{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T22:54:00Z","timestamp":1791845640648,"version":"4.3.4"},"reference-count":19,"publisher":"Georg Thieme Verlag KG","issue":"05","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Z Geburtshilfe Neonatol"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>To evaluate inflammatory, immuno-nutritional, and composite stress indices\nderived from routine laboratory parameters in pregnancies complicated by\npreviable preterm premature rupture of membranes (PPROM) and compare these\nwith gestational age\u2013matched healthy controls.<\/jats:p>\n                  <jats:p>This retrospective cohort included 50 women with previable PPROM before 22\nweeks and 50 gestational age\u2013matched controls. Hematological and biochemical\nparameters obtained within 24 hours of admission were used to calculate\nneutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio\n(dNLR), systemic immune-inflammation index (SII), white blood\ncell-to-albumin ratio (WAR), neutrophil-to-albumin ratio (NAR),\nneutrophil-to-lymphocyte-to-albumin ratio (NLAR), lymphocyte-to-albumin\nratio (LAR), platelet-to-albumin ratio (PAR), platelet-to-lymphocyte ratio\n(PLR), and hemoglobin-to-albumin ratio (HAR). In addition, a novel\nhemato-immuno-nutritional impairment index (HINI) and newly proposed\ncomposite stress\u2013reserve indices\u2014composite stress index (CSI),\ninflammation-over-reserve index (IORI), thrombo-hemoglobin composite index\n(THCI), and global composite systemic index (GCSI)\u2014were evaluated.\nStatistical comparisons, age-adjusted logistic regression, and receiver\noperating characteristic analysis were performed.<\/jats:p>\n                  <jats:p>In age-adjusted logistic regression analyses, only NLR, dNLR, SII, WAR, NAR,\nNLAR, CSI, IORI, and GCSI remained independently associated with PPROM,\nwhereas other evaluated indices did not retain statistical significance.\nReceiver operating characteristic analysis demonstrated the strongest\ndiscriminatory performance for NAR, NLAR, and IORI.<\/jats:p>\n                  <jats:p>Previable PPROM is characterized by acute neutrophil-dominant inflammation.\nCombined indices integrating inflammatory activity with physiological\nreserve, especially NAR, NLAR, and IORI, may improve early identification of\naffected pregnancies.<\/jats:p>","DOI":"10.1055\/a-2824-1036","type":"journal-article","created":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T22:50:22Z","timestamp":1774911022000},"page":"411-418","source":"Crossref","is-referenced-by-count":0,"title":["Inflammatory, Immuno-Nutritional, and Composite Stress Indices in\nPreviable Preterm Premature Rupture of Membranes"],"prefix":"10.1055","volume":"230","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7308-352X","authenticated-orcid":false,"given":"Ilayda","family":"Gercik Arzik","sequence":"additional","affiliation":[{"name":"Perinatology, Ministry of Health Izmir City Hospital,\nIzmir, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hale","family":"Ankara Aktas","sequence":"additional","affiliation":[{"name":"Perinatology, Ministry of Health Izmir City Hospital,\nIzmir, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zubeyde","family":"Emiralioglu Cakir","sequence":"additional","affiliation":[{"name":"Perinatology, Izmir Democracy University Buca Seyfi Demirsoy Education\nand Research Hospital, Izmir, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilknur","family":"Toka","sequence":"additional","affiliation":[{"name":"Perinatology, Ministry of Health Izmir City Hospital,\nIzmir, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6233-4207","authenticated-orcid":false,"given":"Burak","family":"Bayraktar","sequence":"additional","affiliation":[{"name":"Perinatology, Turgut Ozal University, Malatya Training and Research\nHospital, Malatya, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raziye","family":"Torun","sequence":"additional","affiliation":[{"name":"Perinatology, Izmir Democracy University Buca Seyfi Demirsoy Education\nand Research Hospital, Izmir, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ceren","family":"Saglam Purut","sequence":"additional","affiliation":[{"name":"Perinatology, Ministry of Health Izmir City Hospital,\nIzmir, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emre","family":"Bayram","sequence":"additional","affiliation":[{"name":"Perinatology, Ministry of Health Izmir City Hospital,\nIzmir, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esra","family":"Bozcelik","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology, Ministry of Health Izmir\nCity Hospital, Izmir, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8682-5537","authenticated-orcid":false,"given":"Hakan","family":"Golbasi","sequence":"additional","affiliation":[{"name":"Perinatology, Ministry of Health Izmir City Hospital,\nIzmir, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,3,30]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"233","DOI":"10.4236\/ojog.2021.113023","article-title":"Prevalence, risk factors and outcome of preterm premature rupture of membranes\nat the Bamenda Regional Hospital","volume":"11","author":"D W Pisoh","year":"2021","journal-title":"OJOG"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1515\/jpm-2017-0027","article-title":"Mid-trimester preterm premature rupture of membranes (PPROM): etiology,\ndiagnosis, classification, international recommendations of treatment options\nand outcome","volume":"46","author":"M Tchirikov","year":"2018","journal-title":"J