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Peer-reviewedCC BYJournal of global health

Systemic inflammatory indices for predicting severe placenta accreta spectrum: a retrospective cohort study.

  • Xiafen Lu1
  • Xiaoyun Lei1
  • Congcong Guo2
  • Qian Tang1
  • Xiaomei Zhang1
  • Wenting Mai1
  • Ming Mo1
  • Meiling Yuan1
  • Wen Wang2
  • Dazhi Fan1,3,4,5,6
6 affiliations
  1. 1Department of Obstetrics, The Affiliated Foshan Women and Children Hospital, Guangdong Medical University, Foshan, China.
  2. 2Reproductive Medicine Center, The Affiliated Foshan Women and Children Hospital, Guangdong Medical University, Foshan, China.
  3. 3Foshan Fetal Medicine Research Institute, The Affiliated Foshan Women and Children Hospital, Guangdong Medical University, Foshan, China.
  4. 4Foshan Key Laboratory of Stem Cell and Maternal-Child Health, Foshan Women and Children Hospital, Foshan, China.
  5. 5Stem Cell Clinical Research Center, Foshan Women and Children Hospital, Foshan, China.
  6. 6Guangdong Medical University Stem Cell & Clinical Research Collaboration Alliance, The Affiliated Foshan Women and Children Hospital, Guangdong Medical University, Foshan, China.
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Abstract

Background

Placenta Accreta Spectrum (PAS) disorders are associated with substantial maternal morbidity, and distinguishing mild from severe forms prenatally remains difficult. Inflammatory indices derived from peripheral blood counts have emerged as promising biomarkers, yet their role in grading PAS severity has been insufficiently investigated. This study aimed to assess the discriminative value of the systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and other inflammatory indices for differentiating severe from mild PAS within an already diagnosed PAS population in late pregnancy.Methods

This retrospective single-centre cohort study included 1,276 patients with histopathologically confirmed PAS. Third-trimester neutrophil, lymphocyte, monocyte, and platelet counts were used to derive neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), SII, and SIRI. Multivariable logistic regression, receiver operating characteristic curve analysis, and decision curve analysis (DCA) were conducted.Results

Compared with the mild PAS group (n = 1,060), the severe PAS group (n = 216) showed significantly lower SIRI, SII, NLR, and PLR values (all P < 0.001). SIRI demonstrated moderate discriminative performance (area under the curve = 0.712). DCA suggested its potential clinical usefulness across threshold probabilities.Conclusions

Lower third-trimester SIRI, SII, NLR, and PLR values are associated with severe PAS. SIRI shows moderate diagnostic performance and may serve as a cost-effective adjunct to imaging for prenatal risk stratification. Prospective validation is warranted.

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Cite

BibTeXRIS
BibTeX
@article{lu2026systemic,
  title = {{Systemic inflammatory indices for predicting severe placenta accreta spectrum: a retrospective cohort study.}},
  author = {Xiafen Lu and Xiaoyun Lei and Congcong Guo and Qian Tang and Xiaomei Zhang and Wenting Mai and Ming Mo and Meiling Yuan and Wen Wang and Dazhi Fan},
  journal = {Journal of global health},
  year = {2026},
  month = oct,
  doi = {10.7189/jogh.16.04353},
  url = {https://europepmc.org/article/MED/42895275},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Systemic inflammatory indices for predicting severe placenta accreta spectrum: a retrospective cohort study.
AU  - Xiafen Lu
AU  - Xiaoyun Lei
AU  - Congcong Guo
AU  - Qian Tang
AU  - Xiaomei Zhang
AU  - Wenting Mai
AU  - Ming Mo
AU  - Meiling Yuan
AU  - Wen Wang
AU  - Dazhi Fan
PY  - 2026
DA  - 2026/10/19
JO  - Journal of global health
DO  - 10.7189/jogh.16.04353
UR  - https://europepmc.org/article/MED/42895275
AB  - Background  Placenta Accreta Spectrum (PAS) disorders are associated with substantial maternal morbidity, and distinguishing mild from severe forms prenatally remains difficult. Inflammatory indices derived from peripheral blood counts have emerged as promising biomarkers, yet their role in grading PAS severity has been insufficiently investigated. This study aimed to assess the discriminative value of the systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and other inflammatory indices for differentiating severe from mild PAS within an already diagnosed PAS population in late pregnancy.Methods  This retrospective single-centre cohort study included 1,276 patients with histopathologically confirmed PAS. Third-trimester neutrophil, lymphocyte, monocyte, and platelet counts were used to derive neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), SII, and SIRI. Multivariable logistic regression, receiver operating characteristic curve analysis, and decision curve analysis (DCA) were conducted.Results  Compared with the mild PAS group (n = 1,060), the severe PAS group (n = 216) showed significantly lower SIRI, SII, NLR, and PLR values (all P < 0.001). SIRI demonstrated moderate discriminative performance (area under the curve = 0.712). DCA suggested its potential clinical usefulness across threshold probabilities.Conclusions  Lower third-trimester SIRI, SII, NLR, and PLR values are associated with severe PAS. SIRI shows moderate diagnostic performance and may serve as a cost-effective adjunct to imaging for prenatal risk stratification. Prospective validation is warranted.
SN  - 2047-2978
SN  - 2047-2986
ER  -