Predictive value of serum inflammatory markers for histological chorioamnionitis among women with preterm premature rupture of membranes after undergoing cervical cerclage

Li, Li; Huang, Xinxin; Yan, Jianying; Zhang, Jun; Yang, Danlin; Pan, Mian

doi:10.1016/j.clinsp.2023.100292

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Original articles • Clinics 78 • 2023 • https://doi.org/10.1016/j.clinsp.2023.100292 copy

Predictive value of serum inflammatory markers for histological chorioamnionitis among women with preterm premature rupture of membranes after undergoing cervical cerclage

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose:

To determine the predictive value of maternal White Blood Cells (WBC), neutrophils, and C-Reactive Protein (CRP) for diagnosing Histological Chorioamnionitis (HCA) among women with Preterm Premature Rupture of Membranes (PPROM) who underwent cervical cerclage.

Methods:

A retrospective cross-sectional study was conducted among women with singleton pregnancy and PPROM, who underwent cervical cerclage during 2018-2020.

Results:

A total of 55 eligible women were included in the final analysis, including 36 (61.02%) cases with HCA and 19 (38.98%) without HCA. Women with HCA had higher WBC count (12.31 ± 2.80) × 10⁹/L and neutrophil count (9.67 ± 2.90)×10⁹/L than those without HCA (10.35 ± 2.53) × 10⁹/L and 7.82 ± 2.82 × 10⁹/L, respectively) (both p < 0.05). The cut-off value of WBC count at 10.15×10⁹/L was found to be the most effective in identifying HCA, with an Area Under Curve (AUC) of 0.707 (95% CI: 0.56-0.86; p = 0.012), sensitivity of 86.11%, specificity of 57.90%, Positive Predictive Value (PPV) of 79.49%, Negative Predictive Value (NPV) of 68.75%, and Youden index of 0.44. The combination of WBC + neutrophil had a slightly higher (AUC = 0.711, 95% CI: 0.57–0.86; p = 0.011), specificity (68.42%), and PPV (81.25%), but lower sensitivity (72.22%), than the WBC count alone. A cut-off value of neutrophil at 7.46 × 10⁹/L was effective in identifying HCA, with an AUC of 0.689 (95% CI: 0.53-0.84; p = 0.022).

Discussion:

Combination use of WBC+neutrophil was found to be the most accurate predictor of HCA among women with PPROM after surgery of cervical cerclage.

Keywords:
White blood cell; Neutrophil; Histological chorioamnionitis; Preterm premature rupture of membranes (PPROM); Cervical cerclage

Highlights

Study on predictive value for HCA among women with PPROM after undergoing cervical cerclage.
WBC and neutrophil can predict HCA among women with PPROM after surgery of cervical cerclage.
The study provides a valuable prediction tool for early detection of HCA.

	Histological chorioamnionitis [χ±s/n (%)]
	Yes (n = 36)	No (n = 19)	χ²/t	p-value
Maternal age, y	31.00 ± 5.40	33.74 ± 5.21	−1.831	0.081
Multipara			0.164	0.685
Yes	15 (41.70)	9 (47.37)
No	21 (58.30)	10 (52.63)
History of miscarriages in the second trimester			0.115	0.734
Yes	8 (22.2)	5 (26.3)
No	28 (77.8)	14 (73.7)
History of miscarriages			0.368	0.544
Yes	14 (38.9)	9 (47.4)
No	22 (61.1)	10 (52.6)
History of preterm birth			0.245	0.621
Yes	4 (11.11)	3 (15.79)
No	32 (88.89)	16 (84.21)
History of hysteroscopy			0.322	0.571
Yes	8 (22.22)	3 (15.79)
No	28 (77.78)	16 (84.21)
Gestational age at cerclage, wk	22.68 ± 3.22	22.81 ± 2.55	0.164	0.879
Gestational age at PPROM, wk	27.53 ± 4.80	31.8 ± 4.74	3.222	0.002
Gestational age at delivery, wk	28.14 ± 4.67	32.21 ± 4.43	3.536	0.001
Placental abruption			1.628	0.202
Yes	9 (25.00)	2 (10.53)
No	27 (75.00)	17 (89.47)
Cesarean section			3.220	0.073
Yes	7 (19.44)	8 (42.11)
No	29 (80.56)	11 (57.89)
Clinical chorioamnionitis			20.864	< 0.001
Yes	23 (63.90)	0 (0)
No	13 (36.10)	19 (100.00)
Birth weight, g	1405.42 ± 838.31	2245.00 ± 783.39	3.610	< 0.001
Apgar score (1 min)	8.68 ± 2.17	9.72 ± 0.58	2.289	0.055
Apgar score (5 min)	9.21 ± 2.17	9.94 ± 0.24	1.652	0.160
Apgar score (10 min)	9.50 ± 1.32	10.00 ± 0.00	1.857	0.117

	Histological chorioamnionitis [χ±s/P₅₀(P₂₅, P₇₅)]		t/z	p-value
	Yes (n = 36)	No (n = 19)
White blood cell (×10⁹/L)	12.31 ± 2.80	10.35 ± 2.53	2.558	0.013
Neutrophil (×10⁹/L)	9.67 ± 2.90	7.82 ± 2.82	2.261	0.028
Platelet (×10⁹/L)	208.00 ± 37.56	222.94 ± 42.20	1.295	0.201
Neutrophil-to-lymphocyte ratio	7.05 ± 4.52	5.43 ± 3.80	1.332	0.189
Platelet-to-white blood cell ratio	21.14 ± 5.88	18.87 ± 5.03	1.502	0.139
C-reactive protein^a a C-reactive protein normality test result: p < 0.001 for Kolmogorov-Smirnov and p < 0.001 for Shapiro-Wilk. (mg/dL) (IQR)	7.95 (0.73, 25.44)	6.50 (2.08, 11.85)	0.788	0.430

	AUC	95%CI		p-value	Sensitivity	Specificity	PPV	NPV	Youden index
White blood cell^a a Cutoff value was 10.15×109/L for white blood cell; 7.46×109/L for neutrohil. Value.	0.707	0.56	0.86	0.012	86.11	57.90	79.49	68.75	0.44
Neutrophil^a a Cutoff value was 10.15×109/L for white blood cell; 7.46×109/L for neutrohil. Value.	0.689	0.53	0.84	0.022	80.56	57.90	78.38	61.11	0.39
White blood cell+neutrophil	0.711	0.57	0.86	0.011	72.22	68.42	81.25	56.52	0.41

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E-mail: clinics@hc.fm.usp.br

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[1] *Corresponding author. E-mail address:YANJY_2004@163.com (J. Yan).