ArticleObstetrics & gynecology science2026
The neutrophil-to-lymphocyte ratio: a marker for microbial invasion of the amniotic cavity in preterm prelabor rupture of membranes.
Article in Obstetrics & gynecology science, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveThis study investigated the relationship between maternal blood neutrophil-to-lymphocyte ratio (NLR), serum C-reactive protein (CRP) levels, and microbial invasion of the amniotic cavity (MIAC) in the context of preterm prelabor rupture of membranes (pPROM).
methodsThis retrospective cohort study included 154 women with pPROM between 20+0 and 33+6 weeks of gestation who underwent transabdominal amniocentesis. MIAC was defined as a positive amniotic fluid culture. Maternal blood samples were collected within 24 hours after amniocentesis. CRP levels and leukocyte differential counts were quantified.
resultsMIAC was diagnosed in 36.4% of patients with pPROM. Patients with MIAC had higher median NLR and CRP levels than those without MIAC (NLR, 6.8 vs. 5.0; CRP, 0.58 mg/dL vs. 0.26 mg/dL; both P=0.007). NLR and CRP exhibited comparable areas under the curve of 0.67 (95% confidence interval [CI], 0.58-0.75) vs. 0.63 (95% CI, 0.54-0.72); P=0.59. Receiver operating characteristic curve analysis was performed to establish diagnostic cutoff values for NLR and CRP (6.2 for NLR and 0.7 mg/dL for CRP). The prevalence of MIAC was highest in patients with both elevated NLR and CRP levels (54.3%) and lowest in those with low values of both parameters (18.8%). Intermediate prevalence rates were observed in patients with discordant NLR and CRP values.
conclusionNLR exhibited a positive association with MIAC in patients with pPROM, with diagnostic performance similar to CRP. Nonetheless, the presence of MIAC in 18.8% of patients with low levels of both parameters highlights the limitations of these measures in ruling out MIAC.
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