Dynamic Change of Novel Systemic Inflammation Markers to Predict Maternal-Neonatal Prognosis After Cervical Cerclage

Figures & data

Table 1 Clinical Characteristics of the Study Population

Characteristics		Number of Cases (%)
Mother	Maternal age (years)	31.0±4.4 (21–48)
	BMI (cm^2/kg)	22.8±3.3
	Gravida	2 (0–8)
	Parity	0 (0–3)
	GDM	126 (28.4)
	Gestational hypertension	22 (6.7)
	Recurrent Abortion	30 (9.1)
	Cervical length (cm)
	≤1.5	211 (64.3)
	>1.5	117 (35.7)
	Cervical dilation (cm)
	≧2	60 (18.3)
	<2	268 (81.3)
	Bulging membrane	96 (29.3)
	GA at cerclage (weeks)	22^+3 (12^+5–27^+4)
	GA at PPROM (weeks)	33^+3 (22^+3–41^+4)
	GA at delivery (weeks)	34^+3 (17^+3–41^+1)
	Cerclage to delivery interval (days)	82.1±43.3 (0–177)
	PPROM	77 (23.5)
	Intrapartum fever	8 (2.4)
	Cesarean delivery	130 (39.6)
	Postpartum hemorrhage	9 (2.7)
Newborn	GA at delivery (week)
	<24 wk	24 (7.3)
	≥24 to <28 wk	36 (11.0)
	≥28 to <32 wk	45 (13.7)
	≥32 to <37 wk	69 (21.0)
	37≥wk	154 (47.0)
	Mortality	36 (11.0)
	Birth weight (g)	2491.2±1019.5 (310–4675)
	Apgar score (1 min)	9.7±1.0 (3–10)
	Apgar score (5 min)	9.9±0.3 (8–10)
	Apgar score (10 min)	10.0±0.3 (8–10)
	NICU admission	80 (27.4)
	Time in hospital (days)	14.5±21.2 (0–97)
	RDS	59 (20.1)
	IVH	25 (8.5)
	Sepsis	16 (5.5)
	NEC	14 (4.2)
	Retinopathy of prematurity	19 (6.5)
	PDA	24 (8.2)

Notes: Continuous variables are presented as mean ± SD (range) and categorical variables as n (%). Recurrent abortion was defined as at least three spontaneous abortions.

Abbreviations: BMI, body mass index; GDM, gestational diabetes; GA, gestational age; PPROM, preterm premature rupture of membranes; NICU, neonatal intensive care unit; RDS, respiratory distress syndrome; IVH, intraventricular haemorrhage; NEC, necrotizing enterocolitis; PDA, patent ductus arteriosus.

Table 2 The Association Between Inflammatory Markers and Cervical Cerclage Outcomes

Variable	Successful (N=223) n (%)	Unsuccessful (N=105) n (%)	P-value
Maternal age (years)	30.6±4.2	31.9±4.8	0.012
BMI (cm^2/kg)	22.5±3.2	23.6±3.5	0.006
Gravida	2 (0–8)	3 (1–7)	0.006
Parity	0 (0–3)	0 (0–3)	0.678
GDM	97 (39.0%)	39 (37.1%)	0.745
Gestational hypertension	16 (7.2%)	6 (5.7%)	0.622
Recurrent Abortion	15 (6.7%)	15 (14.3%)	0.027
PPROM	51 (19.0%)	26 (24.5%)	0.031
Cervical length (cm)			<0.001
<1.5	172 (77.1%)	28 (26.7%)
≧1.5	51 (22.9%)	77 (73.3%)
Cervical dilation (cm)			<0.001
≧2	18 (8.1%)	42 (40.0%)
<2	205 (91.9%)	63 (60.0%)
Bulging membrane	43 (19.3%)	53 (50.5%)	<0.001
Pre-SII (×10^9/L)*	968.7±380.9	1348.5±502.5	<0.001
Pre-SIRI (×10^9/L)*	2.9±1.1	5.1±3.3	<0.001
Post-SII (×10^9/L)^§	853.2±325.0	1762.5±782.1	<0.001
Post-SIRI (×10^9/L)^§	2.8±1.7	5.3±3.2	<0.001
SII (×10^9/L)^Δ	249.9±420.8	−513.2±670.1	<0.001
SIRI (×10^9/L)^Δ	0.3±1.8	−0.4±3.6	0.056

Notes: Categorical data were analysed using chi-squared tests, and continuous data with t-tests. *Means before the cervical cerclage; ^§Means after the cervical cerclage; ^ΔMeans Pre-SII/SIRI minus Post-SII/SIRI.

Abbreviations: BMI, body mass index; GDM, gestational diabetes; PPROM, preterm premature rupture of membranes; SII, systemic immune inflammation index; SIRI, systemic inflammation response index.

