Relationship of hyperemesis gravidarum with platelet crit, hemoglobin-to-red cell distribution width ratio, and neutrophil-to-lymphocyte ratio

SUMMARY

OBJECTIVE:  The aim of this study was to investigate the relationship between the severity of hyperemesis gravidarum disease and subclinical inflammatory factors such as platelet crit, hemoglobin-to-red cell distribution width ratio, neutrophil-to-lymphocyte ratio, which are known to be closely associated with inflammation in patients with hyperemesis gravidarum.

METHODS:  This retrospective case–control study was conducted between December 2020 and December 2021. A total of 215 pregnant women, 102 with hyperemesis gravidarum and 113 healthy pregnant women, were included in the study. Hyperemesis gravidarum patients were divided into three groups according to the modified Pregnancy-Unique Quantification of Emesis and nausea classification as mild (n=38), moderate (n=32), and severe (n=32).

RESULTS:  Platelet crit, hemoglobin-to-red cell distribution width ratio, and neutrophil-to-lymphocyte ratio values were found to be statistically significantly higher in the hyperemesis gravidarum group compared to the control group (p<0.05). There was a mild-to-severe increase in platelet crit, hemoglobin-to-red cell distribution width ratio, and neutrophil-to-lymphocyte ratio values in hyperemesis gravidarum patients (p<0.05). Logistic regression analysis revealed that a one-unit increase in platelet crit, hemoglobin-to-red cell distribution width ratio, and neutrophil-to-lymphocyte ratio resulted in a 2.14-, 1.41-, and 2.36-fold increase in hyperemesis gravidarum risk, respectively.

CONCLUSIONS:  Platelet crit, hemoglobin-to-red cell distribution width ratio, and neutrophil-to-lymphocyte ratio are inflammatory markers that increase in patients with hyperemesis gravidarum and have predictive value for the development of hyperemesis gravidarum. In our study, we suggested the use of a new prognostic marker for patients with hyperemesis gravidarum. We believe that our study will be a source for future studies on hyperemesis gravidarum.

KEYWORDS:
Hyperemesis gravidarum; Inflammation; Complete blood count; Pregnancy complications; Biomarkers

INTRODUCTION

Hyperemesis gravidarum (HEG), characterized by severe nausea and vomiting during pregnancy, affects approximately 0.3–2% of pregnancies and is associated with both maternal and fetal morbidity¹. The pathophysiology of HEG remains unclear, but proposed mechanisms include hormonal changes, gastrointestinal dysmotility, genetic predisposition, and systemic inflammation²,³. The lack of objective and widely accepted diagnostic criteria continues to complicate clinical management.

Recent studies have highlighted the role of systemic inflammation in various chronic and acute diseases and have proposed that hemogram-derived indices may serve as accessible inflammatory markers⁴. In particular, neutrophil-to-lymphocyte ratio (NLR), platelet crit (PCT), and the relatively novel hemoglobin-to-red cell distribution width ratio (HRR) have gained attention for their predictive value in systemic inflammation, autoimmune disease, and even infection⁵–⁷. Inflammatory indices such as NLR and PCT have been found to be significantly elevated in COVID-19⁸, autoimmune thyroiditis⁹, and various thyroid disorders¹⁰, supporting their potential utility in HEG, a condition with an increasingly recognized inflammatory component.

Aktas et al. have shown that both NLR and PCT are elevated in diverse clinical settings and may reflect subtle inflammatory shifts not captured by traditional acute-phase reactants⁸–¹⁰. Furthermore, hemogram-based inflammatory indices are cost-effective, reproducible, and rapidly obtainable—making them highly valuable for use in obstetric settings, especially in under-resourced environments⁷.

Despite the expanding use of these markers, the relationship between HRR and HEG has not yet been explored in the literature. Given the strong predictive capacity of HRR in cardiovascular and oncologic contexts¹¹,¹², it is logical to investigate its role in pregnancy-related inflammatory states such as HEG. This study aimed to evaluate whether PCT, HRR, and NLR are significantly elevated in patients with HEG and whether these markers can be used to predict disease severity.

METHODS

Study design

This retrospective case–control study was conducted in the Gynecology and Obstetrics Unit of Van Training and Research Hospital. As a retrospective analysis, no prospective randomization or control over confounding variables (such as nutritional status or hormonal levels) was possible.

