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Publications

Journal Article Epublish

PubMed: 42895275 DOI: 10.7189/jogh.16.04353

Systemic inflammatory indices for predicting severe placenta accreta spectrum: a retrospective cohort study.

J Glob Health 16:04353

Authors: Xiafen Lu, Xiaoyun Lei, Congcong Guo, Qian Tang, Xiaomei Zhang, Wenting Mai, Ming Mo, Meiling Yuan, Wen Wang, Dazhi Fan

Affiliations

  • Department of Obstetrics, The Affiliated Foshan Women and Children Hospital, Guangdong Medical University, Foshan, China.
  • Reproductive Medicine Center, The Affiliated Foshan Women and Children Hospital, Guangdong Medical University, Foshan, China.
  • Foshan Fetal Medicine Research Institute, The Affiliated Foshan Women and Children Hospital, Guangdong Medical University, Foshan, China.
  • Foshan Key Laboratory of Stem Cell and Maternal-Child Health, Foshan Women and Children Hospital, Foshan, China.
  • Stem Cell Clinical Research Center, Foshan Women and Children Hospital, Foshan, China.
  • Guangdong Medical University Stem Cell & Clinical Research Collaboration Alliance, The Affiliated Foshan Women and Children Hospital, Guangdong Medical University, Foshan, China.

Abstract

BACKGROUND

Placenta Accreta Spectrum (PAS) disorders are associated with substantial maternal morbidity, and distinguishing mild from severe forms prenatally remains difficult. Inflammatory indices derived from peripheral blood counts have emerged as promising biomarkers, yet their role in grading PAS severity has been insufficiently investigated. This study aimed to assess the discriminative value of the systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and other inflammatory indices for differentiating severe from mild PAS within an already diagnosed PAS population in late pregnancy.

METHODS

This retrospective single-centre cohort study included 1,276 patients with histopathologically confirmed PAS. Third-trimester neutrophil, lymphocyte, monocyte, and platelet counts were used to derive neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), SII, and SIRI. Multivariable logistic regression, receiver operating characteristic curve analysis, and decision curve analysis (DCA) were conducted.

RESULTS

Compared with the mild PAS group (n = 1,060), the severe PAS group (n = 216) showed significantly lower SIRI, SII, NLR, and PLR values (all P < 0.001). SIRI demonstrated moderate discriminative performance (area under the curve = 0.712). DCA suggested its potential clinical usefulness across threshold probabilities.

CONCLUSIONS

Lower third-trimester SIRI, SII, NLR, and PLR values are associated with severe PAS. SIRI shows moderate diagnostic performance and may serve as a cost-effective adjunct to imaging for prenatal risk stratification. Prospective validation is warranted.

MeSH

Prenatal Diagnosis, Lymphocytes, Global Health, Cohort Studies, Neutrophils, Placenta Accreta, Blood Platelets, Placenta