Predictive value of inflammatory indices for disease severity and perinatal outcomes in intrahepatic cholestasis of pregnancy
Abstract Background The etiology of intrahepatic cholestasis of pregnancy (ICP) is not fully understood; however, genetic, hormonal, environmental factors, and inflammation are believed to contribute to its development. This study aimed to investigate the relationship between systemic immune-inflamm...
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BMC
2025-07-01
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| Series: | BMC Pediatrics |
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| Online Access: | https://doi.org/10.1186/s12887-025-05842-y |
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| author | Erkan Sağlam Mustafa Raşit Özler Ebu Bekir Sıddık Yılmaz Sıddık Yılmaz Mevlüt Bucak |
| author_facet | Erkan Sağlam Mustafa Raşit Özler Ebu Bekir Sıddık Yılmaz Sıddık Yılmaz Mevlüt Bucak |
| author_sort | Erkan Sağlam |
| collection | DOAJ |
| description | Abstract Background The etiology of intrahepatic cholestasis of pregnancy (ICP) is not fully understood; however, genetic, hormonal, environmental factors, and inflammation are believed to contribute to its development. This study aimed to investigate the relationship between systemic immune-inflammation index (SII), systemic inflammatory response index (SIRI), and neutrophil-to-monocyte ratio (NMR) levels with disease severity in ICP and to evaluate their potential in predicting adverse perinatal outcomes. Materials and methods A total of 240 pregnant women who delivered at Bursa City Hospital between 2019 and 2024 were retrospectively analyzed. Based on fasting serum bile acid (SBA) levels, patients were divided into three groups: control (SBA < 10 µmol/L), mild (SBA 10–40 µmol/L), and severe (SBA ≥ 40 µmol/L) cholestasis. Inflammatory indices were calculated using complete blood count. Blood samples had been collected at the time of diagnosis, between 28 and 36 weeks of gestation during the third trimester, and prior to the initiation of any treatment. Intergroup comparisons and correlation analyses were conducted. The predictive value of these indices was assessed using receiver operating characteristic (ROC) analysis. Results No significant differences were found between groups in WBC and other complete blood count parameters. Only NMR was significantly higher in the severe cholestasis group compared to the control group (p = 0.0057). SII and SIRI levels did not differ significantly among the groups. Gestational age at delivery, birth weight, Apgar scores, and neonatal intensive care unit (NICU) admission rates were significantly worse in the cholestasis groups than in controls (p < 0.001). SII showed a negative correlation with gestational age and 5th-minute Apgar score. In ROC analysis, SII predicted preterm birth with an AUC of 0.600 (cut-off: 897.35; sensitivity: 57%; specificity: 67%) and predicted low 5th-minute Apgar scores with an AUC of 0.669 (cut-off: 1248.38; sensitivity: 75%; specificity: 83%). Conclusion The SII and the SIRI may not be reliable markers for the diagnosis or severity assessment of ICP. However, the SII may serve as a potential predictor for preterm birth and low Apgar scores. NMR was significantly elevated in severe ICP patients, suggesting its potential diagnostic value, which should be supported by further studies. |
| format | Article |
| id | doaj-art-e72ae63bdfb84b76aeba514c86c5526c |
| institution | Kabale University |
| issn | 1471-2431 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pediatrics |