Participants

This retrospective case–control study was conducted in the Gynecology and Obstetrics Unit of Van Training and Research Hospital. The study examined the records of pregnant women hospitalized with a diagnosis of HEG between December 2020 and 2021. A total of 213 pregnant women were included in the study: 102 women diagnosed with HEG and 113 healthy pregnant women between 5 and 16 weeks of gestation. Due to the study's design and sample availability, subgroup sizes were relatively limited, particularly when stratified by disease severity. The inclusion criteria for HEG diagnosis were defined as a weight loss of 5% or more from the beginning of pregnancy, vomiting at least three times a day, and a ketonuria value of +1 or higher in a urinalysis test.

Ethical approval and consent

Ethics approval was obtained from the Van Ministry of Health University Training and Research Hospital Clinical Research and Ethics Committee (decision no: 2022/02-01, dated 18.01.2022). Verbal informed consent was provided by all participants.

Data source

Data were retrieved from medical records, including Pregnancy-Unique Quantification of Emesis and nausea (PUQE) scores, body mass index (BMI), gestational age (based on the last menstrual period and sonography), and hematological parameters (HRR, eosinophil-to-lymphocyte ratio [ELR], NLR, platelet-to-lymphocyte ratio [PLR], platelet distribution width [PDW], mean platelet volume [MPV], PCT, white blood cell [WBC] count, hemoglobin [Hb], platelet count [PLT], and ketonuria results).

Exclusion criteria

Participants were excluded if they smoked or had urinary tract infections, psychological or gastrointestinal disorders, thyroid or inflammatory diseases, eating disorders, multiple pregnancies, or pregnancies via assisted reproductive techniques.

Data collection and assessment

Hematological ratios and related parameters were collected from medical records to evaluate their association with HEG.

Statistical analysis

Statistical analysis was performed using SPSS version 22.0. Shapiro-Wilk test was used to assess whether the variables followed normal distribution or not. Variables were reported as mean (minimum:maximum) values. A Mann-Whitney U test was used to compare patients in the HEG and control groups. Receiver operating characteristic (ROC) curve analysis was used to identify the optimal cutoff values of PCT, HRR, and NLR for diagnosing severe HEG with maximum sensitivity and specificity. A Kruskal-Wallis test was performed to compare patients with mild, moderate, and severe HEG. Moreover, a Mann-Whitney U test was used for pairwise comparison. To identify the independent risk factors affecting the development of HEG, binary logistic regression analysis was performed with the backward selection procedure. No specific measures were taken to control for potential confounders such as pre-existing nutritional deficiencies, gastrointestinal comorbidities, or hormonal variations. This limitation stems from the retrospective nature of the study and the reliance on pre-recorded hospital data. The level of significance was set at α=0.05.

RESULTS

The demographic characteristics and laboratory findings of the patients are shown in Table 1. There was no significant difference between the HEG and control groups in terms of age, gestational age, parity, BMI, and thyroid functions (p>0.05). However, WBC, Hb, PCT, HRR, and NLR values were higher in the HEG group (p<0.05).

Table 1
Comparison of demographic and laboratory parameters between the groups.

	Control group (n=113)		HEG group (n=102)		p
Age	29.49	(18.00–42.00)	29.89	(18–42)	0.63a
Gravida	1	(1–4)	1	(1–4)	0.67a
Gestational age (week)	10.53	(7–12)	10.34	(7.00–12)	0.43a
Parity (number)	1	(0:5)	1	(0:5)	0.30a
Body mass index (kg/m2)	26.70	(22.10–30.10)	26.30	(22.10–30.20)	0.17a
TSH (U/L)	0.32	0.28–3.6	0.31	0.29–3.4	0.23a
fT4 (pmol/L)	13.43	13–18	13.39	12–19	0.34a
WBC	6.53	(5.30–8.20)	9.79	(4.73–15.80)	0.001 a
Hb (g/dL)	12.93	±1.06	13.47	±1.19	0.001 b
MCV	92.22	(90.50–96.00)	92.30	(83.10–99.70)	0.64a
PLT (103/μL)	265.63	(195–355)	271.48	(166–409)	0.48a
PCT (%)	0.23	(0.16–0.23)	0.31	(0.17–0.58)	0.001 a
RDW (%)	16.49	(16.10–16.50)	16.47	(11.7–16.90)	0.43a
MPV (fL)	9.20	±0.42	9.17	±0.95	0.23b
HRR (%)	0.98	(0.79–1.17)	1.0063	(0.66–1.27)	0.04 a
PLR (%)	182.19	(62.10–581.97)	187.04	(54.43–670.50)	0.07a
NLR (%)	2.88	(0.42–8.07)	5.43	(1.15–21.8)	0.001 a
MLR (%)	0.26	(0.06–0.56)	0.27	(0.12–1.03)	0.15a
ELR (%)	0.05	(0.001–0.32)	0.04	(0.01–0.29)	0.09a

