
,
Fikret Akyürek
Department of Obstetrics and Gynecology, Faculty of Medicine, Selçuk University, Selçuklu, Konya, Turkey, India
,
Çetin Çelik
Department of Obstetrics and Gynecology, Faculty of Medicine, Selçuk University, Selçuklu, Konya, Turkey, India
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Abstract

INTRODUCTION: Subclinical inflammation markers play a significant role in hyperemesis gravidarum (HEG). Simple hematological markers such as mean platelet volume (MPV), platelet distribution width (PDW), neutrophil-to-lymphocyte ratio (NLR), red cell distribution width (RDW), plateletcrit (PCT), and platelet-to-lymphocyte ratio (PLR) have been shown to reflect inflammatory burden and disease activity in several disorders. Ketonuria is a parameter used in the diagnosis of severe HEG, but its correlation with disease severity remains controversial. The relationship of subclinical inflammation markers with degree of ketonuria has not been examined previously. In this study, we aimed to determine the diagnostic value of these subclinical inflammation markers and the relationship between these markers and grade of ketonuria in patients with HEG.

MATERIALS AND METHODS: A total of 94 pregnant women with a diagnosis of HEG and 100 gestational age-matched healthy pregnant women were enrolled in this retrospective study. MPV, PDW, NLR, PLR, PCT, and ketonuria were calculated and analyzed from complete blood cell counts and total urine analyses.

RESULTS: Lymphocyte count was significantly higher in the control group (P < 0,001); NLR and PLR values were significantly higher in the HEG group (P < 0,001). Among inflammation markers, RDW increased significantly (P = 0,008) with an increase in ketonuria in patients with HEG. A statistically significant correlation was found between white blood cell (WBC) and NLR, PLR, PCT. A moderate uphill relationship was observed between NLR and WBC and a weak uphill linear relationship was observed between WBC and PLR and between WBC and PCT

CONCLUSIONS: PLR and NLR can be considered effective markers to aid in the diagnosis of HEG. No marker was found to correlate with ketonuria grade except RDW, although the relationship of the severity of ketonuria with severity of disease is controversial. RDW increases as the degree of ketonuria increases.

Key words

Hyperemesis gravidarum - ketonuria - subclinical inflammation


Publication History

Received: 13 November 2018

Accepted: 01 March 2019

Article published online:
06 April 2020

© 2019.

Thieme Medical and Scientific Publishers Private Ltd.
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  • References

