Association of hyperemesis gravidarum severity with HALP score and hematologic inflammatory markers

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Abstract
This study aimed to investigate the diagnostic and prognostic value of the HALP score and hematological inflammatory indices in pregnant women with hyperemesis gravidarum (HEG). In this prospective observational study, 48 pregnant women diagnosed with HEG and 51 healthy, gestational age-matched controls were enrolled. Demographic, clinical, and laboratory data were collected. Hematological markers, including the HALP score, systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR), were calculated. The severity of HEG was assessed using the Pregnancy-Unique Quantification of Emesis and Nausea (PUQE) score. Body mass index, platelet count, lymphocyte count, and albumin levels were significantly lower in the HEG group, whereas NLR, MLR, and SII were significantly higher (p < 0.05 for all). The HALP score was also significantly lower in patients with HEG and demonstrated a strong negative correlation with disease severity. Both NLR and SII were positively correlated with PUQE scores. ROC analysis revealed that NLR and MLR had moderate diagnostic accuracy for HEG. In the multivariable logistic regression analysis, only NLR was identified as an independent risk factor for HEG development. The results indicate that hematological inflammatory indices, particularly the NLR and HALP score, are significantly altered in HEG. Although their discriminative ability was only moderate, they may be considered easily accessible and supportive indicators rather than stand-alone diagnostic tools. Further prospective multicenter studies are needed to confirm the clinical utility of these biomarkers in the management of hyperemesis gravidarum.

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