The relationship between hemogram based inflammatory indices and prognosis in ectopic pregnancy cases treated with methotrexate

Abstract

Abstract This study aimed to evaluate the effectiveness of β-hCG levels and inflammatory indices (NLR, MLR, PLR, and SII) in predicting rupture risk and treatment success in ectopic pregnancies treated with methotrexate (MTX). A retrospective analysis was conducted between 2017 and 2024 at Kütahya Health Sciences University, including 85 patients diagnosed with ectopic pregnancy. The diagnosis was confirmed by transvaginal ultrasonography. Patients with non-tubal ectopic pregnancies, active infections, autoimmune diseases, or organ failure were excluded. Demographic data, β-hCG levels (at admission, treatment day, and days 4 and 7), and inflammatory parameters were recorded. ROC analysis was used to assess rupture risk, with significance set at p < 0.05. The mean age was 32.1 ± 6.3 years, and the mean BMI was 24.95 ± 3.87 kg/m². Post-treatment β-hCG levels were significantly higher in rupture cases: 10178.7 ± 11236.1 mIU/mL on day 4 and 9671.9 ± 10468.7 mIU/mL on day 7. ROC analysis yielded an AUC of 0.753 (cut-off: 2480.5 mIU/mL) on day 4 and 0.815 (cut-off: 1295.0 mIU/mL) on day 7, with sensitivities of 70% and specificities of 70% and 74%, respectively. NLR, MLR, PLR, and SII showed no significant predictive values. Hospitalization was longer in the surgical group (7.9 ± 5.8 days) compared to methotrexate-only cases (5.8 ± 3.9 days). β-hCG levels are reliable biomarkers for predicting rupture risk in ectopic pregnancies. Regular monitoring reduces surgical intervention and supports personalized treatment strategies.