Journal of South Asian Federation of Obstetrics and Gynaecology

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VOLUME 13 , ISSUE 3 ( May-June, 2021 ) > List of Articles


Clinical Ability of Neutrophil–Lymphocyte Ratio in Pregnancy as a Predictor of Preeclampsia

Rendy Singgih, Yohanes Firmansyah, Andriana Kumala Dewi

Keywords : Neutrophil–lymphocytes ratio, Preeclampsia, Pregnancy

Citation Information : Singgih R, Firmansyah Y, Dewi AK. Clinical Ability of Neutrophil–Lymphocyte Ratio in Pregnancy as a Predictor of Preeclampsia. J South Asian Feder Obs Gynae 2021; 13 (3):125-130.

DOI: 10.5005/jp-journals-10006-1892

License: CC BY-NC 4.0

Published Online: 09-09-2021

Copyright Statement:  Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.


Aim and objective: Preeclampsia is part of the hypertension spectrum that occurs during the pregnancy period, especially when the gestational age is 20 weeks or more. Preeclampsia has a broad impact not only on pregnant women but also on the fetus they contain. It is said that in preeclampsia, there is an increase in inflammatory stimulation and an abnormal immune response so that routine blood values increase. Neutrophil–lymphocyte ratio (NLR) values reported in several studies have risen notably in the incidence of preeclampsia. Materials and methods: A cross-sectional observational analysis study was conducted on 924 pregnant respondents from January to December 2019 at Cimacan District Hospital, Cianjur. Statistical analysis test of the average difference between the two groups and the prediction test of NLR values was conducted between the healthy pregnant women group of 838 respondents and the group of 86 pregnant women with preeclampsia. Results: In statistical tests regarding the differences in the mean of the two groups, a significant NLR value was obtained (p = 0.004). Then the NLR value was tested again by the receiver-operating characteristic (ROC) curve method, and the results of the area under the curve (AUC) on the variable values were obtained in the form of AUC: 0.595/p-value: 0.035. Conclusion and clinical significance: Despite the differences in the mean NLR in the two groups, however, the NLR of women in predicting the incidence of pregnancy with preeclampsia is very low.

