The role of hematological parameters and systemic immune-inflammation index in the management of symptomatic gestational hydronephrosis

SUMMARY

Objective

The aim of this study was to investigate the clinical, imaging, and hematological parameters predicting the necessity of surgical intervention in pregnant women presenting with symptomatic gestational hydronephrosis.

Methods

We retrospectively evaluated 192 pregnant women diagnosed with symptomatic hydronephrosis between January 2015 and September 2024. Patients were divided into Group 1 (conservative management, n=138) and Group 2 (surgical intervention via double-J stent or percutaneous nephrostomy, n=54). Demographic data, clinical findings, degree of hydronephrosis, urinalysis, and complete blood count parameters—including C-reactive protein, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and systemic immune-inflammation index—were compared. Logistic regression analysis was performed to identify predictors for surgery.

Results

A history of urolithiasis, prolonged pain, fever, severe hydronephrosis, pyuria, and elevated creatinine were significantly higher in Group 2 (p<0.05). White blood cell, neutrophil-to-lymphocyte ratio, and C-reactive protein levels did not differ significantly between the groups. However, platelet counts (p=0.020), platelet-to-lymphocyte ratio (p=0.038), and systemic immune-inflammation index (p=0.015) were significantly elevated in the surgical cohort. Univariate logistic regression analysis revealed that an elevated platelet count (p=0.039) and a higher systemic immune-inflammation index (p=0.004) were significant predictors. In the multivariate analysis, the systemic immune-inflammation index remained an independent predictor (p=0.009), whereas platelet count did not.

Conclusion

While clinical presentation and the severity of hydronephrosis primarily indicate the need for surgical intervention, the systemic immune-inflammation index serves as a valuable, cost-effective auxiliary predictor among the hematological parameters.