First trimester neutrophil-to-lymphocyte ratio (NLR) and pregnancy outcomes in medically assisted reproduction (MAR): a case control study

Abstract

As success rates after medically assisted reproduction (MAR) technologies have remained constantly limited during the last years, there has been a systematic effort to predict clinical outcomes. There is currently weak evidence to name the neutrophil-to-lymphocyte ratio (NLR), as an accurate predictor in MAR. Through a case control study, and by setting strict eligibility criteria, we enrolled 66 women (35 with negative outcome and 31 cycles with live birth), in terms of NLR at the time of oocyte retrieval. Clinical and IVF cycle characteristics were comparable in a normalized population. There was a positive correlation between NLR and the age of the woman (r = 0.310, p=.011 and rs =0.363, p=.033). Higher odds ratios (ORs) of MAR positive outcome were detected only at higher NLR values, when NLR was divided into quartiles, but only in the 4th quartile [OR =4.33 (95%CI: 1.02–10.79)]. ROC curve resulted on an AUC equal to 0.660 (95%CI: 0.529–0.791) and p value .025. The estimated specificity, sensitivity and cutoff point were 0.57, 0.548, and 1.98, respectively, while PPV and NPV values were 70.6% and 59.3%, respectively. In conclusion, NLR was positively correlated with maternal age; in our study cohort, MAR failure was associated with lower NLR values.

摘要

由于过去几年中医学辅助生殖（MAR）技术的成功率一直有限, 已经有系统的努力来预测其临床结局。目前, 有不充分的证据表明中性粒细胞与淋巴细胞的比值（NLR）在MAR中是一个准确预测因子。通过一项病例对照研究, 并设定严格的纳入标准, 我们招募了66名女性（35名不良结局和31名获得活产）, 观察取出卵母细胞时的NLR。临床和IVF周期特征在标准化人群中是可比较的。NLR与女性年龄呈正相关（r = 0.310, p = 0.011, rs = 0.363, p = 0.033）。当NLR被分成四分位数时, 仅在较高的NLR值下检测到MAR有利结局的较高比值比（ORs）, 并仅在第四个四分位数[OR = 4.33（95％CI：1.02-10.79）]。ROC曲线的曲线下面积（AUC）等于0.660（95％CI：0.529-0.791）和p值0.025。估计的特异性、灵敏度和截止点分别为0.57, 0.548和1.98, 而PPV和NPV值分别为70.6％和59.3％。总之, NLR与母亲年龄呈正相关；在我们的研究队列中, MAR失败与较低的NLR值相关。

The Chinese abstracts are translated by Prof. Dr. Xiangyan Ruan and her team: Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China.

Keywords:

• NLR
• miscarriage
• inflammation markers
• MAR prognosis
• pregnancy outcome
• live birth

Acknowledgements

The authors wish to thank Paraskevi Vogiatzi, embryologist of the IVF Unit where the study took place, for providing valuable information on the techniques and for revising the manuscript.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.