What question did this study set out to answer?

This study aims to evaluate the predictive value of hematological indices for preterm labor.

June 15, 2026Open Access

Predictive Value of Neutrophils, Lymphocytes, Platelets, Neutrophil–Lymphocyte Ratio (NLR), and Platelets–Lymphocyte Ratio (PLR) in Preterm Labor: Single and Combined Indices

Key Points

This study aims to evaluate the predictive value of hematological indices for preterm labor.
Conducted a retrospective case-control study involving 1000 patients with preterm labor.
Measured levels of neutrophils, lymphocytes, platelets, NLR, and PLR and compared them with normal pregnancies.
Utilized ROC curves to estimate cutoff values and determined predictive accuracy for each marker.
Neutrophils, platelets, NLR, and PLR were significantly higher in total preterm labor cases compared to controls (p ≤ 0.0001 to 0.05).
AUC for markers in early preterm labor was weak, ranging from 0.593 to 0.640.
Combined Score Index and Systemic Immune-Inflammatory Index had weak predictive values with AUCs from 0.604 to 0.684.

Abstract

Introduction Maternal neutrophils (N), lymphocyte, platelets (PLTs), neutrophil–lymphocyte ratio (NLR), and platelets–lymphocyte ratio (PLR) have been used to predict preterm birth. We studied changes in these markers in preterm labor (PTL) and whether they can serve as single or combined predictive indicators. Material and Methods Patients in premature labor participated in a retrospective case–control study. CBC, Hb, HCT, lymphocytes, N, PLTs, NLR, and PLR were measured and compared between total preterm cases (20 0/7–36 6/7 weeks) and normal pregnancies. Subgroups of early preterm labor (EPL) (20 0/7–33 6/7 weeks) and late preterm labor (LPL) (34 0/7–36 6/7 weeks) were also compared with gestational‐age‐matched controls. ROC curves were utilized to estimate the cutoff, specificity, sensitivity, and area under the curve (AUC) for every marker. According to cutoff levels of each marker, a score system was created (0–4). Combined Score Index and Systemic Immune‐Inflammatory Index (SII) were calculated for total, early, and late preterm groups. Results A total of 1000 patients with PTL were included. No significant difference was found in lymphocytes between groups. N, PLTs, NLR, and PLR were significantly higher in total PTL vs. controls. In EPL, N, PLTs, NLR, and PLR were significantly elevated ( p ≤ 0.0001, 0.0001, 0.0002, and 0.0009). Similarly, LPL showed significant differences ( p ≤ 0.0003, 0.01, 0.0008, and 0.05). These markers were also significantly higher in EPL vs. LPL ( p ≤ 0.0001, 0.05, 0.0001, and 0.05). AUC values in early preterm for N, PLTs, NLR, and PLR were 0.640, 0.626, 0.627, and 0.593, respectively, and in late preterm, 0.611, 0.568, 0.610, and 0.581—indicating a weak predictive value. A high score index (3‐4) was more frequent in total (57%), early (31.7%), and late (50.27%) preterm compared with controls (38.5%, 15.56%, and 31.86%). AUC of Combined Score Index was 0.604, 0.630, and 0.611 and for SII, 0.660, 0.684, and 0.622 in total, early, and late preterm, respectively, showing statistically significant but weak predictive values. Conclusion Significant changes in N, PLTs, NLR, and PLR (both as individual and combined markers) are observed in PTL groups, but their predictive value for prematurity remains limited.

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