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Background <p>The association of inflammatory markers, including the systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR), with pregnancy outcomes in twin pregnancies following cervical cerclage remains unclear. This study aimed to evaluate the predictive value of these markers for spontaneous preterm birth before 28 weeks of gestation in this high-risk population.</p> Methods <p>This retrospective study included 111 twin pregnancies undergoing transvaginal cervical cerclage for cervical shortening or dilation. Inflammatory markers (SII, SIRI, NLR, and PLR) were calculated from maternal peripheral blood collected before the procedure. The primary outcome was cerclage failure, defined as spontaneous preterm birth before 28 weeks of gestation. The area under the receiver operating characteristic curve (AUC) was used to assess predictive performance, and modified Poisson regression was applied to evaluate the association between these markers and cerclage failure.</p> Results <p>Cerclage failure occurred in 13 pregnancies (11.7%). For predicting cerclage failure, the AUC values of SII, SIRI, NLR, and PLR were 0.844, 0.722, 0.835, and 0.776, respectively. Modified Poisson regression analysis revealed that elevated levels of SII (aRR = 4.44, 95% CI 1.16–16.97, <i>P</i> = 0.029), SIRI (aRR = 4.36, 95% CI 1.62–11.80, <i>P</i> = 0.004), and NLR (aRR = 8.06, 95% CI 1.09–59.49, <i>P</i> = 0.041) were significantly associated with cerclage failure. After additional adjustment for cerclage indication, the associations for SII (aRR = 3.64, 95% CI 1.09–12.24, <i>P</i> = 0.036) and SIRI (aRR = 3.42, 95% CI 1.32–9.89, <i>P</i> = 0.011) remained significant, whereas the association for NLR was attenuated and no longer statistically significant (aRR = 5.84, 95% CI 0.81–42.27, <i>P</i> = 0.081).</p> Conclusions <p>This exploratory study suggests that SII and SIRI may serve as potential noninvasive predictors of cerclage failure in twin pregnancies. These indices may aid in preoperative risk stratification but require validation in larger prospective cohorts.</p>

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The association of inflammatory markers with cerclage failure in twin pregnancies

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月30日

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  • Lihua Wang,
  • Danlin Yang,
  • Rong Lin,
  • Mian Pan

摘要

Background

The association of inflammatory markers, including the systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR), with pregnancy outcomes in twin pregnancies following cervical cerclage remains unclear. This study aimed to evaluate the predictive value of these markers for spontaneous preterm birth before 28 weeks of gestation in this high-risk population.

Methods

This retrospective study included 111 twin pregnancies undergoing transvaginal cervical cerclage for cervical shortening or dilation. Inflammatory markers (SII, SIRI, NLR, and PLR) were calculated from maternal peripheral blood collected before the procedure. The primary outcome was cerclage failure, defined as spontaneous preterm birth before 28 weeks of gestation. The area under the receiver operating characteristic curve (AUC) was used to assess predictive performance, and modified Poisson regression was applied to evaluate the association between these markers and cerclage failure.

Results

Cerclage failure occurred in 13 pregnancies (11.7%). For predicting cerclage failure, the AUC values of SII, SIRI, NLR, and PLR were 0.844, 0.722, 0.835, and 0.776, respectively. Modified Poisson regression analysis revealed that elevated levels of SII (aRR = 4.44, 95% CI 1.16–16.97, P = 0.029), SIRI (aRR = 4.36, 95% CI 1.62–11.80, P = 0.004), and NLR (aRR = 8.06, 95% CI 1.09–59.49, P = 0.041) were significantly associated with cerclage failure. After additional adjustment for cerclage indication, the associations for SII (aRR = 3.64, 95% CI 1.09–12.24, P = 0.036) and SIRI (aRR = 3.42, 95% CI 1.32–9.89, P = 0.011) remained significant, whereas the association for NLR was attenuated and no longer statistically significant (aRR = 5.84, 95% CI 0.81–42.27, P = 0.081).

Conclusions

This exploratory study suggests that SII and SIRI may serve as potential noninvasive predictors of cerclage failure in twin pregnancies. These indices may aid in preoperative risk stratification but require validation in larger prospective cohorts.