The Predictive Value of Neutrophil-to-Platelet Ratio (NPR) and Platelet-to-Lymphocyte Ratio (PLR) for Substantive Adverse Neonatal Outcomes in Severe Preeclampsia: A Retrospective Cohort Study 

The Predictive Value of Neutrophil-to-Platelet Ratio (NPR) and Platelet-to-Lymphocyte Ratio (PLR) for Substantive Adverse Neonatal Outcomes in Severe Preeclampsia: A Retrospective Cohort Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Predictive Value of Neutrophil-to-Platelet Ratio (NPR) and Platelet-to-Lymphocyte Ratio (PLR) for Substantive Adverse Neonatal Outcomes in Severe Preeclampsia: A Retrospective Cohort Study Huihui Ju, Ruoyun Wei, Yilin Wang, Yonghua Li, Xiaokang Deng This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9395224/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Objective: To evaluate the independent predictive value of the Neutrophil-to-Platelet Ratio (NPR) and Platelet-to-Lymphocyte Ratio (PLR) for direct adverse neonatal outcomes—excluding preterm birth—in patients with severe preeclampsia (PE). Methods: A retrospective study was conducted on 524 pregnant women with severe PE. Patients were categorized into a normal group (n=418) and an adverse outcome group (n=106). Adverse outcomes were strictly defined as neonatal asphyxia, fetal growth restriction (FGR), or NICU admission for organ dysfunction. Six inflammatory indices (SII, SIRI, MLR, NLR, PLR, and NPR) were compared using the Mann-Whitney U test. Multivariate logistic regression and Receiver Operating Characteristic (ROC) curves were used to assess predictive performance. Results: Lower PLR (114.84 vs. 127.65, p= 0.010) and higher NPR (0.04 vs. 0.03, p= 0.005) were significantly associated with adverse outcomes. In the multivariate model, PLR was identified as an independent predictor (OR = 0.984, 95% CI: 0.973–0.996, p= 0.009). The combined inflammatory model achieved an AUC of 0.635, outperforming single indices such as NPR (AUC=0.606) and PLR (AUC=0.592). Conclusion: Decreased PLR and increased NPR are significant biomarkers for substantive neonatal injury in severe PE, independent of the risk of prematurity. Severe preeclampsia Neutrophil-to-platelet ratio Platelet-to-lymphocyte ratio Neonatal outcomes Predictive model Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 08 May, 2026 Reviewers agreed at journal 06 May, 2026 Reviewers invited by journal 05 May, 2026 Editor invited by journal 14 Apr, 2026 Editor assigned by journal 13 Apr, 2026 Submission checks completed at journal 13 Apr, 2026 First submitted to journal 12 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9395224","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":639256044,"identity":"008e86b8-72e0-477e-a8cf-be68454ca2c0","order_by":0,"name":"Huihui Ju","email":"","orcid":"","institution":"Changzhou Maternal and Child Health Care Hospital","correspondingAuthor":false,"prefix":"","firstName":"Huihui","middleName":"","lastName":"Ju","suffix":""},{"id":639256045,"identity":"72881b3b-ab8c-4d25-80f9-2afccbc6349e","order_by":1,"name":"Ruoyun Wei","email":"","orcid":"","institution":"Nanjing Jiangning Hospital of Chinese 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","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Severe preeclampsia, Neutrophil-to-platelet ratio, Platelet-to-lymphocyte ratio, Neonatal outcomes, Predictive model","lastPublishedDoi":"10.21203/rs.3.rs-9395224/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9395224/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eTo evaluate the independent predictive value of the Neutrophil-to-Platelet Ratio (NPR) and Platelet-to-Lymphocyte Ratio (PLR) for direct adverse neonatal outcomes—excluding preterm birth—in patients with severe preeclampsia (PE).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA retrospective study was conducted on 524 pregnant women with severe PE. Patients were categorized into a normal group (n=418) and an adverse outcome group (n=106). Adverse outcomes were strictly defined as neonatal asphyxia, fetal growth restriction (FGR), or NICU admission for organ dysfunction. Six inflammatory indices (SII, SIRI, MLR, NLR, PLR, and NPR) were compared using the Mann-Whitney U test. Multivariate logistic regression and Receiver Operating Characteristic (ROC) curves were used to assess predictive performance.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eLower PLR (114.84 vs. 127.65, \u003cem\u003ep=\u003c/em\u003e0.010) and higher NPR (0.04 vs. 0.03, \u003cem\u003ep=\u003c/em\u003e0.005) were significantly associated with adverse outcomes. In the multivariate model, PLR was identified as an independent predictor (OR = 0.984, 95% CI: 0.973–0.996, \u003cem\u003ep=\u003c/em\u003e0.009). The combined inflammatory model achieved an AUC of 0.635, outperforming single indices such as NPR (AUC=0.606) and PLR (AUC=0.592).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eDecreased PLR and increased NPR are significant biomarkers for substantive neonatal injury in severe PE, independent of the risk of prematurity.\u003c/p\u003e","manuscriptTitle":"The Predictive Value of Neutrophil-to-Platelet Ratio (NPR) and Platelet-to-Lymphocyte Ratio (PLR) for Substantive Adverse Neonatal Outcomes in Severe Preeclampsia: A Retrospective Cohort Study ","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-13 06:36:03","doi":"10.21203/rs.3.rs-9395224/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"254294877569245623996261536271680734722","date":"2026-05-08T21:21:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"104603500482059711620595876972010551279","date":"2026-05-06T19:21:33+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-05-05T20:04:59+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-14T08:33:51+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-14T01:28:41+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-14T01:28:08+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2026-04-12T15:00:50+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8f736981-465a-4ebc-9fd4-266230c55f4f","owner":[],"postedDate":"May 13th, 2026","published":true,"recentEditorialEvents":[{"type":"reviewerAgreed","content":"254294877569245623996261536271680734722","date":"2026-05-08T21:21:27+00:00","index":42,"fulltext":""},{"type":"reviewerAgreed","content":"104603500482059711620595876972010551279","date":"2026-05-06T19:21:33+00:00","index":41,"fulltext":""},{"type":"reviewersInvited","content":"30","date":"2026-05-05T20:04:59+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-13T06:36:03+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-13 06:36:03","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9395224","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9395224","identity":"rs-9395224","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}