Diagnostic value of five inflammatory markers for the subclinical chorioamnionitis in pregnancies with preterm premature rupture of membranes / 中华检验医学杂志

ABSTRACT

Objective Chorioamnionitis in pregnancies with preterm premature rupture of membranes(PPROM) may lead to perinatal morbidity. There is no definite diagnostic method for detecting chorioamnionitis before delivery. In this retrospective study, the diagnostic value of five inflammatory markers, including white blood cell (WBC), neutrophil percentage (NEU), c-reactive protein (CRP), interleukin-6 (IL-6), and procalcitonin (PCT) of subclinical chorioamnionitis in PPROM were investigated. Methods A total of 74 PPROM (Group A 21 PPROM without infection; Group B 43 PPROM with subclinical chorioamnionitis;Group C10 PPROM with chorioamnionitis) and 46 controls (Group Dnormal full-term pregnancies) were recruited from the Third Affiliated Hospital of Army Medical University between 2013 and 2017. The five markers were measured within 24 hours before the delivery. The diagnostic value of inflammatory markers for subclinical chorioamnionitis were assessed by t test and ROC curve. Results The levels of WBC, NEU and IL-6 in group A were significantly higher than those in group D (T=5.412, Z=-3.312, T=2.798, all P<0.05). The levels of five inflammatory markers in group B and C were all significantly increased compare with group D(Zb=-5.797, Zb=-5.296, Zb=-5.116, Zb=-3.279, Zb=-4.36, Tc=7.732, Zc=-4.622, Zc=-4.591, Zc=-3.509, Zc=-4.387,all P<0.05). Group B CRP, IL-6 and PCT levels were significantly higher than those of group A(Z=-3.10, Z=-2.95, Z=-2.202, all P<0.05). All five markers of group C were significantly higher than those of group A(T=-5.285, Z=-2.536, Z=-3.819, Z=-3.228, Z=-3.719, all P<0.05). The levels of WBC, NEU and IL-6 in group C were significantly higher than those in PPROM group B(Z=-3.296, T=-2.738, Z=-3.501, all P<0.05). In terms of predictive capability of subclinical chorioamnionitis, the individual area under ROC curve (AUC) of CRP, IL-6, and PCT were 0.740, 0.671, and 0.728 corresponding to the optimal cutoff 10.3 mg/L, 5.995 pg/ml, and 0.055 ng/ml respectively. The sensitivity value were 39.5％, 60.5％ and 74.4％, the specificity value were 100％, 85.7％and 61.9％.The area under the ROC curves of CRP+IL-6,CRP+PCT,IL-6+PCT and CRP+IL+6+PCT were 0.746, 0.805, 0.776 and 0.816. The sensitivity value were 51.2％, 74.4％, 81.4％ and 62.8％, the specificity value were 95.2％, 81％, 66.7％and 90.5％. Conclusions The model (combined with PCT, CRP and IL-6) may be helpful for the diagnosis of the subclinical chorioamnionitis in PPROM. Combined diagnosis of two markers in PCT,CRP and IL-6 could be superior to single inflammatory marker. Combined diagnosis of three could be better,which may provide a reference for clinical diagnosis.