  • 1 Lacasse A, Rey E, Ferreira E, Morin C, Bérard A. Nausea and vomiting of pregnancy: What about quality of life? BJOG 2008;115:1484-93.
  • 2 Godsey RK, Newman RB. Hyperemesis gravidarum. A comparison of single and multiple admissions. J Reprod Med 1991;36:287-90.
  • 3 Eliakim R, Abulafia O, Sherer DM. Hyperemesis gravidarum: A current review. American journal of perinatology. 2000;17:207-18.
  • 4 Buckwalter JG, Simpson SW. Psychological factors in the etiology and treatment of severe nausea and vomiting in pregnancy. Am J Obstet Gynecol 2002;186:S210-4.
  • 5 Brzana RJ, Koch KL. Gastroesophageal reflux disease presenting with intractable nausea. Ann Intern Med 1997;126:704-7.
  • 6 Kurt RK, Güler A, Silfeler DB, Ozçil MD, Karateke A, Hakverdi AU, et al. Relation of inflammatory markers with both presence and severity of hyperemesis gravidarum. Ginekol Pol 2014;85:589-93.
  • 7 Caglayan EK, Engin-Ustun Y, Gocmen AY, Sarı N, Seckin L, Kara M, et al. Is there any relationship between serum sirtuin-1 level and neutrophil-lymphocyte ratio in hyperemesis gravidarum? J Perinat Med 2016;44:315-20.
  • 8 Niemeijer MN, Grooten IJ, Vos N, Bais JM, van der Post JA, Mol BW, et al. Diagnostic markers for hyperemesis gravidarum: A systematic review and metaanalysis. Am J Obstet Gynecol 2014;211:150.e1-15.
  • 9 Yildirim M, Turkyilmaz E, Avsar AF. Preoperative neutrophil-to-lymphocyte ratio has a better predictive capacity in diagnosing tubo-ovarian abscess. Gynecol Obstet Invest 2015;80:234-9.
  • 10 Torun S, Tunc BD, Suvak B, Yildiz H, Tas A, Sayilir A, et al. Assessment of neutrophil-lymphocyte ratio in ulcerative colitis: A promising marker in predicting disease severity. Clin Res Hepatol Gastroenterol 2012;36:491-7.
  • 11 Aktar F, Tekin R, Bektaş MS, Güneş A, Köşker M, Ertuǧrul S, et al. Diagnostic role of inflammatory markers in pediatric Brucella arthritis. Ital J Pediatr 2016;42:3.
  • 12 Beyazit F, Öztürk FH, Pek E, Ünsal MA. Evaluation of the hematologic system as a marker of subclinical inflammation in hyperemesis gravidarum: A case control study. Ginekol Pol 2017;88:315-9.
  • 13 Tayfur C, Burcu DC, Gulten O, Betul D, Tugberk G, Onur O, et al. Association between platelet to lymphocyte ratio, plateletcrit and the presence and severity of hyperemesis gravidarum. J Obstet Gynaecol Res 2017;43:498-504.
  • 14 Netravathi M, Sinha S, Taly AB, Bindu PS, Bharath RD. Hyperemesis-gravidarum-induced Wernicke's encephalopathy: Serial clinical, electrophysiological and MR imaging observations. J Neurol Sci 2009;284:214-6.
  • 15 Kiyokawa Y, Yoneyama Y. Relationship between adenosine and T-helper 1/T-helper 2 balance in hyperemesis gravidarum. Clin Chim Acta 2006;370:137-42.
  • 16 Ipek S, Cekic C, Alper E, Coban E, Eliacik E, Arabul M, et al. Can red cell distribution width be a marker of disease activity in ulcerative colitis? Int J Clin Exp Med 2015;8:13848-53.
  • 17 Viana-Rojas JA, Rosas-Cabral A, Prieto-Macías J, Terrones-Saldívar MC, Arcos-Noguez P, Bermúdez-Gómez J, et al. Relation of red cell distribution width and mean platelet volume with the severity of preeclampsia. Rev Med Inst Mex Seguro Soc 2017;55:176-81.
  • 18 Zhao T, Cui L, Li A. The significance of RDW in patients with hepatocellular carcinoma after radical resection. Cancer Biomark 2016;16:507-12.
  • 19 Sari N, Ede H, Engin-Ustun Y, Göçmen AY, Çaǧlayan EK. Hyperemesis gravidarum is associated with increased maternal serum ischemia-modified albumin. J Perinat Med 2017;45:421-5.
  • 20 Giacomini A, Legovini P, Gessoni G, Antico F, Valverde S, Salvadego MM, et al. Platelet count and parameters determined by the Bayer ADVIA 120 in reference subjects and patients. Clin Lab Haematol 2001;23:181-6.
  • 21 Adibi P, Faghih Imani E, Talaei M, Ghanei M. Population-based platelet reference values for an Iranian population. Int J Lab Hematol 2007;29:195-9.
  • 22 Sandhaus LM, Meyer P. How useful are CBC and reticulocyte reports to clinicians? Am J Clin Pathol 2002;118:787-93.
  • 23 Bath PM, Butterworth RJ. Platelet size: Measurement, physiology and vascular disease. Blood Coagul Fibrinolysis 1996;7:157-61.
  • 24 Kisacik B, Tufan A, Kalyoncu U, Karadag O, Akdogan A, Ozturk MA, et al. Mean platelet volume (MPV) as an inflammatory marker in ankylosing spondylitis and rheumatoid arthritis. Joint Bone Spine 2008;75:291-4.
  • 25 Wen Y. High red blood cell distribution width is closely associated with risk of carotid artery atherosclerosis in patients with hypertension. Exp Clin Cardiol 2010;15:37-40.
  • 26 Weiss G. Anemia of chronic disorders: New diagnostic tools and new treatment strategies. Semin Hematol 2015;52:313-20.
  • 27 Dolan RD, Lim J, McSorley ST, Horgan PG, McMillan DC. The role of the systemic inflammatory response in predicting outcomes in patients with operable cancer: Systematic review and meta-analysis. Sci Rep 2017;7:16717.
  • 28 Tan PC, Jacob R, Quek KF, Omar SZ. Indicators of prolonged hospital stay in hyperemesis gravidarum. Int J Gynaecol Obstet 2006;93:246-7.
  • 29 Tan PC, Jacob R, Quek KF, Omar SZ. Readmission risk and metabolic, biochemical, haematological and clinical indicators of severity in hyperemesis gravidarum. Aust N Z J Obstet Gynaecol 2006;46:446-50.
  • 30 Tan PC, Tan NC, Omar SZ. Effect of high levels of human chorionic gonadotropin and estradiol on the severity of hyperemesis gravidarum. Clin Chem Lab Med 2009;47:165-71.
  • 31 Derbent AU, Yanik FF, Simavli S, Atasoy L, Urün E, Kuşçu UE, et al. First trimester maternal serum PAPP-A and free β-HCG levels in hyperemesis gravidarum. Prenat Diagn 2011;31:450-3.