• The levels of categories are presented as the mean±standard deviation for parametric variables and median (min–max) for nonparametric variables. Statistically significant values are denoted in bold. TSH: thyroid-stimulating hormone; fT4: free T4; WBC: white blood cell; Hb: hemoglobin; MCV: mean corpuscular volume; PLT: platelet count; PCT: platelet crit; RDW: red cell distribution width; MPV: mean platelet volume; HRR: hemoglobin-to-red cell distribution width ratio; PLR: platelet-to-lymphocyte ratio; NLR: neutrophil-to-lymphocyte ratio; MLR: monocyte-to-lymphocyte ratio; ELR: eosinophil-to-lymphocyte ratio; HEG: hyperemesis gravidarum.
• ^a
  Mann-Whitney U test, and
• ^b
  independent-sample t-test.

In the HEG subgroups (mild, moderate, and severe), based on laboratory values, significant differences were observed in PCT, HRR, and NLR levels. Specifically, PCT, HRR, and NLR values were significantly higher in the severe group compared to the mild and moderate groups, while there was no significant difference between the mild and moderate groups. This trend indicated that PCT, HRR, and NLR values increased progressively from mild-to-severe HEG cases.

The diagnostic utility of PCT, HRR, and NLR for severe HEG was evaluated using ROC analysis, revealing that the areas under the curve (AUC) for PCT, HRR, and NLR were 0.80, 0.76, and 0.71, respectively. Threshold values associated with an increased risk of severe HEG were identified as PCT>0.29, HRR>1.03, and NLR>4.93, all with p<0.05. PCT demonstrated the highest sensitivity (78%) and specificity (72%), followed by HRR with a sensitivity of 75% and a specificity of 74%, and NLR with a sensitivity of 71% and a specificity of 60% (Table 2).

Table 2
Receiver operating characteristic analysis results for inflammatory variables.

Variables	AUC	SE	p	Predictive value	Sensitivity	Specificity	95%CI
PCT	0.80	0.47	0.001	0.29	0.78	0.72	0.71	0.89
HRR	0.76	0.51	0.001	1.03	0.75	0.74	0.67	0.86
NLR	0.71	0.57	0.001	4.93	0.71	0.60	0.60	0.82

• AUC: area under the curve; SE: standard error; CI: confidence interval; PCT: platelet crit; HRR: hemoglobin-to-red cell distribution width ratio; NLR: neutrophil-to-lymphocyte ratio. Statistically significant values are denoted in bold.

Logistic regression analysis showed that a one-unit increase in PCT, HRR, and NLR was associated with a 2.14-, 1.41-, and 2.36-fold increase in the risk of developing HEG, respectively (Table 3).

Table 3
The effects of platelet crit, hemoglobin-to-red cell distribution width ratio, and neutrophil-to-lymphocyte ratio on hyperemesis gravidarum development by binary logistic regression analysis.

Variables	B	OR	95%CI	P
PCT	0.76	2.14	1.65–2.79	0.001
HRR	0.34	1.41	1.12–1.76	0.03
NLR	0.863	2.36	1.66–3.36	0.001

• OR: odds ratio; CI: confidence interval; PCT platelet crit; HRR: hemoglobin-to-red cell distribution width ratio; NLR: neutrophil-to-lymphocyte ratio. Statistically significant values are denoted in bold.

DISCUSSION

HEG is a condition that causes severe nausea and vomiting in early pregnancy and often requires hospitalization. HEG has a pathophysiological mechanism due to many causes¹³. HEG may be severe enough to require hospitalization. It may even progress to central pontine myelinolysis and Wernicke's encephalopathy. Therefore, early diagnosis and treatment of HEG are essential for maternal and child health¹⁴.