Table 3 Relationships Between the Inflammatory Markers and Maternal-Neonatal Outcomes

Variable		Pre-SII	Pre-SIRI	Post-SII	Post-SIRI	SII^Δ	SIRI^Δ
Cerclage to delivery interval (days)	r-value	−0.360	−0.372	−0.495	−0.363	0.355	0.080
	p-value	<0.001	<0.001	<0.001	<0.001	<0.001	0.149
PPROM	r-value	0.028	0.056	−0.024	−0.026	0.008	0.074
	p-value	0.618	0.313	0.669	0.639	0.889	0.180
Intrapartum fever	r-value	−0.107	−0.065	−0.032	0.031	−0.022	−0.092
	p-value	0.054	0.240	0.558	0.572	0.688	0.096
Cesarean delivery	r-value	−0.072	0.018	−0.073	−0.018	0.027	0.054
	p-value	0.196	0.745	0.184	0.749	0.621	0.326
Postpartum hemorrhage	r-value	−0.012	0.047	−0.009	0.058	0.049	−0.018
	p-value	0.825	0.401	0.874	0.297	0.374	0.752
Mortality	r-value	−0.191	−0.173	−0.378	−0.154	0.343	0.064
	p-value	<0.001	0.002	<0.001	0.005	<0.001	0.248
Birth weight (g)	r-value	−0.391	−0.385	−0.534	−0.387	0.449	0.062
	p-value	<0.001	<0.001	<0.001	<0.001	<0.001	0.271
Apgar score (1 min)	r-value	−0.126	−0.309	−0.334	−0.150	0.298	−0.105
	p-value	0.031	<0.001	<0.001	0.010	<0.001	0.071
Apgar score (5 min)	r-value	−0.093	−0.139	−0.212	−0.080	0.190	0.031
	p-value	0.111	0.017	<0.001	0.172	0.001	0.595
Apgar score (10 min)	r-value	−0.083	−0.138	−0.214	−0.066	0.183	0.044
	p-value	0.155	0.018	<0.001	0.255	0.002	0.448
NICU admission	r-value	0.362	0.449	0.530	0.411	−0.446	−0.101
	p-value	<0.001	<0.001	<0.001	<0.001	<0.001	0.084
Time in hospital (days)	r-value	0.395	0.422	0.522	0.450	−0.411	−0.110
	p-value	<0.001	<0.001	<0.001	<0.001	<0.001	0.062
RDS	r-value	0.349	0.430	0.532	0.398	−0.471	−0.061
	p-value	<0.001	<0.001	<0.001	<0.001	<0.001	0.298
IVH	r-value	0.168	0.218	0.377	0.258	−0.312	−0.187
	p-value	0.004	<0.001	<0.001	<0.001	<0.001	0.001
Sepsis	r-value	0.191	0.264	0.241	0.207	−0.189	−0.020
	p-value	0.001	<0.001	<0.001	<0.001	0.001	0.735
NEC	r-value	0.126	0.024	0.230	0.082	−0.237	−0.096
	p-value	0.031	0.685	<0.001	0.163	<0.001	0.100
Retinopathy of prematurity	r-value	0.129	0.157	0.316	0.268	−0.339	−0.179
	p-value	0.028	0.007	<0.001	<0.001	<0.001	0.002
PDA	r-value	0.261	0.203	0.323	0.226	−0.220	−0.033
	p-value	<0.001	<0.001	<0.001	<0.001	<0.001	0.571

Notes: Analysis was performed using Spearman’s rank correlation analysis. ^ΔMeans Pre-SII/SIRI minus Post-SII/SIRI.

Abbreviations: PPROM, preterm premature rupture of membranes; SII, systemic immune inflammation index; SIRI, systemic inflammation response index; NICU, neonatal intensive care unit; RDS, respiratory distress syndrome; IVH, intraventricular haemorrhage; NEC, necrotizing enterocolitis; PDA, patent ductus arteriosus.

Figure 1 Cut-off, the optimal novel systemic inflammation markers level is used to predict the outcome of cervical cerclage according to the ROC curve. (A) Pre-SII level; (B) Pre-SIRI level; (C) Post-SII level; (D) Post-SIRI level; (E) ^ΔSII level; (F) ^ΔSIRI levels.

Note: ^ΔMeans Pre-SII/SIRI minus Post-SII/SIRI.

Abbreviations: SII, systemic immune inflammation index; SIRI, systemic inflammation response index; AUC, the area under the ROC curve; CI, confidence interval.

Table 4 Diagnostic Accuracy of the Inflammatory Markers for the Outcomes of Cervical Cerclage

	Sensitivity	Specificity	PPV	NPV
Pre-SII*	56.19 (46.70–65.68)	88.79 (74.36–87.35)	70.24 (60.46–80.01)	81.15 (76.24–86.06)
Pre-SIRI*	59.05 (49.64–68.45)	80.27 (75.05–85.49)	58.49 (49.11–67.87)	80.63 (75.43–85.83)
Post-SII^§	68.57 (59.69–77.45)	92.83 (89.44–96.21)	81.82 (73.76–89.88)	86.25 (81.89–90.61)
Post-SIRI^§	75.24 (66.98–83.49)	74.89 (69.20–80.58)	58.52 (50.21–66.83)	86.53 (81.71–91.34)
SII^Δ	71.43 (62.79–80.07)	90.58 (86.75–94.42)	78.13 (69.86–86.39)	87.07 (82.75–91.39)
SIRI^Δ	43.81 (34.32–53.30)	86.65 (81.05–90.25)	58.97 (48.06–69.89)	76.40 (71.14–81.66)

Notes: *Means before the cervical cerclage; ^§Means after the cervical cerclage; ^ΔMeans Pre-SII/SIRI minus Post-SII/SIRI.

Abbreviations: PPV, Positive Predictive Value; NPV, Negative Predictive Value; SII, systemic immune inflammation index; SIRI, systemic inflammation response index.

Figure 2 Independent risk factors for predicting the unsuccessful cervical cerclage.

Note: ^ΔMeans Pre-SII/SIRI minus Post-SII/SIRI.

Abbreviations: SII, systemic immune inflammation index; SIRI, systemic inflammation response index; BMI, body mass index; PPROM, preterm premature rupture of membranes; OR, odds ratio, CI, confidence interval.