Predictive value of platelet distribution width, neutrophil-to-lymphocyte ratio, and alanine aminotransferase for recurrence of pregnancy loss in early gestation

Zhifang He, Haixia Zhang, Junwei Yang, Yun Wang, Qili Zhang

Abstract

This study aimed to evaluate the value of combined platelet distribution width, neutrophil-to-lymphocyte ratio, and alanine aminotransferase detection in predicting recurrence risk among patients with recurrent pregnancy loss in early pregnancy. A retrospective case-control study was conducted among 305 patients with early pregnancy RPL from January 2024 to May 2025. Patients were divided into a pregnancy loss group (n=116) and a live birth group (n=189). Peripheral blood platelet distribution width, neutrophil-to-lymphocyte ratio, alanine aminotransferase, and related laboratory parameters were compared between the groups. Platelet distribution width, neutrophil-to-lymphocyte ratio, and alanine aminotransferase levels were significantly higher in the pregnancy loss group than in the live birth group. Multivariate logistic regression identified platelet distribution width, neutrophil-to-lymphocyte ratio, and alanine aminotransferase as independent risk factors for recurrent pregnancy loss. Receiver operating characteristic analysis showed that the combined platelet distribution width+neutrophil-to-lymphocyte ratio+alanine aminotransferase model had an area under the curve of 0.706, outperforming any single marker. These findings suggest that combined detection of platelet distribution width, neutrophil-to-lymphocyte ratio, and alanine aminotransferase may provide a simple and effective tool for early risk stratification in patients with recurrent pregnancy loss, reflecting potential platelet activation, inflammatory immune imbalance, and hepatic metabolic stress.

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