The relationship between inflammation markers and ketonuria in hyperemesis gravidarum

Abstract

Objective: Hyperemesis gravidarum is an illness that starts in early pregnancy and manifests itself with oral intake problems, electrolyte imbalance, ketonuria, and weight loss. Inflammation is closely associated with the hyperemesis gravidarum, and inflammatory indicators have been studied to understand its pathophysiology. This study investigates the relationship of ketonuria levels with inflammatory markers platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), and neutrophil-to-lymphocyte ratio (NLR) for hyperemesis gravidarum patients. Material and Methods: This retrospective case control study was conducted at Kütahya Medical Sciences University Tertiary Research and Training Hospital between December 2019 and December 2020. A total of 173 pregnancies, 82 of them with hyperemesis gravidarum and 91 of them low-risk pregnancies were included in the study. The patients' demographic profiles and laboratory parameters were recorded. The patients were divided into hyperemesis gravidarum and control groups and the groups were compared for the levels of inflammation markers. For the hyperemesis gravidarum group, the relationship between ketonuria levels and the inflammation severity was investigated. Results: MLR, NLR, PLR levels were higher in the hyperemesis gravidarum group than the control group in a statistically significant way (p < 0.001 for all of the comparisons). The hyperemesis gravidarum group was subdivided into four groups based on their ketonuria levels, and their MLR, NLR, PLR levels were compared. The differences between the groups were statistically significant (p < 0.001) and the indicators increased with the ketonuria levels. Finally, ketonuria levels had a positive and significant correlation with MLR (rho =0.67, p < 0.001), PLR (rho =0.67, p < 0.001), and NLR (rho =0.8, p < 0.001). Conclusion: Hyperemesis gravidarum patients have higher levels of hematologic inflammation indicators than healthy pregnant patients. For these patients, the levels of the indicators increase with ketonuria levels.

The predictive value of HALP score and systemic immune inflammation (SII) index in hyperemesis gravidarum

“…19 Soysal et al classified the severity of ketonuria into four groups and found a positive correlation between ketonuria levels and inflammatory markers (PLR, MLR, and NLR levels) in patients with HG. 20 In our study, NLR, PLR, and PCT counts were found to be significantly higher in the HG group than in the control group. Our results were consistent with the literature, and these hematological parameters can be considered an indicator of subclinical inflammation in patients with HG.…”

“…Another study defined the mean corpuscular hemoglobin (MCH), NLR, and PLR levels as independent predictors of the presence of HG and level of ketone positivity 19 . Soysal et al classified the severity of ketonuria into four groups and found a positive correlation between ketonuria levels and inflammatory markers (PLR, MLR, and NLR levels) in patients with HG 20 . In our study, NLR, PLR, and PCT counts were found to be significantly higher in the HG group than in the control group.…”

Are serum delta neutrophil index and other inflammatory marker levels different in hyperemesis gravidarum?

“…Koot et al's study concluded that the level of ketonuria was not related to the severity of HEG 47 . In the study of Soysal et al, which investigated the relationship between inflammatory parameters and ketonuria levels, NLR, MLR and PLR increased significantly as the ketonuria level increased 48 . In the study of Çintesun et al, no inflammatory markers were correlated with the degree of ketonuria 36 .…”

“…47 In the study of Soysal et al, which investigated the relationship between inflammatory parameters and ketonuria levels, NLR, MLR and PLR increased significantly as the ketonuria level increased. 48 In the study of Çintesun et al, no inflammatory markers were correlated with the degree of ketonuria. 36 In this study, the level of ketonuria was not used as a criterion for HEG severity.…”

The role of serum ADAMTS-1 levels in Hyperemesis Gravidarum

“…Although most studies could not find a relationship between ketonuria and HEG severity, we detected a significant degree of ketonuria in our HEG group compared to the control group, and we observed a positive correlation between ketonuria and ADAMTS-1 levels [ 26 ]. In a different study that investigated the relation between ketonuria and HEG, Soysal et al [ 27 ] claimed that ketonuria in HEG was determined by the inflammatory response in pregnancy rather than HEG itself. Similar to that study, we found that inflammatory markers such as PDW, PCT, and MPV were higher in the HEG group compared with the control group.…”