Clinical Application of Combined Measurement of Cardiac Injury Markers and Platelet Parameters in Pregnant Women with Preeclampsia

Background  Preeclampsia (PE) is a severe pregnancy complication characterized by hypertension and organ damage. Recent evidence suggests that cardiac injury and platelet dysfunction may contribute to the progression of PE. This study aimed to evaluate the clinical value of combined detection of cardiac injury markers and platelet parameters in the diagnosis, risk stratification, and prognosis of PE in pregnant women.

Material and methods This retrospective study included 120 pregnant women with PE (PE group) and 120 healthy pregnant women (control group) hospitalized from January 2020 to December 2022. Serum cardiac injury markers (cardiac troponin I [cTnI], creatine kinase-MB [CK-MB], and N-terminal pro-B-type natriuretic peptide [NT-proBNP]) and platelet parameters (platelet count [PLT], mean platelet volume [MPV], platelet distribution width [PDW], and plateletcrit [PCT]) were measured. Receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic efficacy of individual markers and their combinations.

Results  Compared with the control group, PE patients had significantly elevated cTnI, CK-MB, NT-proBNP, MPV, and PDW, and decreased PLT and PCT (all p<0.01). The diagnostic performance of a combined detection model (AUC=0.907, 95 % CI: 0.867–0.947) was superior to any single marker. In PE patients, elevated cardiac injury markers were positively correlated with PE disease severity, blood pressure, and proteinuria. Patients with both abnormal cardiac markers and platelet parameters had significantly higher rates of maternal and neonatal adverse outcomes (p<0.001) and were more likely to require early delivery and intensive care.

Conclusions  Combined detection of cardiac injury markers and platelet parameters provides better diagnostic accuracy for PE and can serve as a valuable tool for risk stratification and prognosis prediction. This approach may facilitate early intervention and individualized management strategies for pregnant women with PE.

1. Dimitriadis E, Rolnik DL, Zhou W, Estrada-Gutierrez G, Koga K, Francisco RPV et al. Pre-eclampsia. Nature Reviews Disease Primers. 2023;9(1):8. DOI: 10.1038/s41572-023-00417-6

2. Khan B, Allah Yar R, Khakwani AK, Karim S, Arslan Ali H. Preeclampsia Incidence and Its Maternal and Neonatal Outcomes With Associated Risk Factors. Cureus. 2022;14(11):e31143. DOI: 10.7759/cureus.31143

3. Bokuda K, Ichihara A. Preeclampsia up to date – What’s going on? Hypertension Research. 2023;46(8):1900–7. DOI: 10.1038/s41440-023-01323-w

4. Fixler JS, Byrne JJ, Mcintire DD, Nelson DB, Gary Cunningham F. Intrapartum trends of NT-proBNP and hs-cTnT in patients with severe features of preeclampsia. Pregnancy Hypertension. 2024;35:1–5. DOI: 10.1016/j.preghy.2023.11.006

5. Walle M, Gelaw Y, Getu F, Asrie F, Getaneh Z. Preeclampsia has an association with both platelet count and mean platelet volume: A systematic review and meta-analysis. PLOS ONE. 2022;17(9):e0274398. DOI: 10.1371/journal.pone.0274398

6. Li P, Chen H, Zhang X, Wang J, Li Y, Wang Y et al. Potential Predictive Value of Platelet Parameters in Preeclampsia. Women’s Health Reports. 2024;5(1):453–60. DOI: 10.1089/whr.2023.0162

7. He R-R, Yue G-L, Dong M-L, Wang J-Q, Cheng C. Sepsis Biomarkers: Advancements and Clinical Applications – A Narrative Review. International Journal of Molecular Sciences. 2024;25(16):9010. DOI: 10.3390/ijms25169010

8. Tomkiewicz J, Darmochwał-Kolarz DA. Biomarkers for Early Prediction and Management of Preeclampsia: A Comprehensive Review. Medical Science Monitor. 2024;30:e944104. DOI: 10.12659/MSM.944104

9. Ng KW, Chaturvedi N, Coté GL, Fisher SA, Mabbott S. Biomarkers and point of care screening approaches for the management of preeclampsia. Communications Medicine. 2024;4(1):208. DOI: 10.1038/s43856-024-00642-4

10. Nguyen TX, Nguyen VT, Nguyen-Phan HN, Hoang Bui B. Serum Levels of NT-Pro BNP in Patients with Preeclampsia. Integrated Blood Pressure Control. 2022;15:43–51. DOI: 10.2147/IBPC.S360584

