Association of immunonutrition-based indices (Hemoglobin-Albumin-Lymphocyte-Platelet, prognostic nutritional index, and C-reactive protein–albumin–lymphocyte) with the latency period in preterm prelabor rupture of membranes

Arzik, Ilayda Gercik; Golbasi, Hakan; Aktas, Hale Ankara; Toka, Ilknur; Cakir, Zubeyde Emiralioglu; Purut, Ceren Saglam; Torun, Raziye; Bayram, Emre; Bayraktar, Burak; Ekin, Atalay

doi:10.1590/1806-9282.20251977

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Original Article • Rev. Assoc. Med. Bras. 72 (4) • 2026 • https://doi.org/10.1590/1806-9282.20251977 linkcopy

Association of immunonutrition-based indices (Hemoglobin-Albumin-Lymphocyte-Platelet, prognostic nutritional index, and C-reactive protein–albumin–lymphocyte) with the latency period in preterm prelabor rupture of membranes

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE: The aim of this study was to evaluate the predictive value of immunonutrition-based indices (Hemoglobin, Albumin, Lymphocyte, Platelet score, prognostic nutritional index, and C-reactive protein–albumin–lymphocyte index) for latency duration and neonatal outcomes in preterm prelabor rupture of membranes.

METHODS: This retrospective cohort study included 145 singleton pregnancies diagnosed with PPROM between 24 and 34 weeks. Patients were categorized by latency duration (≤48 vs. >48 h), and subgroup analyses used thresholds of 72 h, 96 h, and 7 days. Maternal, laboratory, and neonatal characteristics were compared. Logistic regression adjusted for parity and gestational age evaluated associations between indices and latency.

RESULTS: Hemoglobin, Albumin, Lymphocyte, Platelet, prognostic nutritional index, and C-reactive protein–albumin–lymphocyte values showed no significant differences across latency groups (all p>0.05). Only respiratory distress syndrome was more frequent in the short-latency group (p=0.005).

CONCLUSION: Immunonutrition indices remained stable across latency durations, highlighting the predominance of localized inflammatory and structural mechanisms in preterm prelabor rupture of membranes pathophysiology.

KEYWORDS:
Fetal membranes; Premature rupture; Nutrition assessment; Inflammation; Infant, premature; Pregnancy outcome

	Latency period ≤48 h n=70 (48.3%)	Latency period >48 h n=75 (51.7%)	p-value
Maternal age (years)	30.3±6.5	30.5±6.7	0.894
Gravidity	1 (1)	2 (3)	0.010
Parity	0 (1)	1 (2)	0.049
Nulliparous	40 (57.1%)	34 (45.3%)	0.155
In vitro fertilization	1 (1.4%)	2 (2.6%)	0.616
BMI (kg/m²)	27.7±4.7	28.3±4.8	0.403
Gestational age at hospitalization (weeks)	30.2±3.5	27.4±3.2	<0.001
Gestational age at delivery (weeks)	31±3.3	32±2.7	0.102
Mode of delivery			0.318
Vaginal birth	24 (34.3%)	20 (26.6%)
Cesarean section	46 (65.3%)	55 (73.7%)
Birth weight (gram)	1,643±642	1,977±614	0.010
Apgar score at 1st min	7 (3)	7 (2)	0.120
Apgar score at 5th min	8 (1)	8 (1)	0.340
Transient tachypnea of the newborn	7 (10%)	13 (17.3%)	0.200
Respiratory distress syndrome	53 (75.7%)	40 (53.3%)	0.005
Continuous positive airway pressure	35 (50%)	33 (44%)	0.469
Mechanical ventilation	16 (22.8%)	15 (20%)	0.675
Neonatal sepsis	8 (11.4%)	9 (12.8%)	0.914
Neonatal hyperbilirubinemia	25 (35.7%)	28 (37.3%)	0.839
Phototherapy for neonates	23 (32.8%)	27 (36%)	0.690
NICU admission	66 (94.3%)	69 (92%)	0.587
Perinatal mortality	3 (4.3%)	3 (5.3%)	0.931

	Latency period ≤48 h n=70 (48.3%)	Latency period >48 h n=75 (51.7%)	p-value
Hemoglobin (g/dL)	11.3±0.8	11.1±0.8	0.125
White blood cell count (10⁹/L)	12.26±3.19	12.19±4.43	0.934
Neutrophil count (10⁹/L)	8.96 (3.95)	8.73 (4.04)	0.484
Lymphocyte count (10⁹/L)	1.96±0.56	2±0.65	0.730
Platelet count (10⁹/L)	239±70	247±66	0.572
Albumin (g/L)	36.8±2.7	36.2±3.7	0.652
CRP (mg/dL)	7 (16)	6 (10.5)	0.148

	Latency period ≤ 48 h n=70 (48.3%)	Latency period >48 h n=75 (51.7%)	p-value	Adjusted p-value*	Latency period ≤ 72 h n=84 (57.9%)	Latency period >72 h n=61 (42.1%)	p-value	Adjusted p-value*
CALLY	10.64 (17.58)	12.04 (19.34)	0.222	0.435	11.1 (17.58)	10.62 (19.1)	0.958	0.994
HALP	3.61±1.19	3.41±1.33	0.447	0.176	3.45±1.17	3.67±1.49	0.441	0.689
PNI	36.88±2.74	36.23±3.74	0.334	0.891	36.54±3.22	36.54±3.53	0.999	0.283
	Latency period ≤96 h n=94 (64.8%)	Latency period >96 h n=51 (35.2%)	p-value	Adjusted p-value *	Latency period ≤7 days n=110 (75.9%)	Latency period >7 days n=35 (24.1%)	p-value	Adjusted p-value *
CALLY	11 (19.21)	10.32 (18.9)	0.942	0.995	10.99 (17.95)	11.92 (21.29)	0.408	0.413
HALP	3.51±1.32	3.51±1.1	0.989	0.776	3.54±1.30	3.25±0.92	0.499	0.079
PNI	36.43±3.24	36.88±3.51	0.564	0.817	36.42±3.19	37.6±4.19	0.284	0.904

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[TFN1] BMI: body mass index; NICU: neonatal intensive care unit. Data are expressed as mean±SD, median (interquartile range), or n, % where appropriate.