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  1. Gogoi P, Sinha P, Gupta B, et al. Neutrophil-to-lymphocyte ratio and platelet indices in pre-eclampsia. Int J Gynecol Obstet 2019;144(1):16–20. DOI: 10.1002/ijgo.12701.
  2. The American College of Obstetricians and Gynecologists. Gestational hypertension and preeclampsia. ACOG Pract Bull Clin Manag Guidel Obstet 2019;133(76):168–186. DOI: 10.1097/AOG.0000000000003018.
  3. Umesawa M, Kobashi G. Epidemiology of hypertensive disorders in pregnancy: prevalence, risk factors, predictors and prognosis. Hypertens Res 2017;40(3):213–220. DOI: 10.1038/hr.2016.126.
  4. Society of Obstetricians and Gynaecologists of Canada (SOGC). Hypertension in Pregnancy. In: Advances in Labour and Risk Management Textbook (ALARM International - participant's manual) [Internet]. 4th editio. Society of Obstetricians and Gynaecologists of Canada (SOGC); p. 1–12. Available from:
  5. Indonesia KKR. Hipertensi Dalam Kehamilan, Preeklampsia, dan Eklampsia. In: EM M, D O, GMK S, R F, L L, SM O, editors. Buku Saku Pelayanan Kesehatan Ibu Di Fasilitias Kesehatan Dasar dan Rujukan [Internet]. 1st edition. Jakarta: Kementerian Kesehatan Republik Indonesia; 2013. p. 109–17. Available from:
  6. Anitha GS, Krishnappa TK, Shivamurthy G, et al. Maternal and fetal outcome in HELLP syndrome: an observational study. J South Asian Feder Obs Gynaecol 2020;12(3):122–132. DOI: 10.5005/jp-journals-10006-1779.
  7. Abd-elfattah AFM. Neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, and c-reactive protein as markers for severity of pre-eclampsia. ROAIC 2019;6:64–71. DOI: 10.4103/roaic.roaic_101_17.
  8. Widyastiti N, Setianingrum E. Perbedaan antara rasio neutrofil/limfosit dan rasio platelet/limfosit pada kehamilan normal, preeklampsia ringan dan berat. Cendana Med J 2019;17(2014):334–340. DOI: 10.35508/cmj.v7i2.1807.
  9. Muti M, Tshimanga M, Notion GT, et al. Prevalence of pregnancy induced hypertension and pregnancy outcomes among women seeking maternity services in Harare, Zimbabwe. BMC Cardiovasc Disord 2015;15(1):1–8. DOI: 10.1186/s12872-015-0110-5.
  10. Gezer C, Ekin A, Ertas IE, et al. High first-trimester neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios are indicators for early diagnosis of preeclampsia. Ginekol Pol 2016;87(6):431–435. Available at:
  11. Yücel B, Ustun B. Neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, mean platelet volume, red cell distribution width and plateletcrit in preeclampsia. Pregnancy Hypertens 2017;7:29–32. DOI: 10.1016/j.preghy.2016.12.002.
  12. Phipps EA, Thadhani R, Benzing T, et al. Pre-eclampsia: pathogenesis, novel diagnostics and therapies. Nat Rev Nephrol 2019;15(5):275–289. DOI: 10.1038/s41581-019-0119-6.
  13. Mannaerts D, Heyvaert S, De Cordt C, et al. Are neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and/or mean platelet volume (MPV) clinically useful as predictive parameters for preeclampsia? J Matern Neonatal Med 2019;32(9):1412–1419. DOI: 10.1080/14767058.2017.1410701.
  14. Zheng WF, Zhan J, Chen A, et al. Diagnostic value of neutrophil-lymphocyte ratio in preeclampsia: a PRISMA-compliant systematic review and meta-analysis. Medicine 2019;98(51):e18496. DOI: 10.1097/MD.0000000000018496.
  15. Excellence NI for H and C. Hypertension in pregnancy: diagnosis and management. Am J Obs Gynecol 2010;77(1):S1–S22. Available at:
  16. Yavuzcan A, Çağlar M, Üstün Y, et al. Mean platelet volume, neutrophil-lymphocyte ratio and platelet-lymphocyte ratio in severe preeclampsia. Ginekol Pol 2014;85(3):197–203. Available at:
  17. Kurtoglu E, Kokcu A, Celik H, et al. May ratio of neutrophil to lymphocyte be useful in predicting the risk of developing preeclampsia? A pilot study. J Matern Neonatal Med 2015;28(1):97–99. DOI: 10.3109/14767058.2014.905910.
  18. Klement AH, Hadi E, Asali A, et al. Neutrophils to lymphocytes ratio and platelets to lymphocytes ratio in pregnancy: a population study. PLoS One 2018;13(5):e0196706. DOI: 10.1371/journal.pone.0196706.
  19. Toptas M, Asik H, Kalyoncuoglu M, et al. Are neutrophil/lymphocyte ratio and platelet/lymphocyte ratio predictors for severity of preeclampsia? J Clin Gynecol Obstet 2016;5(1):27–31. DOI: 10.14740/jcgo389w.
  20. Hai L, Hu Z-D. The clinical utility of neutrophil to lymphocyte ratio in pregnancy related complications: a mini-review. J Lab Precis Med 2020;5:1. DOI: 10.21037/jlpm.2019.10.03.
  21. Khatoon F, Gupta H, Sinha P, et al. Prediction of preterm birth on the basis of complete blood count parameters. 2020;5:7. DOI: 10.5005/jp-journals-10006-1820.
  22. Wang J, Zhu QW, Cheng XY, et al. Assessment efficacy of neutrophil-lymphocyte ratio and monocyte-lymphocyte ratio in preeclampsia. J Reprod Immunol 2019;132:29–34. DOI: 10.1016/j.jri.2019.02.001.
  23. Study PAR. Neutrophil lymphocyte ratio and red cell distribution width as a marker of neutrophil lymphocyte ratio and red cell distribution width as a marker of preeclampsia: a retrospective study. J Preg Child Health 2017;4:307. DOI: 10.4172/2376-127X.1000307.
  24. Serin S, Avci F, Ercan O, et al. Is neutrophil/lymphocyte ratio a useful marker to predict the severity of pre-eclampsia? Preg Hypertens 2016;6(1):22–25. DOI: 10.1016/j.preghy.2016.01.005.
  25. Mohammad AH, Radwan MS, Shokr AA. Is neutrophil/lymphocyte ratio a useful marker to predict the severity of pre-eclampsia? Pregnancy Hypertens 2018;73(October):6621–6625. DOI: 10.21608/ejhm.2018.15594.
  26. Kang Q, Li W, Yu N, et al. Predictive role of neutrophil-to-lymphocyte ratio in preeclampsia: a meta-analysis including 3982 patients. Pregnancy Hypertens 2020;20(July 2019):111–118. DOI: 10.1016/j.preghy.2020.03.009.
  27. Sachan R, Patel ML, Sachan P, et al. Diagnostic accuracy of neutrophil to lymphocyte ratio in prediction of nonsevere preeclampsia and severe preeclampsia. 2018;79–83. Available at:;year=2017;volume=3;issue=2; spage=79;epage=83;aulast=Sachan
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