Prognostic evaluation of albumin-associated inflammatory indices (LAR, NAR, MAR, FAR, SII/Alb, SIRI/Alb, NPAR, and CAR) in preterm premature rupture of membranes (PPROM) pregnancies

Abstract Objective To evaluate the prognostic value of albumin-associated inflammatory indices in predicting delivery latency in pregnancies complicated by preterm premature rupture of membranes (PPROM). Methods This retrospective study included a cohort of singleton pregnancies diagnosed with PPROM between 24 and 34 weeks of gestation. Inflammatory indices calculated at admission included leukocyte-to-albumin ratio (LAR), neutrophil-to-albumin ratio (NAR), monocyte-to-albumin ratio (MAR), fibrinogen-to-albumin ratio (FAR), systemic immune-inflammation index to albumin ratio (SII/Alb), systemic inflammation response index to albumin ratio (SIRI/Alb), neutrophil percentage-to-albumin ratio (NPAR), and C-reactive protein-to-albumin ratio (CAR). Latency periods were categorized as ≤ 48 hours (h), 72 h, 96 h, and 7 days. Receiver operating characteristic (ROC) analyses were performed to assess predictive performance. Results This retrospective study evaluated 311 PPROM cases managed at a tertiary center between January 2023 and December 2023. Among the evaluated indices, LAR, NAR, and FAR demonstrated consistent and statistically significant associations with shorter latency periods across all predefined intervals (≤ 48 h, 72 h, 96 h, and 7 days). FAR exhibited the strongest predictive performance for delivery within 48 h (AUC: 0.637), followed by NAR and LAR. NPAR and CAR showed moderate predictive value at 72 h and 96 h (AUCs ~ 0.566–0.603), and NPAR remained significant at the 7-day mark (AUC: 0.605). SII/Alb was predictive at 72 and 96 h (AUCs: 0.584 and 0.616, respectively), while SIRI/Alb reached significance only at 96 h (AUC: 0.574). MAR did not demonstrate predictive value at any time point. Conclusion Albumin-associated inflammatory indices—particularly LAR, NAR, and FAR—are promising, cost-effective markers for identifying PPROM patients at risk for imminent delivery. These easily accessible laboratory parameters may support individualized management strategies. Further prospective studies are warranted to validate these findings and explore their role in clinical decision-making.