Physiological and Statistical Evaluation of Neutrophil-Lymphocyte Ratio as a Predictor of First Trimester Miscarriage Among Residents of Hyderabad

Syed Farhan Uddin; Keenjhar Rani; Tazeen Shah; Nudrat Zeba; Allah Wadhayo Kalo; Kiran Waheen; Syeda Mahnoor

Syed Farhan Uddin Associate Professor at Department of Physiology, Muhammad Medical College, Mirpurkhas
Keenjhar Rani Associate Professor at Department of Physiology, Liaquat University of Health Sciences Jamshoro
Tazeen Shah Associate Professor at Department of Physiology, Liaquat University of Health Sciences Jamshoro
Nudrat Zeba Associate Professor at Department of Community Medicine, Bilawal Medical College, LUMHS, Jamshoro
Allah Wadhayo Kalo Lecturer Department of Community Medicine, Bilawal Medical College, LUMHS, Jamshoro, Sindh
Kiran Waheen Assistant professor at department of Biochemistry, LUMHS Jamshoro
Syeda Mahnoor House officer at Department of OBGYn of Liaquat university hospital Hyderabad

Keywords: Neutrophil-lymphocyte ratio, miscarriage

Abstract

Objective: To determine the role of Neutrophil-Lymphocyte Ratio (NLR) as a predictive biomarker for first-trimester miscarriage.

Methodology: It was a cross-sectional study that was conducted at Muhammad Medical College Hospital, Mirpurkhas, Pakistan, from February 01 -2024, to May 30, 2024. The ethical approval was obtained from the ethical committee of Muhammad Medical College Mirpurkhas. The sample size of this study was 200 participants; the cases were included based on confirmed miscarriage by ultrasound, while the control group had a normal pregnancy but underwent elective termination. Then the neutrophil-lymphocyte ratio of each patient was assessed after taking blood samples. The analysis was done on GraphPad Prism 9. The percentages, frequency distribution, and histogram tests were applied for variable analysis. The statistical significance was determined by Fischer’s exact test (p ≤ 0.05).

Results: These study results show 76% of the participants who had miscarriages showed an NLR greater than 3, and 16.62% had an NLR less than 3. Indicating the strong correlation between two entities with sensitivity of 76%, specificity of 84%, positive predictive value (PPV) of 60.3%, negative predictive value (NPV) of 91%, and overall accuracy of 81%, showing that NLR is a statistically significant predictor for miscarriage in the first trimester.

Conclusion: This study concludes that there is a strong statistical correlation between a raised neutrophil-lymphocyte ratio (NLR) and an increased risk for miscarriage in the first trimester of pregnancy.