| spelling | doaj-art-e72ae63bdfb84b76aeba514c86c5526c2025-08-20T03:42:00ZengBMCBMC Pediatrics1471-24312025-07-012511710.1186/s12887-025-05842-yPredictive value of inflammatory indices for disease severity and perinatal outcomes in intrahepatic cholestasis of pregnancyErkan Sağlam0Mustafa Raşit Özler1Ebu Bekir Sıddık Yılmaz2Sıddık Yılmaz3Mevlüt Bucak4Bursa City Hospital, Perinatology ClinicBursa City Hospital, Perinatology ClinicBursa City Hospital, Perinatology ClinicBursa City Hospital, Perinatology ClinicEtlik City Hospital, Perinatology ClinicAbstract Background The etiology of intrahepatic cholestasis of pregnancy (ICP) is not fully understood; however, genetic, hormonal, environmental factors, and inflammation are believed to contribute to its development. This study aimed to investigate the relationship between systemic immune-inflammation index (SII), systemic inflammatory response index (SIRI), and neutrophil-to-monocyte ratio (NMR) levels with disease severity in ICP and to evaluate their potential in predicting adverse perinatal outcomes. Materials and methods A total of 240 pregnant women who delivered at Bursa City Hospital between 2019 and 2024 were retrospectively analyzed. Based on fasting serum bile acid (SBA) levels, patients were divided into three groups: control (SBA < 10 µmol/L), mild (SBA 10–40 µmol/L), and severe (SBA ≥ 40 µmol/L) cholestasis. Inflammatory indices were calculated using complete blood count. Blood samples had been collected at the time of diagnosis, between 28 and 36 weeks of gestation during the third trimester, and prior to the initiation of any treatment. Intergroup comparisons and correlation analyses were conducted. The predictive value of these indices was assessed using receiver operating characteristic (ROC) analysis. Results No significant differences were found between groups in WBC and other complete blood count parameters. Only NMR was significantly higher in the severe cholestasis group compared to the control group (p = 0.0057). SII and SIRI levels did not differ significantly among the groups. Gestational age at delivery, birth weight, Apgar scores, and neonatal intensive care unit (NICU) admission rates were significantly worse in the cholestasis groups than in controls (p < 0.001). SII showed a negative correlation with gestational age and 5th-minute Apgar score. In ROC analysis, SII predicted preterm birth with an AUC of 0.600 (cut-off: 897.35; sensitivity: 57%; specificity: 67%) and predicted low 5th-minute Apgar scores with an AUC of 0.669 (cut-off: 1248.38; sensitivity: 75%; specificity: 83%). Conclusion The SII and the SIRI may not be reliable markers for the diagnosis or severity assessment of ICP. However, the SII may serve as a potential predictor for preterm birth and low Apgar scores. NMR was significantly elevated in severe ICP patients, suggesting its potential diagnostic value, which should be supported by further studies.https://doi.org/10.1186/s12887-025-05842-yIntrahepatic cholestasis of pregnancy (ICP)Systemic immune-inflammation index (SII)Systemic inflammatory response index (SIRI)Neutrophil-to-Monocyte ratio (NMR) |
| spellingShingle | Erkan Sağlam Mustafa Raşit Özler Ebu Bekir Sıddık Yılmaz Sıddık Yılmaz Mevlüt Bucak Predictive value of inflammatory indices for disease severity and perinatal outcomes in intrahepatic cholestasis of pregnancy BMC Pediatrics Intrahepatic cholestasis of pregnancy (ICP) Systemic immune-inflammation index (SII) Systemic inflammatory response index (SIRI) Neutrophil-to-Monocyte ratio (NMR) |
| title | Predictive value of inflammatory indices for disease severity and perinatal outcomes in intrahepatic cholestasis of pregnancy |
| title_full | Predictive value of inflammatory indices for disease severity and perinatal outcomes in intrahepatic cholestasis of pregnancy |
| title_fullStr | Predictive value of inflammatory indices for disease severity and perinatal outcomes in intrahepatic cholestasis of pregnancy |
| title_full_unstemmed | Predictive value of inflammatory indices for disease severity and perinatal outcomes in intrahepatic cholestasis of pregnancy |
| title_short | Predictive value of inflammatory indices for disease severity and perinatal outcomes in intrahepatic cholestasis of pregnancy |
| title_sort | predictive value of inflammatory indices for disease severity and perinatal outcomes in intrahepatic cholestasis of pregnancy |
| topic | Intrahepatic cholestasis of pregnancy (ICP) Systemic immune-inflammation index (SII) Systemic inflammatory response index (SIRI) Neutrophil-to-Monocyte ratio (NMR) |
| url | https://doi.org/10.1186/s12887-025-05842-y |
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