COMPARATIVE ACCURACY OF BLOOD AND PLACENTAL MARKERS IN THE PREDICTION OF PREECLAMPSIA IN THE UPPER EAST REGION

Abstract

Preeclampsia (PE) remains a significant global concern for maternal-foetus health, particularly in low to middle-income countries. Identifying biomarkers for early PE diagnosis is paramount for effective prevention and management. This case-control study, conducted at Bolgatanga Regional Hospital, involved 250 pregnant women (PE=100 and controls=150), aged 18 to 41 years, spanning January to December 2022. Fasting venous blood samples and placental tissues were collected at delivery and analyzed for neutrophil to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte ratio (MLR). Additionally, placental and serum levels of total cholesterol (TCHOL), low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, aspartate aminotransferase (AST), alanine aminotransferase (ALT), creatinine (CRT), urea, blood urea nitrogen (BUN), and uric acid (UA) were assessed. Furthermore, placental malondialdehyde (MDA), catalase activity (CAT), total peroxide activity (TP), total antioxidant capacity (TAC), and oxidative stress index (OSI) were estimated. All analyses were conducted using fully automated haematology and biochemistry analyzers. The findings revealed elevated levels of both NLR and MLR in PE cases, demonstrating significant predictive capacity for PE with area under the curve (AUC) values of 0.85 and 0.89, respectively. Furthermore, PE was associated with higher placental levels of MDA and OSI, along with reduced total TAC and CAT activities. Additionally, placental levels of MDA, TAC, CAT, and TP emerged as significant predictors of PE, with respective AUCs of 0.68, 0.76, 1.00, and 0.70. Furthermore, elevated placental levels of CRT and UA were observed in PE cases. On the contrary, PE was associated with higher serum levels of TCHOL, LDL cholesterol, AST, ALT, urea, CRT, BUN, and UA, while serum HDL levels were lower. Notably, in predicting PE, placental CRT exhibited significant potential with an AUC of 0.95 at P<0.001. Regarding serum markers, the performances were as follows (AUC, P-value): HDL (0.68, 0.037), LDL (0.86, <0.001), AST (0.93, <0.001), ALT (0.95, <0.001), urea (0.72, 0.004), CRT (0.77, <0.001), BUN (0.72, 0.006), and uric acid (0.76, 0.002). Placental catalase activity emerges as the strongest predictor of preeclampsia. However, assessing placental catalase activity may pose challenges due to the more invasive, time-consuming, and costly sampling procedure. Consequently, less invasive and more cost-effective markers, such as red cell indices or serum-based markers, are preferred alternatives