Although the exact mechanism underlying HEG is not fully understood, inflammation has been suggested as a contributing factor. Hormonal changes, particularly rising levels of estrogen and human chorionic gonadotropin (hCG), are believed to trigger a cascade of immune responses. These responses include increased production of cytokines such as interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and other proinflammatory mediators, which may exacerbate nausea and vomiting symptoms¹⁵,¹⁶.

Although the link between HEG and inflammation is not fully understood, studies on markers of inflammation in HEG patients suggest a strong association between them¹⁷,¹⁸.

The rationale for studying inflammatory biomarkers in HEG is based on their ability to reflect underlying systemic inflammation, which may correlate with disease severity. These markers—including procalcitonin (PCT), NLR, and HRR—can be easily obtained from routine blood tests and offer a practical approach to risk stratification in pregnant women. Demir Cendek et al. demonstrated that blood-based inflammatory and nutritional parameters are significantly altered in women with HEG, supporting their potential diagnostic and prognostic utility¹⁹. Similarly, elevated ischemia-modified albumin (IMA) levels and decreased total-sulfhydryl concentrations observed in HEG patients suggest that subclinical inflammation and oxidative stress are both implicated in the pathophysiology of the condition²⁰.

PCT, an inflammatory marker obtained from a complete blood count, has been reported to have prognostic and predictive properties in various diseases such as gynecological and gastrointestinal malignancies, autoimmune diseases, and coronary artery diseases²¹,²². There are not many studies on the relationship between PCT and HEG. In the study by Tayfur et al., PCT values were found to be higher in women with HEG. In the same study, mild, moderate, and severe HEG cases were compared, and it was reported that PCT values were higher in severe HEG cases²³. In our study, PCT values in the HEG group were found to be significantly higher than in the control group. In addition, mild, moderate, and severe HEG cases were compared, and PCT values increased as one went from the mild group to the severe group. According to the ROC analysis result, the rate of PCT>0.29 was determined statistically, and this parameter was significantly associated with an increased risk of severe HEG disease. Logistic regression analysis revealed that a one-unit increase in PCT resulted in a 2.14-fold increase in HEG risk.

HRR is a recently used inflammatory marker derived from Hb and red cell distribution width (RDW), which are complete blood count parameters used in routine practice. In addition, it has been shown to be a bad prognostic factor alone in many cancers, such as stomach cancer and lung cancer²⁴,²⁵. Çintesun et al. found no significant difference in RDW between the HEG and control groups in their study²¹. Similarly, in our study, no significant difference was observed between the control and HEG groups in terms of RDW. There is no study in the literature about HRR in patients with HEG. We believe that the data we obtained in this study will lay the groundwork for future studies. In our study, HRR levels were found to be significantly higher in the HEG group than in the control group. When HEG subgroups were examined, HRR values increased significantly from mild to severe. According to the ROC analysis result, the rate of HRR>1.03 was determined statistically, and this parameter was significantly associated with an increased risk of severe HEG disease. Logistic regression analysis revealed that a one-unit increase in HRR resulted in a 1.41-fold increase in HEG risk.

NLR has been reported to increase in gastrointestinal and gynecological malignancies, heart diseases, and various inflammatory conditions²⁶,²⁷. Looking at the literature, there are few studies on the severity of NLR and HEG. Soysal et al. reported that NLR levels were higher in the patient group. In the same study, a significant correlation was found between increased levels of ketonuria and NLR²⁸. In another study, NLR levels were found to be high in HEG patients. However, no correlation was found between NLR values and the degree of ketonuria²¹. In the study by Kan et al., NLR levels were higher in the HEG group. However, no correlation was found between the severity of the disease and NLR values²⁹. In another similar study, a significant correlation was found between NLR levels and HEG groups³⁰. In our study, NLR values were higher in the HEG group. NLR values increase as one moves from the mild group to the severe group. According to the ROC analysis result, the rate of NLR>4.93 was determined statistically, and this parameter was significantly associated with an increased risk of severe HEG disease. Logistic regression analysis revealed that a one-unit increase in NLR resulted in a 2.36-fold increase in HEG risk.

Another important consideration is the role of potential confounding factors such as hormonal fluctuations and nutritional deficiencies. Elevated hCG and estrogen levels can directly contribute to nausea and vomiting, independent of inflammation. Additionally, thiamine, folate, and iron deficiencies—which are common in pregnant women—may worsen HEG symptoms and indirectly influence inflammatory markers. Kaplan et al. and Kuscu et al. both highlighted the importance of evaluating cytokine levels and their correlation with clinical symptoms in the context of these confounders¹⁵,¹⁶. Future studies should take such variables into account to better clarify the causal relationships between inflammation and HEG.

