Assessment of albumin-related inflammatory indices in preeclampsia and their relationship with composite adverse perinatal outcomes

Abstract

Background Preeclampsia is characterized by systemic inflammation, endothelial dysfunction, and multi-organ involvement, contributing to increased risk of adverse perinatal outcomes. Albumin-based inflammatory and nutritional indices have recently gained interest as easily accessible biomarkers in high-risk pregnancies. This study aimed to compare albumin-related indices between preeclamptic and normotensive pregnancies and to evaluate their predictive value for composite adverse perinatal outcomes (CAPO) in preeclampsia. Methods This retrospective case-control study included 186 preeclamptic patients and 186 healthy controls matched for maternal age, BMI, gravidity, and gestational age. Laboratory parameters measured at delivery and calculated indices (NAR, FAR, sACR, HALP, and BAR) were compared. The preeclampsia cohort was further classified into CAPO (+) and CAPO (-) groups. Logistic regression models were used to identify independent predictors of CAPO, and receiver operating characteristic (ROC) analysis assessed predictive performance. Results Albumin-based indices differed significantly between preeclamptic and healthy pregnancies, with higher NAR, FAR, and BAR values and lower sACR levels in the preeclampsia group (all p < 0.001). Among preeclamptic patients, CAPO developed in 44.1% (n = 82). CAPO (+) patients demonstrated higher NAR, BAR, and HALP values and lower sACR levels compared to CAPO (-) patients. In multivariable logistic regression, only the blood urea nitrogen-to-albumin ratio (BAR) remained independently associated with CAPO (aOR = 1.157, p = 0.015). BAR demonstrated moderate discriminative performance for CAPO (AUC = 0.718; cut-off > 0.61; sensitivity 67.1%; specificity 69.2%; p < 0.001). Conclusion All albumin-based indices showed significant alterations in preeclampsia; however, only BAR independently predicted adverse perinatal outcomes. BAR is a simple, inexpensive biomarker derived from routine laboratory parameters and may support risk stratification and neonatal outcome prediction in preeclamptic pregnancies. Prospective multicenter studies are warranted to validate its clinical applicability.