Differences in hematocrit-to-plasma albumin ratio as a predictor of severe maternal morbidity in hypertensive disorders of pregnancy: a retrospective cohort study.

Introduction: This study aimed to evaluate the hematocrit-to-albumin ratio (HCT-ALB) as a predictor of severe maternal morbidity (SMM) in pregnancies complicated with hypertensive disorders of pregnancy (HDP).

Areas Covered: This retrospective cohort study analyzed clinical data of 794 women with singleton pregnancies diagnosed with HDP at Fujian Provincial Maternal and Child Health Hospital from 1 January 2016, to 31 December 2018. HCT-ALB was a primary outcome of interest. Maternal outcomes, including SMM events (e.g. ICU admission or transfusion), were recorded. Multivariate logistic regression, threshold effect analysis, and receiver operating characteristic (ROC) curve evaluation were used to assess the predictive value of HCT-ALB and other clinical indicators. HCT-ALB was identified as an independent risk factor for SMM, with an inflection point at 6.9, beyond which the risk increased significantly. ROC curve analysis demonstrated that HCT-ALB had an area under the curve (AUC) of 0.717, outperforming other single biomarkers. When combined with gestational age, platelet index, systolic blood pressure and maternal age, the AUC improved to 0.817.

Expert Opinion/commentary: HCT-ALB is a practical and scalable biomarker for predicting SMM in HDP. Its integration into clinical protocols could improve risk stratification and early intervention. Future studies should validate these findings in multi-ethnic and multi-center populations, incorporating social and economic factors to enhance predictive models and global applicability.