Limitations of this study: First, the patient data were obtained from a single center, the number of patients was not large, and the study design was retrospective. Therefore, it may be subject to selection bias and lacks the ability to control for possible confounding variables such as nutritional deficiencies, hormonal status, and underlying systemic conditions. Moreover, the single-center nature of the study may limit the generalizability of our findings to broader populations or different clinical settings. Second, only HRR, PLR, NLR, ELR, monocyte-to-lymphocyte ratio (MLR), and other hematological parameters were used as inflammatory markers, and biochemical inflammatory markers such as C-reactive protein (CRP) or ILs were not evaluated. Furthermore, the relatively limited sample size may have reduced the statistical power of subgroup comparisons and may not have fully captured population-level variations.

The strength of our study is that it is the first to investigate the association of HRR with HEG, providing a basis for future prospective, multi-center studies.

CONCLUSION

PCT, HRR, and NLR are inflammatory markers that increase in patients with HEG and have a predictive value for the development of HEG. In our study, we suggested using the Hb/RDW ratio as a new prognostic marker for patients with HEG. HRR, PCT, and NLR can be implemented at no additional cost. Since the relationship of HRR with HEG has not been definitively investigated, we cannot make a definitive statement about its clinical use yet. As more data on HRR levels are collected, HRR may be a marker of HEG. We believe that our study will be a source for future studies on the subject.

• Funding:
  none.
• ETHICS APPROVAL
  This study was conducted in line with the principles of the Declaration of Helsinki. Ethics committee approval was obtained for the study from the Van Ministry of Health University Training and Research Hospital Clinical Research and Ethics Committee with the decision number 2022/02-01 dated 18.01.2022.

DATA AVAILABILITY STATEMENT

The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request.