11. Udeh PI, Olumodeji AM, Kuye-Kuku TO, Orekoya OO, Ayanbode O, Fabamwo AO. Evaluating mean platelet volume and platelet distribution width as predictors of early-onset pre-eclampsia: a prospective cohort study. Maternal Health, Neonatology and Perinatology. 2024;10(1):5. DOI: 10.1186/s40748-024-00174-8

12. Lin S-S, Wang C-R, Wei D-M, Lu J-H, Chen X-J, Chen Q-Z et al. Incremental predictive value of platelet parameters for preeclampsia: results from a large prospective cohort study. BMC Pregnancy and Childbirth. 2023;23(1):387. DOI: 10.1186/s12884-023-05661-y

13. Tariq H, Khan MH, Poombal F, Khan MS, Ahmad MM, Khalid M et al. Platelet indices in preeclampsia: comparative analysis with normotensive pregnant women. Expert Review of Hematology. 2025;18(2):135–42. DOI: 10.1080/17474086.2025.2458262

14. Woldeamanuel GG, Tlaye KG, Wu L, Poon LC, Wang CC. Platelet count in preeclampsia: a systematic review and meta-analysis. American Journal of Obstetrics & Gynecology MFM. 2023;5(7):100979. DOI: 10.1016/j.ajogmf.2023.100979

15. Bachnas MA, Asaduddin AH, Ali AS, Indarta AF, Anshari SY, Febrinasari RP et al. A Systematic Review of NT-proBNP as Prognostic Biomarker for Preeclampsia Complications. Journal of Maternal and Child Health. 2024;9(2):186–200. DOI: 10.26911/thejmch.2024.09.02.06

16. Schuermans A, Truong B, Ardissino M, Bhukar R, Slob EAW, Nakao T et al. Genetic Associations of Circulating Cardiovascular Proteins With Gestational Hypertension and Preeclampsia. JAMA Cardiology. 2024;9(3):209–20. DOI: 10.1001/jamacardio.2023.4994

17. Gibbone E, Huluta I, Wright A, Nicolaides KH, Charakida M. Maternal Cardiac Function at Midgestation and Development of Preeclampsia. Journal of the American College of Cardiology. 2022;79(1):52–62. DOI: 10.1016/j.jacc.2021.10.033

18. Agbani EO, Skeith L, Lee A. Preeclampsia: Platelet procoagulant membrane dynamics and critical biomarkers. Research and Practice in Thrombosis and Haemostasis. 2023;7(2):100075. DOI: 10.1016/j.rpth.2023.100075

19. Garrido-Giménez C, Cruz-Lemini M, Álvarez FV, Nan MN, Carretero F, Fernández-Oliva A et al. Predictive Model for Preeclampsia Combining sFlt-1, PlGF, NT-proBNP, and Uric Acid as Biomarkers. Journal of Clinical Medicine. 2023;12(2):431. DOI: 10.3390/jcm12020431

20. Li Z, Dai Y, Yun L, Guo W. A prediction model for the progression from gestational hypertension to pre‐eclampsia complicated with HELLP syndrome. International Journal of Gynecology & Obstetrics. 2024;165(3):1002–12. DOI: 10.1002/ijgo.15274

21. Thomas G, Syngelaki A, Hamed K, Perez-Montaño A, Panigassi A, Tuytten R et al. Preterm preeclampsia screening using biomarkers: combining phenotypic classifiers into robust prediction models. American Journal of Obstetrics & Gynecology MFM. 2023;5(10):101110. DOI: 10.1016/j.ajogmf.2023.101110

22. Peterson J, Smith DM, Johnstone ED, Mahaveer A. Perinatal optimisation for periviable birth and outcomes: a 4-year network analysis (2018–2021) across a change in national guidance. Frontiers in Pediatrics. 2024;12:1365720. DOI: 10.3389/fped.2024.1365720

23. Kim YR, Chung SW, Kim M-J, Choi W-M, Choi J, Lee D et al. Limited Generalizability of Retrospective Single-Center Cohort Study in Comparison to Multicenter Cohort Study on Prognosis of Hepatocellular Carcinoma. Journal of Hepatocellular Carcinoma. 2024;11:1235–49. DOI: 10.2147/JHC.S456093

24. Velegrakis A, Kouvidi E, Fragkiadaki P, Sifakis S. Predictive va lue of the sFlt-1/PlGF ratio in women with suspected preeclampsia: An update (Review). International Journal of Molecular Medicine. 2023;52(4):89. DOI: 10.3892/ijmm.2023.5292

25. Inversetti A, Pivato CA, Cristodoro M, Latini AC, Condorelli G, Di Simone N et al. Update on long-term cardiovascular risk after preeclampsia: a systematic review and meta-analysis. European Heart Journal - Quality of Care and Clinical Outcomes. 2024;10(1):4–13. DOI: 10.1093/ehjqcco/qcad065