Predictive Value of Neutrophil Percentage to Albumin Ratio (NPAR) and Platelet-to-Lymphocyte Ratio (PLR) in Methotrexate Treatment Outcomes for Ectopic Pregnancy

ABSTRACT
Objective: This study investigates the predictive role of the Neutrophil Percentage to Albumin Ratio (NPAR), Platelet-to-Lymphocyte Ratio (PLR), and Systemic Immune-Inflammation Index (SII) in determining methotrexate (MTX) treatment outcomes in patients with ectopic pregnancy (EP).
Materials and Methods: We conducted a retrospective analysis of 166 patients with ectopic pregnancy treated with MTX at a tertiary hospital between January 1, 2020, and May 1, 2024. Patients were categorized into two groups: those achieving successful MTX treatment and those experiencing treatment failure, necessitating additional MTX doses or surgical intervention. NPAR, PLR, and SII values were calculated from baseline blood parameters and analyzed to assess their predictive value. Statistical analyses included logistic regression and ROC curve analysis to determine optimal cutoff values. Results: NPAR and PLR were significant predictors of MTX treatment outcomes, with higher values correlating with increased likelihood of MTX failure (p <0.05). In contrast, SII did not show a significant association with treatment outcomes. ROC analysis showed that NPAR and PLR had satisfactory predictive performance, with AUC values of 0.777 (95% CI: 0.690-0.864) and 0.659 AUC (95% CI: 0.548-0.770), respectively. Optimal cutoff values for NPAR and PLR were determined to guide clinical decision-making.
Conclusion: This study identified NPAR and PLR as valuable markers for predicting MTX treatment outcomes in ectopic pregnancy, whereas SII was not predictive in this context. NPAR and PLR may aid in early identification of patients at risk for MTX treatment failure, enabling more personalized and effective management of ectopic pregnancy. Further research is needed to validate these findings in larger, prospective studies.
Keywords: Ectopic pregnancy, methotrexate treatment, neutrophil percentage to albumin ratio (NPAR), platelet-to-lymphocyte ratio (PLR), systemic Inflammatory markers