REFERENCES

• ¹ Fejzo MS, Sazonova OV, Sathirapongsasuti JF, Hallgrímsdóttir IB, Vacic V, MacGibbon KW, et al. Placenta and appetite genes GDF15 and IGFBP7 are associated with hyperemesis gravidarum. Nat Commun. 2018;9(1):1178. https://doi.org/10.1038/s41467-018-03258-0
  » https://doi.org/10.1038/s41467-018-03258-0
• ² Gabra A, Habib H, Gabra M. Hyperemesis gravidarum, diagnosis, and pathogenesis. Crit Care Obstet Gynecol. 2019;5(1):1-5.
• ³ Kurt RK, Güler A, Silfeler DB, Ozçil MD, Karateke A, Hakverdi AU. Relation of inflammatory markers with both presence and severity of hyperemesis gravidarum. Ginekol Pol. 2014;85(8):589-93. https://doi.org/10.17772/gp/1776
  » https://doi.org/10.17772/gp/1776
• ⁴ Karagöz İ, Özer B, Aktaş G. The predictors of outcome in patients that require management in intensive care units: a narrative review. Hitit Med J. 2024;6(3):367-78. https://doi.org/10.52827/hititmedj.1443663
  » https://doi.org/10.52827/hititmedj.1443663
• ⁵ Aktas G, Tel BA, Duman TT. Inflammatory indices derived from hemogram as prognostic markers of cardiovascular outcome. Int J Cardiovasc Sci. 2024;37:e20240012.
• ⁶ Basaran E, Aktas G. The relationship of vitamin D levels with hemogram indices and metabolic parameters in patients with type 2 diabetes mellitus. AIMS Med Sci. 2024;11(1):47-57. https://doi.org/10.3934/medsci.2024004
  » https://doi.org/10.3934/medsci.2024004
• ⁷ Aktas G, Duman TT, Atak BM, Kurtkulagi O, Bilgin S, Basaran E, et al. Irritable bowel syndrome is associated with novel inflammatory markers derived from hemogram parameters. Fam Med Prim Care Rev. 2020;22(2):107-10. https://doi.org/10.5114/fmpcr.2020.95311
  » https://doi.org/10.5114/fmpcr.2020.95311
• ⁸ Aktas G. Hematological predictors of novel Coronavirus infection. Rev Assoc Med Bras (1992). 2021;67(Suppl 1):1-2. https://doi.org/10.1590/1806-9282.67.Suppl1.20200678
  » https://doi.org/10.1590/1806-9282.67.Suppl1.20200678
• ⁹ Aktas G, Sit M, Dikbas O, Erkol H, Altinordu R, Erkus E, et al. Elevated neutrophil-to-lymphocyte ratio in the diagnosis of Hashimoto's thyroiditis. Rev Assoc Med Bras (1992). 2017;63(12):1065-8. https://doi.org/10.1590/1806-9282.63.12.1065
  » https://doi.org/10.1590/1806-9282.63.12.1065
• ¹⁰ Afsin H, Aktas G. Platelet to lymphocyte and neutrophil to lymphocyte ratios are useful in differentiation of thyroid conditions with normal and increased uptake. Ethiop J Health Dev. 2021;35(3):149-53.
• ¹¹ Wu F, Yang S, Tang X, Liu W, Chen H, Gao H. Prognostic value of baseline hemoglobin-to-red blood cell distribution width ratio in small cell lung cancer: a retrospective analysis. Thorac Cancer. 2020;11(4):888-97. https://doi.org/10.1111/1759-7714.13330
  » https://doi.org/10.1111/1759-7714.13330
• ¹² Yılmaz A, Mirili C, Tekin SB, Bilici M. The ratio of hemoglobin to red cell distribution width predicts survival in patients with gastric cancer treated by neoadjuvant FLOT: a retrospective study. Ir J Med Sci. 2020;189(1):91-102. https://doi.org/10.1007/s11845-019-02153-x
  » https://doi.org/10.1007/s11845-019-02153-x
• ¹³ Fejzo MS, MacGibbon KW, Mullin PM, Romero R, Goodwin TM, Hahn SH et al. The genetic basis of hyperemesis gravidarum: results of the first 23andMe genome-wide association study. CMAJ. 2024;196(14)
• ¹⁴ Fejzo MS, MacGibbon KW, Mullin PM, Romero R, Goodwin TM, Hahn SH et al. Wernicke's encephalopathy and central pontine myelinolysis as complications of hyperemesis gravidarum: importance of early diagnosis and treatment. Eur J Obstet Gynecol Reprod Biol. 2024;257:10-5.
• ¹⁵ Kuscu NK, Yildirim Y, Koyuncu F, Var A, Uyanik BS. Interleukin-6 levels in hyperemesis gravidarum. Arch Gynecol Obstet. 2003;269(1):13-5. https://doi.org/10.1007/s00404-002-0412-6
  » https://doi.org/10.1007/s00404-002-0412-6
• ¹⁶ Kaplan PB, Gücer F, Sayin NC, Yüksel M, Yüce MA, Yardim T. Maternal serum cytokine levels in women with hyperemesis gravidarum in the first trimester of pregnancy. Fertil Steril. 2003;79(3):498-502. https://doi.org/10.1016/s0015-0282(02)04699-x
  » https://doi.org/10.1016/s0015-0282(02)04699-x
• ¹⁷ Caglayan EK, Engin-Ustun Y, Gocmen AY, Sarı N, Seckin L, Kara M, et al. Is there any relationship between serum sirtuin-1 level and neutrophil-lymphocyte ratio in hyperemesis gravidarum? J Perinat Med. 2016;44(3):315-20. https://doi.org/10.1515/jpm-2015-0178