Perinat Med"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"516","DOI":"10.47582\/jompac.1348845","article-title":"Systemic immune inflammation indices: novel predictors for preterm premature\nrupture of membranes and associated complications","volume":"4","author":"G N K\u00fc\u00e7\u00fckba\u015f","year":"2023","journal-title":"J Med Palliat Care"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.7860\/JCDR\/2015\/15397.6833","article-title":"Prediction of preeclampsia by first trimester combined test and simple complete\nblood count parameters","volume":"9","author":"A Kirbas","year":"2015","journal-title":"J Clin Diagn Res"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"6982","DOI":"10.3390\/jcm11236982","article-title":"The predictive role of maternal biological markers and inflammatory scores NLR,\nPLR, MLR, SII, and SIRI for the risk of preterm delivery","volume":"11","author":"I Hrubaru","year":"2022","journal-title":"JCM"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"759","DOI":"10.1186\/s12884-025-07877-6","article-title":"Prognostic evaluation of albumin-associated inflammatory indices (LAR, NAR, MAR,\nFAR, SII\/Alb, SIRI\/Alb, NPAR, and CAR) in preterm premature rupture of membranes\n(PPROM) pregnancies","volume":"25","author":"R Dayanan","year":"2025","journal-title":"BMC Pregnancy Childbirth"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"6017","DOI":"10.3390\/jcm12186017","article-title":"Serum Albumin Levels: A Biomarker to Be Repurposed in Different Disease Settings\nin Clinical Practice","volume":"12","author":"E Gremese","year":"2023","journal-title":"JCM"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"e80","DOI":"10.1097\/AOG.0000000000003700","article-title":"Prelabor Rupture of Membranes: ACOG Practice Bulletin, Number 217","volume":"135","year":"2020","journal-title":"Obstet Gynecol"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1515\/jpm.2010.099","article-title":"Comparative analysis of insulin-like growth factor binding protein-1 (IGFBP-1),\nplacental alpha-microglobulin-1 (PAMG-1) and nitrazine test to diagnose\npremature rupture of membranes in 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from placenta previa and associated hemorrhage","volume":"14","author":"G Balka\u015f","year":"2025","journal-title":"JCM"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"28","DOI":"10.31083\/j.ceog5102028","article-title":"Evaluating the predictive potential of neutrophil-to-lymphocyte and\nplatelet-to-lymphocyte ratios in the second-trimester preterm premature rupture\nof membranes (PPROM): A retrospective case-control study","volume":"51","author":"P T \u00d6zer","year":"2024","journal-title":"Clin Exp Obstet Gynecol"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"2512","DOI":"10.3390\/cancers16142512","article-title":"A novel prognostic indicator for immunotherapy response: lymphocyte-to-albumin\n(LA) ratio predicts survival in metastatic NSCLC patients","volume":"16","author":"S Yildirim","year":"2024","journal-title":"Cancers"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"2286319","DOI":"10.1080\/01443615.2023.2286319","article-title":"Is 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A\nsystematic review and meta-analysis","volume":"43","author":"T Qiang","year":"2023","journal-title":"J Obstet\nGynaecol"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"e70119","DOI":"10.1002\/iid3.70119","article-title":"The predictive significance of platelet-to-lymphocyte ratio for miscarriage: A\nsystematic review and meta-analysis","volume":"13","author":"X Wang","year":"2025","journal-title":"Immun Inflamm Dis"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"e38664","DOI":"10.7759\/cureus.38664","article-title":"Neutrophil\/lymphocyte and platelet\/lymphocyte ratio in preterm premature rupture\nof membranes","volume":"15","author":"A Esercan","year":"2023","journal-title":"Cureus"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"979","DOI":"10.1007\/s00404-025-08089-1","article-title":"C-reactive protein velocity and inflammatory burden index: new systemic\ninflammatory biomarkers and their predictive value for the latent period in\npreterm premature rupture of membrane pregnancies","volume":"312","author":"D Duygulu Bulan","year":"2025","journal-title":"Arch Gynecol Obstet"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1557919","DOI":"10.3389\/fmed.2025.1557919","article-title":"Interpretable machine learning model for identification and risk\nfactor of premature rupture of membranes (PROM) and its association with\nnutritional inflammatory index: a retrospective study","volume":"12","author":"M Zheng","year":"2025","journal-title":"Front\nMed"}],"container-title":["Zeitschrift f\u00fcr Geburtshilfe und Neonatologie"],"original-title":[],"language":"de","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2824-1036.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T22:38:43Z","timestamp":1791844723000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2824-1036"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,30]]},"references-count":19,"journal-issue":{"issue":"05","published-online":{"date-parts":[[2026,10,12]]},"published-print":{"date-parts":[[2026,10]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2824-1036","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0948-2393","1439-1651"],"issn-type":[{"value":"0948-2393","type":"print"},{"value":"1439-1651","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,30]]}}}