Evaluation of albumin-based inflammatory markers as diagnostic tools in HELLP syndrome

www.nature.com/scientificreports OPEN Evaluation of albumin-based inflammatory markers as diagnostic tools in HELLP syndrome Aziz Kından, Dilara Sarikaya Kurt, Dilruba Ravza Nalbantçılar, Can Ozan Ulusoy & Kadriye Yakut Yücel Objective To evaluate the role of inflammatory and albumin-related indices in the diagnosis and prognosis of HELLP syndrome, with a focus on parameters such as NLR, NPAR, CAR, and FAR. Materials and methods This retrospective study analyzed 126 pregnant women, including 58 with HELLP syndrome and 68 healthy controls, admitted to the Perinatology Department of Etlik City Hospital between January 2023 and September 2024. Demographic and clinical data, including age, gestational week, and laboratory parameters, were collected. Specific inflammatory indices, including Neutrophil-to-Lymphocyte Ratio (NLR), Hemoglobin-Albumin-Lymphocyte-Platelet Score (HALP), Neutrophil Percentage-to-Albumin Ratio (NPAR), C-Reactive Protein-to-Albumin Ratio (CAR) and Fibrinogen-to-Albumin Ratio (FAR) were calculated and compared between the groups. Receiver Operating Characteristic (ROC) analysis was performed to assess the diagnostic performance of these indices. Statistical analyses were conducted with a confidence level of 95%, and p-values less than 0.05 were considered significant. Results Significant differences were observed between the HELLP group and healthy controls in terms of inflammatory and nutritional indices. NLR, NPAR, CAR, and FAR were significantly higher in the HELLP group compared to controls (p < 0.001 for all). ROC analysis revealed good diagnostic performance for CAR (AUC = 0.88, p < 0.001) and NPAR (AUC = 0.84, p < 0.001), while FAR also demonstrated high sensitivity and specificity (AUC = 0.82, p < 0.001). Additionally, PLR values were significantly lower in the HELLP group (p = 0.004), indicating its potential diagnostic relevance. PIV demonstrated the highest diagnostic performance among the markers evaluated (AUC = 0.790, sensitivity = 78%, specificity = 68%), followed by SII (AUC = 0.746). PLR and NAR showed moderate diagnostic accuracy with AUC values of 0.704 and 0.700, respectively. Conclusion Inflammatory and albumin-related indices, particularly CAR, NPAR, and FAR, show good diagnostic accuracy in identifying HELLP syndrome. These parameters may be valuable tools for early diagnosis and effective management of HELLP syndrome by enabling clinicians to identify patients at higher risk of complications, initiate timely interventions, and monitor disease progression more accurately, thus potentially improving maternal and fetal outcomes. Keywords HELLP syndrome, Inflammation, Biomarkers, Pregnancy complications HELLP syndrome, a severe complication of preeclampsia, is characterized by hemolysis, elevated liver enzymes, and low platelet count. It typically occurs in the later stages of pregnancy and presents a significant risk for both maternal and fetal morbidity and mortality1. The pathophysiology of HELLP syndrome remains complex and not fully understood, involving various inflammatory and endothelial dysfunction pathways. Early identification and management are essential to mitigate the syndrome’s severe outcomes2. Albumin, a key protein synthesized in the liver, plays a critical role in maintaining oncotic pressure and acts as a biomarker for various inflammatory conditions3. In recent years, researchers have increasingly focused on albumin levels and related indices, such as albumin-globulin ratio, as potential indicators of disease severity in conditions characterized by systemic inflammation4,5. In HELLP syndrome, alterations in albumin and associated indices may provide insights into the severity and progression of the disorder. Department of Obstetrics and Gynecology, Etlik City Hospital, Ankara, TurkeyVarlık Neighborhood, Halil Sezai Erkut Street, Yenimahalle. email: Scientific Reports | (2025) 15:22125 | https://doi.org/10.1038/s41598-025-01797-3 1 www.nature.com/scientificreports/ The association between albumin-related indices and inflammatory responses in hypertensive pregnancy warrants further investigation6. Albumin levels tend to decrease in patients with HELLP syndrome due to systemic inflammatory responses and liver dysfunction, which contribute to a heightened state of oxidative stress and endothelial damage7. Exploring the implications of these changes could enhance our understanding of HELLP syndrome pathophysiology and potentially improve clinical outcomes. The aim of our study is to evaluate the levels of albumin and associated indices in patients with HELLP syndrome, assessing their potential role as indicators of disease severity and progression. By examining these parameters, we seek to contribute to the understanding of HELLP syndrome and provide evidence that could support the development of new diagnostic or prognostic tools for this serious condition. Materials and methods Study design and participants This retrospective study was conducted to examine pregnant women diagnosed with HELLP syndrome who were admitted to the Perinatology Department of Etlik City Hospital between January 1, 2023, and September 30, 2024. The maternal age range of the pregnant women included in the study was between 18 and 45 years, and the gestational age ranged from 24 to 41 weeks. Only singleton pregnancies without fetal congenital or chromosomal anomalies were selected. The study group consisted of 58 patients diagnosed with HELLP syndrome, while 68 healthy pregnant women, matched for age and gestational week, served as the control group. Thus, a total of 126 cases were evaluated retrospectively. Informed consent was waived by the Ethics Committee of Ankara Etlik City Hospital due to the retrospective nature of the study, in accordance with national regulations and ethical standards. Ethical approval was granted with the approval number AESH-BADEK-2024-936, dated 16/10/2024. The Ethics Committee of Ankara Etlik City Hospital waived the need for informed consent for this study due to its retrospective design, as no direct patient interaction occurred, and all data were anonymized before analysis. This waiver complies with national regulations and the ethical principles outlined in the Declaration of Helsinki. Power analysis To ensure the statistical validity of the study, a power analysis was conducted using the G*Power 3.1 program. The analysis, performed with a 95% confidence level and a 5% margin of error, determined that a minimum of 40 patients per group would be sufficient when the standard effect size is 0.39. In accordance with the study requirements, analyses were performed retrospectively on 58 patients with HELLP syndrome and 68 healthy pregnant women. Collection of demographic and clinical data The demographic and clinical characteristics of the patients included in the study were evaluated in detail. Demographic data collected included age, body mass index (BMI), number of pregnancies, parity, hist (...truncated)