  » https://doi.org/10.1515/jpm-2015-0178
• ¹⁸ Uçkan K, Özgökçe Ç, Başkiran Y, Eyisoy ÖG, Çeleğen İ, Akbay Hİ. The role of ultrasound and mitofusin-2 levels to predict pregnancy outcomes in patients with severe preeclampsia: a case-control study. Rev Assoc Med Bras (1992). 2024;70(8):e20240152. https://doi.org/10.1590/1806-9282.20240152
  » https://doi.org/10.1590/1806-9282.20240152
• ¹⁹ Demir Cendek B, Bayraktar B, Seyhanli Z, Kocyildiz E, Golbasi H, Can Ibanoglu M, et al. Blood-based clinical biomarkers of inflammation and nutrition in hyperemesis gravidarum. J Clin Med. 2024;13(23):7289. https://doi.org/10.3390/jcm13237289
  » https://doi.org/10.3390/jcm13237289
• ²⁰ Uçkan K, Demir H, Demir C. Maternal serum ischemia-modified albumin (IMA), total-sulphydryl concentrations, and some subclinic inflammatory markers in hyperemesis gravidarum (HG). Taiwan J Obstet Gynecol. 2023;62(1):101-6. https://doi.org/10.1016/j.tjog.2022.10.006
  » https://doi.org/10.1016/j.tjog.2022.10.006
• ²¹ Çintesun E, Akar S, Gul A, Çintesun FNI, Sahin G, Ezveci H, et al. Subclinical inflammation markers in hyperemesis gravidarum and ketonuria: a case-control study. J Lab Physicians. 2019;11(2):149-53. https://doi.org/10.4103/JLP.JLP_151_18
  » https://doi.org/10.4103/JLP.JLP_151_18
• ²² Niu MM, Jiang Q, Ruan JW, Liu HH, Chen WX, Qiu Z, et al. Clinical implications of procalcitonin in Kawasaki disease: a useful candidate for differentiating from sepsis and evaluating IVIG responsiveness. Clin Exp Med. 2021;21(4):633-43. https://doi.org/10.1007/s10238-021-00709-9
  » https://doi.org/10.1007/s10238-021-00709-9
• ²³ Tayfur C, Burcu DC, Gulten O, Betul D, Tugberk G, Onur O, et al. Association between platelet to lymphocyte ratio, plateletcrit and the presence and severity of hyperemesis gravidarum. J Obstet Gynaecol Res. 2017;43(3):498-504. https://doi.org/10.1111/jog.13228
  » https://doi.org/10.1111/jog.13228
• ²⁴ Wu F, Yang S, Tang X, Liu W, Chen H, Gao H. Prognostic value of baseline hemoglobin-to-red blood cell distribution width ratio in small cell lung cancer: a retrospective analysis. Thorac Cancer. 2020;11(4):888-97. https://doi.org/10.1111/1759-7714.13330
  » https://doi.org/10.1111/1759-7714.13330
• ²⁵ Yılmaz A, Mirili C, Tekin SB, Bilici M. The ratio of hemoglobin to red cell distribution width predicts survival in patients with gastric cancer treated by neoadjuvant FLOT: a retrospective study. Ir J Med Sci. 2020;189(1):91-102. https://doi.org/10.1007/s11845-019-02153-x
  » https://doi.org/10.1007/s11845-019-02153-x
• ²⁶ Vakhshoori M, Nemati S, Sabouhi S, Yavari B, Shakarami M, Bondariyan N, et al. Neutrophil to lymphocyte ratio (NLR) prognostic effects on heart failure; a systematic review and meta-analysis. BMC Cardiovasc Disord. 2023;23(1):555. https://doi.org/10.1186/s12872-023-03572-6
  » https://doi.org/10.1186/s12872-023-03572-6
• ²⁷ Akpinar MY, Ozin YO, Kaplan M, Ates I, Kalkan IH, Kilic ZMY, et al. Platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio predict mucosal disease severity in ulcerative colitis. J Med Biochem. 2018;37(2):155-62. https://doi.org/10.1515/jomb-2017-0050
  » https://doi.org/10.1515/jomb-2017-0050
• ²⁸ Soysal C, Işıkalan MM, Bıyık İ, Erten Ö, İnce O. The relationship between inflammation markers and ketonuria in hyperemesis gravidarum. J Obstet Gynaecol Res. 2021;47(9):3078-83. https://doi.org/10.1111/jog.14857
  » https://doi.org/10.1111/jog.14857
• ²⁹ Kan E, Emektar E, Corbacioglu K, Safak T, Sariaydin T, Cevik Y. Evaluation of relationship between inflammatory markers and hyperemesis gravidarum in patients admitted to emergency department. Am J Emerg Med. 2020;38(2):292-5. https://doi.org/10.1016/j.ajem.2019.05.007
  » https://doi.org/10.1016/j.ajem.2019.05.007
• ³⁰ Kurt RK, Güler A, Silfeler DB, Ozçil MD, Karateke A, Hakverdi AU. Relation of inflammatory markers with both presence and severity of hyperemesis gravidarum. Ginekol Pol. 2014;85(8):589-93. https://doi.org/10.17772/gp/1776
  » https://doi.org/10.17772/gp/1776

Edited by

• Scientific Editor:
  José Maria Soares Júnior https://orcid.org/0000-0003-0774-9404

Publication Dates

• Publication in this collection
  07 July 2025
• Date of issue
  2025

History

• Received
  09 Oct 2024
• Accepted
  15 Apr 2025